|
PR GEL-ONE
|
Professional
|
Both
|
$1,367.00
|
|
|
Service Code
|
HCPCS J7326
|
| Min. Negotiated Rate |
$506.67 |
| Max. Negotiated Rate |
$1,159.20 |
| Rate for Payer: Aetna Commercial |
$512.21
|
| Rate for Payer: Aetna Medicare |
$683.50
|
| Rate for Payer: BCBS Complete |
$546.80
|
| Rate for Payer: BCBS Trust/PPO |
$506.67
|
| Rate for Payer: BCN Commercial |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$888.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$520.99
|
| Rate for Payer: UHC Exchange |
$520.99
|
|
|
PR GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 91112
|
| Min. Negotiated Rate |
$66.03 |
| Max. Negotiated Rate |
$2,415.54 |
| Rate for Payer: Aetna Commercial |
$1,759.47
|
| Rate for Payer: Aetna Commercial |
$1,759.47
|
| Rate for Payer: Aetna Medicare |
$1,708.50
|
| Rate for Payer: Aetna Medicare |
$98.00
|
| Rate for Payer: BCBS Complete |
$69.33
|
| Rate for Payer: BCBS Complete |
$69.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,077.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,077.20
|
| Rate for Payer: BCN Commercial |
$2,415.54
|
| Rate for Payer: BCN Commercial |
$2,415.54
|
| Rate for Payer: Cash Price |
$2,733.60
|
| Rate for Payer: Cash Price |
$2,733.60
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Meridian Medicaid |
$69.33
|
| Rate for Payer: Meridian Medicaid |
$69.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,221.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.22
|
| Rate for Payer: Priority Health Narrow Network |
$140.22
|
| Rate for Payer: Priority Health Narrow Network |
$140.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,303.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,303.05
|
| Rate for Payer: UHC Exchange |
$1,303.05
|
| Rate for Payer: UHC Exchange |
$1,303.05
|
| Rate for Payer: UHCCP Medicaid |
$66.03
|
| Rate for Payer: UHCCP Medicaid |
$66.03
|
|
|
PR GI TRC IMG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R
|
Professional
|
Both
|
$1,618.00
|
|
|
Service Code
|
HCPCS 91110
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$1,091.21 |
| Rate for Payer: Aetna Commercial |
$912.51
|
| Rate for Payer: Aetna Medicare |
$809.00
|
| Rate for Payer: BCBS Complete |
$73.80
|
| Rate for Payer: BCBS Trust/PPO |
$910.79
|
| Rate for Payer: BCN Commercial |
$1,091.21
|
| Rate for Payer: Cash Price |
$1,294.40
|
| Rate for Payer: Cash Price |
$1,294.40
|
| Rate for Payer: Meridian Medicaid |
$73.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.27
|
| Rate for Payer: Priority Health Narrow Network |
$149.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$894.64
|
| Rate for Payer: UHC Exchange |
$894.64
|
| Rate for Payer: UHCCP Medicaid |
$70.29
|
|
|
PR GLOSSECTOMY HEMIGLOSSECTOMY
|
Professional
|
Both
|
$2,388.00
|
|
|
Service Code
|
HCPCS 41130
|
| Min. Negotiated Rate |
$761.81 |
| Max. Negotiated Rate |
$2,339.24 |
| Rate for Payer: Aetna Commercial |
$1,746.53
|
| Rate for Payer: Aetna Medicare |
$1,194.00
|
| Rate for Payer: BCBS Complete |
$876.49
|
| Rate for Payer: BCBS Trust/PPO |
$761.81
|
| Rate for Payer: BCN Commercial |
$1,923.44
|
| Rate for Payer: Cash Price |
$1,910.40
|
| Rate for Payer: Cash Price |
$1,910.40
|
| Rate for Payer: Meridian Medicaid |
$876.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$834.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,552.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,339.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,339.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,550.74
|
| Rate for Payer: UHC Exchange |
$1,550.74
|
| Rate for Payer: UHCCP Medicaid |
$834.75
|
|
|
PR GLOSSECTOMY <ONE-HALF TONGUE
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 41120
|
| Min. Negotiated Rate |
$640.83 |
| Max. Negotiated Rate |
$1,891.20 |
| Rate for Payer: Aetna Commercial |
$1,414.53
|
| Rate for Payer: Aetna Medicare |
