|
PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
46040
|
| Min. Negotiated Rate |
$278.18 |
| Max. Negotiated Rate |
$1,260.52 |
| Rate for Payer: Aetna Commercial |
$564.66
|
| Rate for Payer: Aetna Medicare |
$462.00
|
| Rate for Payer: BCBS Complete |
$292.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$816.58
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Meridian Medicaid |
$292.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$769.61
|
| Rate for Payer: Priority Health Narrow Network |
$769.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$472.61
|
| Rate for Payer: UHC Exchange |
$472.61
|
| Rate for Payer: UHCCP Medicaid |
$278.18
|
|
|
PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 46040
|
| Min. Negotiated Rate |
$278.18 |
| Max. Negotiated Rate |
$1,260.52 |
| Rate for Payer: Aetna Commercial |
$564.66
|
| Rate for Payer: Aetna Medicare |
$462.00
|
| Rate for Payer: BCBS Complete |
$292.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$816.58
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Meridian Medicaid |
$292.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$769.61
|
| Rate for Payer: Priority Health Narrow Network |
$769.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$472.61
|
| Rate for Payer: UHC Exchange |
$472.61
|
| Rate for Payer: UHCCP Medicaid |
$278.18
|
|
|
PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
46040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$3,682.73 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Aetna Medicare |
$1,155.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,444.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,444.05
|
| Rate for Payer: ASR ASR |
$896.28
|
| Rate for Payer: ASR Commercial |
$896.28
|
| Rate for Payer: BCBS Complete |
$650.17
|
| Rate for Payer: BCBS MAPPO |
$1,155.24
|
| Rate for Payer: BCBS Trust/PPO |
$756.66
|
| Rate for Payer: BCN Commercial |
$716.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.24
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$868.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$739.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.24
|
| Rate for Payer: Healthscope Commercial |
$924.00
|
| Rate for Payer: Healthscope Whirlpool |
$896.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,155.24
|
| Rate for Payer: Mclaren Commercial |
$831.60
|
| Rate for Payer: Mclaren Medicaid |
$619.21
|
| Rate for Payer: Mclaren Medicare |
$1,155.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,213.00
|
| Rate for Payer: Meridian Medicaid |
$650.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,328.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.40
|
| Rate for Payer: Nomi Health Commercial |
$757.68
|
| Rate for Payer: PACE Medicare |
$1,097.48
|
| Rate for Payer: PACE SWMI |
$1,155.24
|
| Rate for Payer: PHP Commercial |
$1,270.76
|
| Rate for Payer: PHP Medicaid |
$619.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,682.73
|
| Rate for Payer: Priority Health Medicare |
$1,155.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,946.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,155.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$813.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,155.24
|
| Rate for Payer: UHC Exchange |
$1,790.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,155.24
|
| Rate for Payer: UHCCP DNSP |
$1,155.24
|
| Rate for Payer: UHCCP Medicaid |
$619.21
|
| Rate for Payer: VA VA |
$1,155.24
|
|
|
PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
46040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: ASR ASR |
$896.28
|
| Rate for Payer: ASR Commercial |
$896.28
|
| Rate for Payer: BCBS Trust/PPO |
$752.97
|
| Rate for Payer: BCN Commercial |
$716.38
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$868.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$739.20
|
| Rate for Payer: Healthscope Commercial |
$924.00
|
| Rate for Payer: Healthscope Whirlpool |
$896.28
|
| Rate for Payer: Mclaren Commercial |
$831.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.40
|
| Rate for Payer: Nomi Health Commercial |
$757.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$813.12
|
|
|
PR I&D OF BARTHOLINS GLAND ABSCESS
|
Professional
|
Both
|
$386.00
|
|
|
Service Code
|
HCPCS 56420
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$275.12 |
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna Medicare |
$193.00
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS Trust/PPO |
