|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
10120
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$163.15 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Aetna Commercial |
$225.90
|
| Rate for Payer: ASR ASR |
$243.47
|
| Rate for Payer: ASR Commercial |
$243.47
|
| Rate for Payer: BCBS Trust/PPO |
$204.54
|
| Rate for Payer: BCN Commercial |
$194.60
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cofinity Commercial |
$235.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.80
|
| Rate for Payer: Healthscope Commercial |
$251.00
|
| Rate for Payer: Healthscope Whirlpool |
$243.47
|
| Rate for Payer: Mclaren Commercial |
$225.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.35
|
| Rate for Payer: Nomi Health Commercial |
$205.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.88
|
|
|
PR INCISION&SUBCUTANEOUS PLMT CRANIAL BONE GRAFT
|
Professional
|
Both
|
$1,593.00
|
|
|
Service Code
|
HCPCS 61316
|
| Min. Negotiated Rate |
$56.45 |
| Max. Negotiated Rate |
$1,035.45 |
| Rate for Payer: Aetna Commercial |
$113.39
|
| Rate for Payer: Aetna Medicare |
$796.50
|
| Rate for Payer: BCBS Complete |
$59.27
|
| Rate for Payer: BCBS Trust/PPO |
$305.36
|
| Rate for Payer: BCN Commercial |
$177.62
|
| Rate for Payer: Cash Price |
$1,274.40
|
| Rate for Payer: Cash Price |
$1,274.40
|
| Rate for Payer: Meridian Medicaid |
$59.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,035.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.58
|
| Rate for Payer: Priority Health Narrow Network |
$149.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.87
|
| Rate for Payer: UHC Exchange |
$103.87
|
| Rate for Payer: UHCCP Medicaid |
$56.45
|
|
|
PR INCISION THROMBOSED HEMORRHOID EXTERNAL
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 46083
|
| Min. Negotiated Rate |
$71.57 |
| Max. Negotiated Rate |
$2,366.78 |
| Rate for Payer: Aetna Commercial |
$145.09
|
| Rate for Payer: Aetna Medicare |
$179.50
|
| Rate for Payer: BCBS Complete |
$75.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,366.78
|
| Rate for Payer: BCN Commercial |
$306.40
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Meridian Medicaid |
$75.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.67
|
| Rate for Payer: Priority Health Narrow Network |
$198.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$125.48
|
| Rate for Payer: UHC Exchange |
$125.48
|
| Rate for Payer: UHCCP Medicaid |
$71.57
|
|
|
PR INCOBOTULINUMTOXIN A
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J0588
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Aetna Commercial |
$5.34
|
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS Trust/PPO |
$5.19
|
| Rate for Payer: BCN Commercial |
$5.21
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.21
|
| Rate for Payer: UHC Exchange |
$5.21
|
|
|
PR INDIV PHYS SUPVJ HOME/DOM/R-HOME MO 30 MIN/>
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 99340
|
| Min. Negotiated Rate |
$87.20 |
| Max. Negotiated Rate |
$141.70 |
| Rate for Payer: Aetna Medicare |
$109.00
|
| Rate for Payer: BCBS Complete |
$87.20
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.70
|
|
|
PR INDUCED ABORT 1/> VAG SUPP DLVR FETUS D&C &/EVAC
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
HCPCS 59856
|
| Min. Negotiated Rate |
$320.99 |
| Max. Negotiated Rate |
$1,248.90 |
| Rate for Payer: Aetna Commercial |
$543.81
|
| Rate for Payer: Aetna Medicare |
$459.00
|
| Rate for Payer: BCBS Complete |
$337.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,248.90
|
| Rate for Payer: BCN Commercial |
$733.51
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Meridian Medicaid |
$337.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$320.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$703.30
|
| Rate for Payer: Priority Health Narrow Network |
$703.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$559.02
|
| Rate for Payer: UHC Exchange |
$559.02
|
| Rate for Payer: UHCCP Medicaid |
$320.99
|
|
|
PR INDUCED ABORT 1/> VAG SUPPOS DLVR FETUS HYSTOT
|
Professional
|
Both
|
$1,829.00
|
|
|
Service Code
|
HCPCS 59857
|
| Min. Negotiated Rate |
$373.82 |
| Max. Negotiated Rate |
$1,188.85 |
| Rate for Payer: Aetna Commercial |
$636.21
|
| Rate for Payer: Aetna Medicare |
$914.50
|
| Rate for Payer: BCBS Complete |
$392.51
|
| Rate for Payer: BCBS Trust/PPO |
$756.53
|
| Rate for Payer: BCN Commercial |
$854.70