$950.00
|
| Rate for Payer: BCBS Complete |
$708.30
|
| Rate for Payer: BCBS Trust/PPO |
$640.83
|
| Rate for Payer: BCN Commercial |
$1,557.41
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Meridian Medicaid |
$708.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,235.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,891.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,891.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,244.05
|
| Rate for Payer: UHC Exchange |
$1,244.05
|
| Rate for Payer: UHCCP Medicaid |
$674.57
|
|
|
PR GLOSSECTOMY PRTL W/UNI RADICAL NECK DSJ
|
Professional
|
Both
|
$3,945.00
|
|
|
Service Code
|
HCPCS 41135
|
| Min. Negotiated Rate |
$438.49 |
| Max. Negotiated Rate |
$3,855.19 |
| Rate for Payer: Aetna Commercial |
$2,879.11
|
| Rate for Payer: Aetna Medicare |
$1,972.50
|
| Rate for Payer: BCBS Complete |
$1,444.33
|
| Rate for Payer: BCBS Trust/PPO |
$438.49
|
| Rate for Payer: BCN Commercial |
$3,161.74
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Meridian Medicaid |
$1,444.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,375.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,564.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,855.19
|
| Rate for Payer: Priority Health Narrow Network |
$3,855.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,598.93
|
| Rate for Payer: UHC Exchange |
$2,598.93
|
| Rate for Payer: UHCCP Medicaid |
$1,375.55
|
|
|
PR GLSSC COMPOSIT W/RESCJ FLOOR & MANDIBULAR RESCJ
|
Professional
|
Both
|
$4,098.00
|
|
|
Service Code
|
HCPCS 41150
|
| Min. Negotiated Rate |
$567.92 |
| Max. Negotiated Rate |
$3,911.86 |
| Rate for Payer: Aetna Commercial |
$2,915.24
|
| Rate for Payer: Aetna Medicare |
$2,049.00
|
| Rate for Payer: BCBS Complete |
$1,464.91
|
| Rate for Payer: BCBS Trust/PPO |
$567.92
|
| Rate for Payer: BCN Commercial |
$3,210.12
|
| Rate for Payer: Cash Price |
$3,278.40
|
| Rate for Payer: Cash Price |
$3,278.40
|
| Rate for Payer: Meridian Medicaid |
$1,464.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,395.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,663.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,911.86
|
| Rate for Payer: Priority Health Narrow Network |
$3,911.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,639.34
|
| Rate for Payer: UHC Exchange |
$2,639.34
|
| Rate for Payer: UHCCP Medicaid |
$1,395.15
|
|
|
PR GONIOSCOPY SEPARATE PROCEDURE
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 92020
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$1,100.98 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna Medicare |
$26.00
|
| Rate for Payer: BCBS Complete |
$13.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,100.98
|
| Rate for Payer: BCN Commercial |
$29.38
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Meridian Medicaid |
$13.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.91
|
| Rate for Payer: Priority Health Narrow Network |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.13
|
| Rate for Payer: UHC Exchange |
$22.13
|
| Rate for Payer: UHCCP Medicaid |
$12.78
|
|
|
PR GRAFT COMPOSITE W/PRIMARY CLOSURE DONOR AREA
|
Professional
|
Both
|
$1,703.00
|
|
|
Service Code
|
HCPCS 15760
|
| Min. Negotiated Rate |
$449.86 |
| Max. Negotiated Rate |
$12,622.63 |
| Rate for Payer: Aetna Commercial |
$749.79
|
| Rate for Payer: Aetna Medicare |
$851.50
|
| Rate for Payer: BCBS Complete |
$472.35
|
| Rate for Payer: BCBS Trust/PPO |
$12,622.63
|
| Rate for Payer: BCN Commercial |
$1,239.29
|
| Rate for Payer: Cash Price |
$1,362.40
|
| Rate for Payer: Cash Price |
$1,362.40
|
| Rate for Payer: Meridian Medicaid |
$472.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$449.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,106.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$946.83
|
| Rate for Payer: Priority Health Narrow Network |
