|
PR STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR
|
Professional
|
Both
|
$565.00
|
|
|
Service Code
|
HCPCS 36908
|
| Min. Negotiated Rate |
$128.44 |
| Max. Negotiated Rate |
$2,085.19 |
| Rate for Payer: Aetna Commercial |
$270.81
|
| Rate for Payer: Aetna Medicare |
$202.10
|
| Rate for Payer: BCBS Complete |
$134.86
|
| Rate for Payer: BCBS MAPPO |
$202.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,924.07
|
| Rate for Payer: BCN Commercial |
$2,085.19
|
| Rate for Payer: BCN Medicare Advantage |
$202.10
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Cofinity Commercial |
$270.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.10
|
| Rate for Payer: Healthscope Commercial |
$242.52
|
| Rate for Payer: Healthscope Whirlpool |
$242.52
|
| Rate for Payer: Meridian Medicaid |
$134.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$212.20
|
| Rate for Payer: PACE SWMI |
$202.10
|
| Rate for Payer: PHP Medicare Advantage |
$202.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$319.70
|
| Rate for Payer: Priority Health Medicare |
$202.10
|
| Rate for Payer: Priority Health Narrow Network |
$319.70
|
| Rate for Payer: UHC Medicare Advantage |
$208.16
|
|
|
PR STEREOSCOPIC X-RAY GUIDANCE
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS G6002
|
| Min. Negotiated Rate |
$12.99 |
| Max. Negotiated Rate |
$590.64 |
| Rate for Payer: Aetna Commercial |
$94.05
|
| Rate for Payer: Aetna Commercial |
$94.05
|
| Rate for Payer: Aetna Medicare |
$70.19
|
| Rate for Payer: Aetna Medicare |
$70.19
|
| Rate for Payer: BCBS Complete |
$13.64
|
| Rate for Payer: BCBS Complete |
$13.64
|
| Rate for Payer: BCBS MAPPO |
$70.19
|
| Rate for Payer: BCBS MAPPO |
$70.19
|
| Rate for Payer: BCBS Trust/PPO |
$590.64
|
| Rate for Payer: BCBS Trust/PPO |
$590.64
|
| Rate for Payer: BCN Commercial |
$108.97
|
| Rate for Payer: BCN Commercial |
$108.97
|
| Rate for Payer: BCN Medicare Advantage |
$70.19
|
| Rate for Payer: BCN Medicare Advantage |
$70.19
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$101.07
|
| Rate for Payer: Cofinity Commercial |
$94.05
|
| Rate for Payer: Cofinity Commercial |
$94.05
|
| Rate for Payer: Cofinity Commercial |
$101.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.19
|
| Rate for Payer: Healthscope Commercial |
$84.23
|
| Rate for Payer: Healthscope Commercial |
$84.23
|
| Rate for Payer: Healthscope Whirlpool |
$84.23
|
| Rate for Payer: Healthscope Whirlpool |
$84.23
|
| Rate for Payer: Meridian Medicaid |
$13.64
|
| Rate for Payer: Meridian Medicaid |
$13.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.70
|
| Rate for Payer: PACE SWMI |
$70.19
|
| Rate for Payer: PACE SWMI |
$70.19
|
| Rate for Payer: PHP Medicare Advantage |
$70.19
|
| Rate for Payer: PHP Medicare Advantage |
$70.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.22
|
| Rate for Payer: Priority Health Medicare |
$70.19
|
| Rate for Payer: Priority Health Medicare |
$70.19
|
| Rate for Payer: Priority Health Narrow Network |
$114.22
|
| Rate for Payer: Priority Health Narrow Network |
$114.22
|
| Rate for Payer: UHC Medicare Advantage |
$72.30
|
| Rate for Payer: UHC Medicare Advantage |
$72.30
|
|
|
PR STEREOTACTIC BX ASPIR/EXC BURR INTRACRANIAL LES
|
Professional
|
Both
|
$2,917.88
|
|
|
Service Code
|
HCPCS 61750
|
| Min. Negotiated Rate |
$662.49 |
| Max. Negotiated Rate |
$2,885.28 |
| Rate for Payer: Aetna Commercial |
$1,900.37
|
| Rate for Payer: Aetna Medicare |
$1,418.19
|
| Rate for Payer: BCBS Complete |
$960.80
|
| Rate for Payer: BCBS MAPPO |
$1,418.19
|
| Rate for Payer: BCBS Trust/PPO |
$662.49
|
| Rate for Payer: BCN Commercial |
$2,885.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,418.19
|
| Rate for Payer: Cash Price |
$2,334.30
|
| Rate for Payer: Cash Price |
$2,334.30
|
| Rate for Payer: Cofinity Commercial |
$2,042.19
|
| Rate for Payer: Cofinity Commercial |
$1,900.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,418.19
|
| Rate for Payer: Healthscope Commercial |
$1,701.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,701.83
|
| Rate for Payer: Meridian Medicaid |
$960.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,489.10
|