|
| Rate for Payer: Cash Price |
$1,463.20
|
| Rate for Payer: Cash Price |
$1,463.20
|
| Rate for Payer: Meridian Medicaid |
$392.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$373.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,188.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$818.34
|
| Rate for Payer: Priority Health Narrow Network |
$818.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$598.79
|
| Rate for Payer: UHC Exchange |
$598.79
|
| Rate for Payer: UHCCP Medicaid |
$373.82
|
|
|
PR INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 59855
|
| Min. Negotiated Rate |
$274.13 |
| Max. Negotiated Rate |
$1,169.13 |
| Rate for Payer: Aetna Commercial |
$464.07
|
| Rate for Payer: Aetna Medicare |
$462.00
|
| Rate for Payer: BCBS Complete |
$287.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,169.13
|
| Rate for Payer: BCN Commercial |
$627.46
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Meridian Medicaid |
$287.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$601.76
|
| Rate for Payer: Priority Health Narrow Network |
$601.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$473.81
|
| Rate for Payer: UHC Exchange |
$473.81
|
| Rate for Payer: UHCCP Medicaid |
$274.13
|
|
|
PR INDUCED ABORTION DILATION AND CURETTAGE
|
Professional
|
Both
|
$806.00
|
|
|
Service Code
|
HCPCS 59840
|
| Min. Negotiated Rate |
$142.71 |
| Max. Negotiated Rate |
$1,030.71 |
| Rate for Payer: Aetna Commercial |
$239.76
|
| Rate for Payer: Aetna Medicare |
$403.00
|
| Rate for Payer: BCBS Complete |
$149.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,030.71
|
| Rate for Payer: BCN Commercial |
$369.44
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Meridian Medicaid |
$149.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$142.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$314.85
|
| Rate for Payer: Priority Health Narrow Network |
$314.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$234.68
|
| Rate for Payer: UHC Exchange |
$234.68
|
| Rate for Payer: UHCCP Medicaid |
$142.71
|
|
|
PR INDUCED ABORTION DILATION & EVACUATION
|
Professional
|
Both
|
$847.00
|
|
|
Service Code
|
HCPCS 59841
|
| Min. Negotiated Rate |
$240.69 |
| Max. Negotiated Rate |
$953.58 |
| Rate for Payer: Aetna Commercial |
$405.93
|
| Rate for Payer: Aetna Medicare |
$423.50
|
| Rate for Payer: BCBS Complete |
$252.72
|
| Rate for Payer: BCBS Trust/PPO |
$953.58
|
| Rate for Payer: BCN Commercial |
$630.40
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Meridian Medicaid |
$252.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$240.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$550.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$526.77
|
| Rate for Payer: Priority Health Narrow Network |
$526.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$410.49
|
| Rate for Payer: UHC Exchange |
$410.49
|
| Rate for Payer: UHCCP Medicaid |
$240.69
|
|
|
PR INDWELLING CATHETER SPECIAL
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS A4340
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Aetna Commercial |
$25.14
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCN Commercial |
$29.71
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.00
|
| Rate for Payer: UHC Exchange |
$17.00
|
|
|
PR INFRATEMPO MID CRANIAL FOSSA W/WO DCOMPR&/MOBI
|
Professional
|
Both
|
$10,965.00
|
|
|
Service Code
|
HCPCS 61591
|
| Min. Negotiated Rate |
$366.64 |
| Max. Negotiated Rate |
$7,127.25 |
| Rate for Payer: Aetna Commercial |
$3,957.60
|
| Rate for Payer: Aetna Medicare |
$5,482.50
|
| Rate for Payer: BCBS Complete |
$2,073.91
|
| Rate for Payer: BCBS Trust/PPO |
$366.64
|
| Rate for Payer: BCN Commercial |
$4,510.49
|
| Rate for Payer: Cash Price |
$8,772.00
|
| Rate for Payer: Cash Price |
$8,772.00
|
| Rate for Payer: Meridian Medicaid |
$2,073.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,975.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,127.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,253.23
|
| Rate for Payer: Priority Health Narrow Network |
$5,253.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,630.20
|
| Rate for Payer: UHC Exchange |
$3,630.20
|
| Rate for Payer: UHCCP Medicaid |
$1,975.15
|
|
|
PR INFRATEMPORAL MID CRANIAL FOSSA W/WO DISARTICLTN
|
Professional
|
Both
|
$6,572.00
|
|
|
Service Code
|
HCPCS 61590
|
| Min. Negotiated Rate |
$514.56 |