$244.07
|
| Rate for Payer: BCN Commercial |
$275.12
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Meridian Medicaid |
$74.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.17
|
| Rate for Payer: Priority Health Narrow Network |
$166.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.23
|
| Rate for Payer: UHC Exchange |
$105.23
|
| Rate for Payer: UHCCP Medicaid |
$70.72
|
|
|
PR I&D PELVIS/HIP JOINT AREA INFECTED BURSA
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
HCPCS 26991
|
| Min. Negotiated Rate |
$341.87 |
| Max. Negotiated Rate |
$1,049.19 |
| Rate for Payer: Aetna Commercial |
$701.42
|
| Rate for Payer: Aetna Medicare |
$622.00
|
| Rate for Payer: BCBS Complete |
$358.96
|
| Rate for Payer: BCBS Trust/PPO |
$758.11
|
| Rate for Payer: BCN Commercial |
$1,049.19
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Meridian Medicaid |
$358.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$341.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$808.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$817.23
|
| Rate for Payer: Priority Health Narrow Network |
$817.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.40
|
| Rate for Payer: UHC Exchange |
$592.40
|
| Rate for Payer: UHCCP Medicaid |
$341.87
|
|
|
PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$1,513.00
|
|
|
Service Code
|
HCPCS 26990
|
| Min. Negotiated Rate |
$433.21 |
| Max. Negotiated Rate |
$1,052.33 |
| Rate for Payer: Aetna Commercial |
$895.50
|
| Rate for Payer: Aetna Medicare |
$756.50
|
| Rate for Payer: BCBS Complete |
$463.18
|
| Rate for Payer: BCBS Trust/PPO |
$433.21
|
| Rate for Payer: BCN Commercial |
$1,004.72
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Meridian Medicaid |
$463.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$983.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,052.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,052.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$700.63
|
| Rate for Payer: UHC Exchange |
$700.63
|
| Rate for Payer: UHCCP Medicaid |
$441.12
|
|
|
PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$1,513.00
|
|
|
Service Code
|
HCPCS 26990
|
| Hospital Charge Code |
26990
|
| Min. Negotiated Rate |
$433.21 |
| Max. Negotiated Rate |
$1,052.33 |
| Rate for Payer: Aetna Commercial |
$895.50
|
| Rate for Payer: Aetna Medicare |
$756.50
|
| Rate for Payer: BCBS Complete |
$463.18
|
| Rate for Payer: BCBS Trust/PPO |
$433.21
|
| Rate for Payer: BCN Commercial |
$1,004.72
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Meridian Medicaid |
$463.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$983.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,052.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,052.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$700.63
|
| Rate for Payer: UHC Exchange |
$700.63
|
| Rate for Payer: UHCCP Medicaid |
$441.12
|
|
|
PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA
|
Facility
|
IP
|
$1,513.00
|
|
|
Service Code
|
CPT 26990
|
| Hospital Charge Code |
26990
|
| Min. Negotiated Rate |
$983.45 |
| Max. Negotiated Rate |
$1,513.00 |
| Rate for Payer: Aetna Commercial |
$1,361.70
|
| Rate for Payer: ASR ASR |
$1,467.61
|
| Rate for Payer: ASR Commercial |
$1,467.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,232.94
|
| Rate for Payer: BCN Commercial |
$1,173.03
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cofinity Commercial |
$1,422.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,210.40
|
| Rate for Payer: Healthscope Commercial |
$1,513.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,467.61
|
| Rate for Payer: Mclaren Commercial |
$1,361.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,286.05
|
| Rate for Payer: Nomi Health Commercial |
$1,240.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$983.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,331.44
|
|
|
PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA
|
Facility
|
OP
|
$1,513.00
|
|
|
Service Code
|
CPT 26990
|
| Hospital Charge Code |
26990
|
| Min. Negotiated Rate |
$983.45 |
| Max. Negotiated Rate |
$4,927.45 |
| Rate for Payer: Aetna Commercial |
$1,361.70
|
| 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 |
$1,467.61
|
| Rate for Payer: ASR Commercial |
$1,467.61
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,239.00
|
| Rate for Payer: BCN Commercial |
$1,173.03
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cofinity Commercial |