$946.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$749.38
|
| Rate for Payer: UHC Exchange |
$749.38
|
| Rate for Payer: UHCCP Medicaid |
$449.86
|
|
|
PR GRAFT DERMA-FAT-FASCIA
|
Professional
|
Both
|
$1,469.00
|
|
|
Service Code
|
HCPCS 15770
|
| Min. Negotiated Rate |
$435.80 |
| Max. Negotiated Rate |
$12,622.63 |
| Rate for Payer: Aetna Commercial |
$716.30
|
| Rate for Payer: Aetna Medicare |
$734.50
|
| Rate for Payer: BCBS Complete |
$457.59
|
| Rate for Payer: BCBS Trust/PPO |
$12,622.63
|
| Rate for Payer: BCN Commercial |
$982.24
|
| Rate for Payer: Cash Price |
$1,175.20
|
| Rate for Payer: Cash Price |
$1,175.20
|
| Rate for Payer: Meridian Medicaid |
$457.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$435.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$917.03
|
| Rate for Payer: Priority Health Narrow Network |
$917.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$697.46
|
| Rate for Payer: UHC Exchange |
$697.46
|
| Rate for Payer: UHCCP Medicaid |
$435.80
|
|
|
PR GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 21235
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$1,079.00 |
| Rate for Payer: Aetna Commercial |
$741.79
|
| Rate for Payer: Aetna Medicare |
$612.50
|
| Rate for Payer: BCBS Complete |
$387.37
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$1,079.00
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Meridian Medicaid |
$387.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$877.28
|
| Rate for Payer: Priority Health Narrow Network |
$877.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$654.16
|
| Rate for Payer: UHC Exchange |
$654.16
|
| Rate for Payer: UHCCP Medicaid |
$368.92
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 25 CC OR LESS
|
Professional
|
Both
|
$1,168.00
|
|
|
Service Code
|
HCPCS 15773
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$873.76 |
| Rate for Payer: Aetna Commercial |
$519.36
|
| Rate for Payer: Aetna Medicare |
$584.00
|
| Rate for Payer: BCBS Complete |
$341.51
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$873.76
|
| Rate for Payer: Cash Price |
$934.40
|
| Rate for Payer: Cash Price |
$934.40
|
| Rate for Payer: Meridian Medicaid |
$341.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$682.24
|
| Rate for Payer: Priority Health Narrow Network |
$682.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$558.92
|
| Rate for Payer: UHC Exchange |
$558.92
|
| Rate for Payer: UHCCP Medicaid |
$325.25
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 50 CC OR LESS
|
Professional
|
Both
|
$1,157.00
|
|
|
Service Code
|
HCPCS 15771
|
| Min. Negotiated Rate |
$332.49 |
| Max. Negotiated Rate |
$889.40 |
| Rate for Payer: Aetna Commercial |
$514.12
|
| Rate for Payer: Aetna Medicare |
$578.50
|
| Rate for Payer: BCBS Complete |
$349.11
|
| Rate for Payer: BCBS Trust/PPO |
$529.69
|
| Rate for Payer: BCN Commercial |
$889.40
|
| Rate for Payer: Cash Price |
$925.60
|
| Rate for Payer: Cash Price |
$925.60
|
| Rate for Payer: Meridian Medicaid |
$349.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$752.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$697.14
|
| Rate for Payer: Priority Health Narrow Network |
$697.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$552.92
|
| Rate for Payer: UHC Exchange |
$552.92
|
| Rate for Payer: UHCCP Medicaid |
$332.49
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 25 CC
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 15774
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$273.17 |
| Rate for Payer: Aetna Commercial |
$146.72
|
| Rate for Payer: Aetna Medicare |
$178.00
|
| Rate for Payer: BCBS Complete |
$96.84
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$273.17
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Meridian Medicaid |
$96.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.34
|