| Max. Negotiated Rate |
$5,159.95 |
| Rate for Payer: Aetna Commercial |
$3,915.31
|
| Rate for Payer: Aetna Medicare |
$3,286.00
|
| Rate for Payer: BCBS Complete |
$2,022.92
|
| Rate for Payer: BCBS Trust/PPO |
$514.56
|
| Rate for Payer: BCN Commercial |
$4,435.24
|
| Rate for Payer: Cash Price |
$5,257.60
|
| Rate for Payer: Cash Price |
$5,257.60
|
| Rate for Payer: Meridian Medicaid |
$2,022.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,926.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,271.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,159.95
|
| Rate for Payer: Priority Health Narrow Network |
$5,159.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,582.32
|
| Rate for Payer: UHC Exchange |
$3,582.32
|
| Rate for Payer: UHCCP Medicaid |
$1,926.59
|
|
|
PR INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 95079
|
| Min. Negotiated Rate |
$43.03 |
| Max. Negotiated Rate |
$376.15 |
| Rate for Payer: Aetna Commercial |
$70.38
|
| Rate for Payer: Aetna Medicare |
$85.00
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: BCBS Trust/PPO |
$376.15
|
| Rate for Payer: BCN Commercial |
$122.66
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Meridian Medicaid |
$45.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.05
|
| Rate for Payer: Priority Health Narrow Network |
$92.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.07
|
| Rate for Payer: UHC Exchange |
$78.07
|
| Rate for Payer: UHCCP Medicaid |
$43.03
|
|
|
PR INGESTION CHALLENGE TEST INITIAL 120 MINUTES
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 95076
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$262.04 |
| Rate for Payer: Aetna Commercial |
$76.44
|
| Rate for Payer: Aetna Medicare |
$121.50
|
| Rate for Payer: BCBS Complete |
$48.98
|
| Rate for Payer: BCBS Trust/PPO |
$262.04
|
| Rate for Payer: BCN Commercial |
$175.93
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Meridian Medicaid |
$48.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.83
|
| Rate for Payer: Priority Health Narrow Network |
$99.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.89
|
| Rate for Payer: UHC Exchange |
$84.89
|
| Rate for Payer: UHCCP Medicaid |
$46.65
|
|
|
PR INGUINOFEM LMPHADEC SUPFC W/CLOQUETS NODE SPX
|
Professional
|
Both
|
$2,629.00
|
|
|
Service Code
|
HCPCS 38760
|
| Min. Negotiated Rate |
$539.10 |
| Max. Negotiated Rate |
$1,708.85 |
| Rate for Payer: Aetna Commercial |
$1,041.85
|
| Rate for Payer: Aetna Medicare |
$1,314.50
|
| Rate for Payer: BCBS Complete |
$566.06
|
| Rate for Payer: BCBS Trust/PPO |
$689.96
|
| Rate for Payer: BCN Commercial |
$1,221.69
|
| Rate for Payer: Cash Price |
$2,103.20
|
| Rate for Payer: Cash Price |
$2,103.20
|
| Rate for Payer: Meridian Medicaid |
$566.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$539.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,675.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,675.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$939.69
|
| Rate for Payer: UHC Exchange |
$939.69
|
| Rate for Payer: UHCCP Medicaid |
$539.10
|
|
|
PR INGUINOFEM LMPHADEC SUPFC W/PEL LMPHADEC
|
Professional
|
Both
|
$2,707.00
|
|
|
Service Code
|
HCPCS 38765
|
| Min. Negotiated Rate |
$524.60 |
| Max. Negotiated Rate |
$2,613.06 |
| Rate for Payer: Aetna Commercial |
$1,622.20
|
| Rate for Payer: Aetna Medicare |
$1,353.50
|
| Rate for Payer: BCBS Complete |
$884.54
|
| Rate for Payer: BCBS Trust/PPO |
$524.60
|
| Rate for Payer: BCN Commercial |
$1,909.76
|
| Rate for Payer: Cash Price |
$2,165.60
|
| Rate for Payer: Cash Price |
$2,165.60
|
| Rate for Payer: Meridian Medicaid |
$884.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$842.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,759.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,613.06
|
| Rate for Payer: Priority Health Narrow Network |
$2,613.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,456.57
|
| Rate for Payer: UHC Exchange |
$1,456.57
|
| Rate for Payer: UHCCP Medicaid |
$842.42
|
|
|
PR INHLJ BRNCL CHALLENGE TSTG W/HISTAMINE/METHACHOL
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 95070
|
| Min. Negotiated Rate |
$34.09 |
| Max. Negotiated Rate |
$302.19 |
| Rate for Payer: Aetna Commercial |
$34.09
|
| Rate for Payer: Aetna Medicare |
$124.50
|
| Rate for Payer: BCBS Complete |
$99.60
|
| Rate for Payer: BCBS Trust/PPO |
$302.19
|
| Rate for Payer: BCN Commercial |