$1,422.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,210.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Healthscope Commercial |
$1,513.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,467.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,179.00
|
| Rate for Payer: Mclaren Commercial |
$1,361.70
|
| 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 |
$1,286.05
|
| Rate for Payer: Nomi Health Commercial |
$1,240.66
|
| 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 |
$983.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,325.69
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,060.61
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,331.44
|
| 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 I&D PENIS DEEP
|
Professional
|
Both
|
$766.00
|
|
|
Service Code
|
HCPCS 54015
|
| Min. Negotiated Rate |
$195.11 |
| Max. Negotiated Rate |
$2,212.52 |
| Rate for Payer: Aetna Commercial |
$391.78
|
| Rate for Payer: Aetna Medicare |
$383.00
|
| Rate for Payer: BCBS Complete |
$204.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,212.52
|
| Rate for Payer: BCN Commercial |
$439.81
|
| Rate for Payer: Cash Price |
$612.80
|
| Rate for Payer: Cash Price |
$612.80
|
| Rate for Payer: Meridian Medicaid |
$204.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$485.73
|
| Rate for Payer: Priority Health Narrow Network |
$485.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.57
|
| Rate for Payer: UHC Exchange |
$372.57
|
| Rate for Payer: UHCCP Medicaid |
$195.11
|
|
|
PR I&D PERIANAL ABSCESS SUPERFICIAL
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 46050
|
| Min. Negotiated Rate |
$66.03 |
| Max. Negotiated Rate |
$1,360.90 |
| Rate for Payer: Aetna Commercial |
$132.59
|
| Rate for Payer: Aetna Medicare |
$225.00
|
| Rate for Payer: BCBS Complete |
$69.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,360.90
|
| Rate for Payer: BCN Commercial |
$349.40
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Meridian Medicaid |
$69.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.15
|
| Rate for Payer: Priority Health Narrow Network |
$183.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.36
|
| Rate for Payer: UHC Exchange |
$111.36
|
| Rate for Payer: UHCCP Medicaid |
$66.03
|
|
|
PR I&D SHOULDER DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 23030
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$648.96 |
| Rate for Payer: Aetna Commercial |
$338.61
|
| Rate for Payer: Aetna Medicare |
$358.00
|
| Rate for Payer: BCBS Complete |
$174.45
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$648.96
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Meridian Medicaid |
$174.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$393.35
|
| Rate for Payer: Priority Health Narrow Network |
$393.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$291.16
|
| Rate for Payer: UHC Exchange |
$291.16
|
| Rate for Payer: UHCCP Medicaid |
$166.14
|
|
|
PR I&D SHOULDER INFECTED BURSA
|
Professional
|
Both
|
$720.00
|
|
|
Service Code
|
HCPCS 23031
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$639.67 |
| Rate for Payer: Aetna Commercial |
$287.48
|
| Rate for Payer: Aetna Medicare |
$360.00
|
| Rate for Payer: BCBS Complete |
$153.21
|
| Rate for Payer: BCBS Trust/PPO |
$18.68
|
| Rate for Payer: BCN Commercial |
$639.67
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Meridian Medicaid |
$153.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$344.50
|
| Rate for Payer: Priority Health Narrow Network |
$344.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.89
|
| Rate for Payer: UHC Exchange |
$240.89
|
| Rate for Payer: UHCCP Medicaid |
$145.91
|
|
|
PR I&D SOFT TISSUE ABSCESS SUBFASCIAL
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 20005
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$334.75 |
| Rate for Payer: Aetna Medicare |
$257.50
|
| Rate for Payer: BCBS Complete |
$206.00
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.75
|
|
|
PR I&D SUBMUCOSAL ABSCESS RECTUM
|
Professional
|
Both
|
$527.00
|
|
|
Service Code
|
HCPCS 45005
|
| Min. Negotiated Rate |
$109.06 |
| Max. Negotiated Rate |
$2,676.37 |
| Rate for Payer: Aetna Commercial |
$217.12
|
| Rate for Payer: Aetna Medicare |
$263.50
|
| Rate for Payer: BCBS Complete |
$114.51
|
| Rate for Payer: BCBS Trust/PPO |
$2,676.37
|
| Rate for Payer: BCN Commercial |
$468.15
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Meridian Medicaid |
$114.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.30
|