| Rate for Payer: Priority Health Narrow Network |
$192.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.25
|
| Rate for Payer: UHC Exchange |
$158.25
|
| Rate for Payer: UHCCP Medicaid |
$92.23
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 50 CC
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 15772
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$6,614.63 |
| Rate for Payer: Aetna Commercial |
$152.33
|
| Rate for Payer: Aetna Medicare |
$183.50
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS Trust/PPO |
$6,614.63
|
| Rate for Payer: BCN Commercial |
$279.04
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Meridian Medicaid |
$99.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$199.12
|
| Rate for Payer: Priority Health Narrow Network |
$199.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.77
|
| Rate for Payer: UHC Exchange |
$164.77
|
| Rate for Payer: UHCCP Medicaid |
$95.21
|
|
|
PR GRAFTING OF AUTOLOGOUS SOFT TISS BY DIRECT EXC
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 15769
|
| Min. Negotiated Rate |
$310.77 |
| Max. Negotiated Rate |
$703.20 |
| Rate for Payer: Aetna Commercial |
$517.80
|
| Rate for Payer: Aetna Medicare |
$487.50
|
| Rate for Payer: BCBS Complete |
$326.31
|
| Rate for Payer: BCBS Trust/PPO |
$543.75
|
| Rate for Payer: BCN Commercial |
$703.20
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Meridian Medicaid |
$326.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$310.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$653.79
|
| Rate for Payer: Priority Health Narrow Network |
$653.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$556.69
|
| Rate for Payer: UHC Exchange |
$556.69
|
| Rate for Payer: UHCCP Medicaid |
$310.77
|
|
|
PR GRAFT THIERSCH RCT INCONTINENCE &/PROLAPSE
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 46753
|
| Min. Negotiated Rate |
$402.14 |
| Max. Negotiated Rate |
$1,116.23 |
| Rate for Payer: Aetna Commercial |
$835.54
|
| Rate for Payer: Aetna Medicare |
$600.00
|
| Rate for Payer: BCBS Complete |
$422.25
|
| Rate for Payer: BCBS Trust/PPO |
$586.41
|
| Rate for Payer: BCN Commercial |
$910.89
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Meridian Medicaid |
$422.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$402.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$780.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,116.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,116.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$685.09
|
| Rate for Payer: UHC Exchange |
$685.09
|
| Rate for Payer: UHCCP Medicaid |
$402.14
|
|
|
PR GROUP BEHAVE COUNS 2-10
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS G0473
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$3,048.82 |
| Rate for Payer: Aetna Commercial |
$10.97
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,048.82
|
| Rate for Payer: BCN Commercial |
$18.08
|
| 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 |
$15.10
|
| Rate for Payer: Priority Health Narrow Network |
$15.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.67
|
| Rate for Payer: UHC Exchange |
$12.67
|
|
|
PR GROUP PSYCHOTHERAPY
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 90853
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$1,235.69 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Medicare |
$27.50
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,235.69
|
| Rate for Payer: BCN Commercial |
$31.02
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.48
|
| Rate for Payer: Priority Health Narrow Network |
$33.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.50
|
| Rate for Payer: UHC Exchange |
$31.50
|
| Rate for Payer: UHCCP Medicaid |
$15.98
|
|
|
PR GSTRCT PRTL DSTL W/GASTRODUODENOSTOMY
|
Professional
|
Both
|
$2,608.00
|
|
|
Service Code
|
HCPCS 43631
|
| Min. Negotiated Rate |
$790.34 |