$50.33
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.08
|
| Rate for Payer: Priority Health Narrow Network |
$48.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.40
|
| Rate for Payer: UHC Exchange |
$41.40
|
|
|
PR INITIAL FOOT EXAM PT LOPS
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
HCPCS G0245
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$92.36 |
| Rate for Payer: Aetna Commercial |
$41.41
|
| Rate for Payer: Aetna Medicare |
$49.00
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: BCBS Trust/PPO |
$90.34
|
| Rate for Payer: BCN Commercial |
$92.36
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.13
|
| Rate for Payer: Priority Health Narrow Network |
$44.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.11
|
| Rate for Payer: UHC Exchange |
$51.11
|
|
|
PR INITIAL HOSP NEONATE 28 D/< NOT CRITICALLY ILL
|
Professional
|
Both
|
$1,065.00
|
|
|
Service Code
|
HCPCS 99477
|
| Min. Negotiated Rate |
$177.51 |
| Max. Negotiated Rate |
$692.25 |
| Rate for Payer: Aetna Commercial |
$342.16
|
| Rate for Payer: Aetna Medicare |
$532.50
|
| Rate for Payer: BCBS Complete |
$335.24
|
| Rate for Payer: BCBS Trust/PPO |
$177.51
|
| Rate for Payer: BCN Commercial |
$489.17
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Meridian Medicaid |
$335.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$692.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$450.05
|
| Rate for Payer: Priority Health Narrow Network |
$450.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$380.12
|
| Rate for Payer: UHC Exchange |
$380.12
|
| Rate for Payer: UHCCP Medicaid |
$319.28
|
|
|
PR INITIAL INPATIENT CONSULT NEW/ESTAB PT 20 MIN
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 99251
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$87.10 |
| Rate for Payer: Aetna Medicare |
$67.00
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.10
|
|
|
PR INITIAL NURSING FACILITY CARE HI MDM 50 MINUTES
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 99306
|
| Min. Negotiated Rate |
$115.45 |
| Max. Negotiated Rate |
$2,045.58 |
| Rate for Payer: Aetna Commercial |
$163.22
|
| Rate for Payer: Aetna Medicare |
$125.50
|
| Rate for Payer: BCBS Complete |
$121.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,045.58
|
| Rate for Payer: BCN Commercial |
$262.91
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Meridian Medicaid |
$121.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.20
|
| Rate for Payer: Priority Health Narrow Network |
$243.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.00
|
| Rate for Payer: UHC Exchange |
$171.00
|
| Rate for Payer: UHCCP Medicaid |
$115.45
|
|
|
PR INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 99305
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$1,949.96 |
| Rate for Payer: Aetna Commercial |
$126.84
|
| Rate for Payer: Aetna Medicare |
$98.50
|
| Rate for Payer: BCBS Complete |
$88.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,949.96
|
| Rate for Payer: BCN Commercial |
$192.54
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Meridian Medicaid |
$88.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.13
|
| Rate for Payer: Priority Health Narrow Network |
$178.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.90
|
| Rate for Payer: UHC Exchange |
$133.90
|
| Rate for Payer: UHCCP Medicaid |
$84.56
|
|
|
PR INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 99304
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$2,272.22 |
| Rate for Payer: Aetna Commercial |
$87.92
|
| Rate for Payer: Aetna Medicare |
$69.00
|
| Rate for Payer: BCBS Complete |
$53.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,272.22
|
| Rate for Payer: BCN Commercial |
$116.31
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Meridian Medicaid |
$53.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.25
|
| Rate for Payer: Priority Health Narrow Network |
$107.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.11
|
| Rate for Payer: UHC Exchange |
$95.11
|
| Rate for Payer: UHCCP Medicaid |
$51.12
|
|
|
PR INITIAL OBSERVATION CARE/DAY 30 MINUTES
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 99218
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$98.15 |
| Rate for Payer: Aetna Medicare |
$75.50
|
| Rate for Payer: BCBS Complete |
$60.40
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.15
|
|