| Rate for Payer: Priority Health Narrow Network |
$298.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.58
|
| Rate for Payer: UHC Exchange |
$181.58
|
| Rate for Payer: UHCCP Medicaid |
$109.06
|
|
|
PR I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 23930
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$531.68 |
| Rate for Payer: Aetna Commercial |
$288.31
|
| Rate for Payer: Aetna Medicare |
$310.00
|
| Rate for Payer: BCBS Complete |
$147.83
|
| Rate for Payer: BCBS Trust/PPO |
$18.25
|
| Rate for Payer: BCN Commercial |
$531.68
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Meridian Medicaid |
$147.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$332.29
|
| Rate for Payer: Priority Health Narrow Network |
$332.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.93
|
| Rate for Payer: UHC Exchange |
$247.93
|
| Rate for Payer: UHCCP Medicaid |
$140.79
|
|
|
PR I&D VAGINAL HEMATOMA NON-OBSTETRICAL
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
HCPCS 57023
|
| Min. Negotiated Rate |
$205.33 |
| Max. Negotiated Rate |
$2,321.35 |
| Rate for Payer: Aetna Commercial |
$380.17
|
| Rate for Payer: Aetna Medicare |
$263.00
|
| Rate for Payer: BCBS Complete |
$215.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,321.35
|
| Rate for Payer: BCN Commercial |
$469.62
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Meridian Medicaid |
$215.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$479.68
|
| Rate for Payer: Priority Health Narrow Network |
$479.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.91
|
| Rate for Payer: UHC Exchange |
$355.91
|
| Rate for Payer: UHCCP Medicaid |
$205.33
|
|
|
PR I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM
|
Professional
|
Both
|
$458.00
|
|
|
Service Code
|
HCPCS 57022
|
| Min. Negotiated Rate |
$116.72 |
| Max. Negotiated Rate |
$3,001.80 |
| Rate for Payer: Aetna Commercial |
$214.36
|
| Rate for Payer: Aetna Medicare |
$229.00
|
| Rate for Payer: BCBS Complete |
$122.56
|
| Rate for Payer: BCBS Trust/PPO |
$3,001.80
|
| Rate for Payer: BCN Commercial |
$266.82
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Meridian Medicaid |
$122.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.84
|
| Rate for Payer: Priority Health Narrow Network |
$271.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.88
|
| Rate for Payer: UHC Exchange |
$190.88
|
| Rate for Payer: UHCCP Medicaid |
$116.72
|
|
|
PR I&D VULVA/PERINEAL ABSCESS
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 56405
|
| Min. Negotiated Rate |
$82.01 |
| Max. Negotiated Rate |
$1,505.13 |
| Rate for Payer: Aetna Commercial |
$146.26
|
| Rate for Payer: Aetna Medicare |
$139.00
|
| Rate for Payer: BCBS Complete |
$86.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,505.13
|
| Rate for Payer: BCN Commercial |
$217.95
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Meridian Medicaid |
$86.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.98
|
| Rate for Payer: Priority Health Narrow Network |
$190.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.85
|
| Rate for Payer: UHC Exchange |
$120.85
|
| Rate for Payer: UHCCP Medicaid |
$82.01
|
|
|
PR IIV3 VACCINE SPLIT VIRUS 0.25 ML DOSAGE IM USE
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 90657
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$9.50
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.78
|
| Rate for Payer: UHC Exchange |
$11.78
|
|
|
PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 90658
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$16.32
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.56
|
| Rate for Payer: UHC Exchange |
$23.56
|
|
|
PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 90656
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.53
|
| Rate for Payer: UHC Exchange |
$24.53
|
|
|
PR IIV3 VACC PRESRV FREE 0.25 ML DOSAGE IM USE
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90655
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$17.81 |
| Rate for Payer: Aetna Commercial |
$16.30
|
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.81
|
| Rate for Payer: UHC Exchange |
$17.81
|
|
|
PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 90686
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$26.82 |
| Rate for Payer: Aetna Commercial |
$22.35
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$22.65
|
| Rate for Payer: BCN Commercial |
$22.65
|
| 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 |
$26.82
|
| Rate for Payer: UHC Exchange |
$26.82
|
|