| Max. Negotiated Rate |
$2,593.40 |
| Rate for Payer: Aetna Commercial |
$1,960.99
|
| Rate for Payer: Aetna Medicare |
$1,304.00
|
| Rate for Payer: BCBS Complete |
$978.92
|
| Rate for Payer: BCBS Trust/PPO |
$790.34
|
| Rate for Payer: BCN Commercial |
$2,109.62
|
| Rate for Payer: Cash Price |
$2,086.40
|
| Rate for Payer: Cash Price |
$2,086.40
|
| Rate for Payer: Meridian Medicaid |
$978.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$932.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,695.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,593.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,593.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,756.68
|
| Rate for Payer: UHC Exchange |
$1,756.68
|
| Rate for Payer: UHCCP Medicaid |
$932.30
|
|
|
PR GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY
|
Professional
|
Both
|
$3,761.00
|
|
|
Service Code
|
HCPCS 43632
|
| Min. Negotiated Rate |
$979.00 |
| Max. Negotiated Rate |
$3,633.26 |
| Rate for Payer: Aetna Commercial |
$2,747.05
|
| Rate for Payer: Aetna Medicare |
$1,880.50
|
| Rate for Payer: BCBS Complete |
$1,369.63
|
| Rate for Payer: BCBS Trust/PPO |
$979.00
|
| Rate for Payer: BCN Commercial |
$2,963.34
|
| Rate for Payer: Cash Price |
$3,008.80
|
| Rate for Payer: Cash Price |
$3,008.80
|
| Rate for Payer: Meridian Medicaid |
$1,369.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,304.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,444.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,633.26
|
| Rate for Payer: Priority Health Narrow Network |
$3,633.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,444.60
|
| Rate for Payer: UHC Exchange |
$2,444.60
|
| Rate for Payer: UHCCP Medicaid |
$1,304.41
|
|
|
PR GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ
|
Professional
|
Both
|
$3,446.00
|
|
|
Service Code
|
HCPCS 43633
|
| Min. Negotiated Rate |
$1,233.70 |
| Max. Negotiated Rate |
$3,437.58 |
| Rate for Payer: Aetna Commercial |
$2,599.01
|
| Rate for Payer: Aetna Medicare |
$1,723.00
|
| Rate for Payer: BCBS Complete |
$1,295.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,591.24
|
| Rate for Payer: BCN Commercial |
$2,799.14
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Meridian Medicaid |
$1,295.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,233.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,239.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,437.58
|
| Rate for Payer: Priority Health Narrow Network |
$3,437.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,315.66
|
| Rate for Payer: UHC Exchange |
$2,315.66
|
| Rate for Payer: UHCCP Medicaid |
$1,233.70
|
|
|
PR GSTRCT TOT W/ESOPHAGOENTEROSTOMY
|
Professional
|
Both
|
$6,616.00
|
|
|
Service Code
|
HCPCS 43620
|
| Min. Negotiated Rate |
$734.87 |
| Max. Negotiated Rate |
$4,300.40 |
| Rate for Payer: Aetna Commercial |
$2,685.76
|
| Rate for Payer: Aetna Medicare |
$3,308.00
|
| Rate for Payer: BCBS Complete |
$1,333.41
|
| Rate for Payer: BCBS Trust/PPO |
$734.87
|
| Rate for Payer: BCN Commercial |
$2,887.11
|
| Rate for Payer: Cash Price |
$5,292.80
|
| Rate for Payer: Cash Price |
$5,292.80
|
| Rate for Payer: Meridian Medicaid |
$1,333.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,269.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,300.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,539.60
|
| Rate for Payer: Priority Health Narrow Network |
$3,539.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,399.89
|
| Rate for Payer: UHC Exchange |
$2,399.89
|
| Rate for Payer: UHCCP Medicaid |
$1,269.91
|
|
|
PR HAIR REDUC 1/2 LEGS
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 00060
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
|
|
PR HAIR REDUC ABD TRAIL
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00052
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