| Rate for Payer: PACE SWMI |
$1,418.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,418.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$915.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,042.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,409.85
|
| Rate for Payer: Priority Health Medicare |
$1,418.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,409.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,460.74
|
|
|
PR STEREOTACTIC COMPUTER ASSISTED PX SPINAL
|
Professional
|
Both
|
$728.00
|
|
|
Service Code
|
HCPCS 61783
|
| Min. Negotiated Rate |
$147.61 |
| Max. Negotiated Rate |
$707.92 |
| Rate for Payer: Aetna Commercial |
$310.89
|
| Rate for Payer: Aetna Medicare |
$232.01
|
| Rate for Payer: BCBS Complete |
$154.99
|
| Rate for Payer: BCBS MAPPO |
$232.01
|
| Rate for Payer: BCBS Trust/PPO |
$707.92
|
| Rate for Payer: BCN Commercial |
$337.68
|
| Rate for Payer: BCN Medicare Advantage |
$232.01
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Cofinity Commercial |
$334.09
|
| Rate for Payer: Cofinity Commercial |
$310.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.01
|
| Rate for Payer: Healthscope Commercial |
$278.41
|
| Rate for Payer: Healthscope Whirlpool |
$278.41
|
| Rate for Payer: Meridian Medicaid |
$154.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$243.61
|
| Rate for Payer: PACE SWMI |
$232.01
|
| Rate for Payer: PHP Medicare Advantage |
$232.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$509.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.26
|
| Rate for Payer: Priority Health Medicare |
$232.01
|
| Rate for Payer: Priority Health Narrow Network |
$391.26
|
| Rate for Payer: UHC Medicare Advantage |
$238.97
|
|
|
PR STEREOTACTIC RADIOSURGERY 1 COMPLEX CRANIAL LES
|
Professional
|
Both
|
$8,153.00
|
|
|
Service Code
|
HCPCS 61798
|
| Min. Negotiated Rate |
$896.73 |
| Max. Negotiated Rate |
$5,707.10 |
| Rate for Payer: Aetna Commercial |
$1,863.00
|
| Rate for Payer: Aetna Medicare |
$1,390.30
|
| Rate for Payer: BCBS Complete |
$941.57
|
| Rate for Payer: BCBS MAPPO |
$1,390.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,623.47
|
| Rate for Payer: BCN Commercial |
$2,036.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,390.30
|
| Rate for Payer: Cash Price |
$6,522.40
|
| Rate for Payer: Cash Price |
$6,522.40
|
| Rate for Payer: Cofinity Commercial |
$2,002.03
|
| Rate for Payer: Cofinity Commercial |
$1,863.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,390.30
|
| Rate for Payer: Healthscope Commercial |
$1,668.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,668.36
|
| Rate for Payer: Meridian Medicaid |
$941.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,459.82
|
| Rate for Payer: PACE SWMI |
$1,390.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,390.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$896.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,707.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,360.02
|
| Rate for Payer: Priority Health Medicare |
$1,390.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,360.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,432.01
|
|
|
PR STEREOTACTIC RADIOSURGERY 1 SIMPLE CRANIAL LES
|
Professional
|
Both
|
$8,153.00
|
|
|
Service Code
|
HCPCS 61796
|
| Min. Negotiated Rate |
$663.50 |
| Max. Negotiated Rate |
$5,707.10 |
| Rate for Payer: Aetna Commercial |
$1,373.61
|
| Rate for Payer: Aetna Medicare |
$1,025.08
|
| Rate for Payer: BCBS Complete |
$696.68
|
| Rate for Payer: BCBS MAPPO |
$1,025.08
|
| Rate for Payer: BCBS Trust/PPO |
$828.90
|
| Rate for Payer: BCN Commercial |
$1,506.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,025.08
|
| Rate for Payer: Cash Price |
$6,522.40
|
| Rate for Payer: Cash Price |
$6,522.40
|
| Rate for Payer: Cofinity Commercial |
$1,476.12
|
| Rate for Payer: Cofinity Commercial |
$1,373.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,025.08
|
| Rate for Payer: Healthscope Commercial |
$1,230.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,230.10
|
| Rate for Payer: Meridian Medicaid |
$696.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,076.33
|
| Rate for Payer: PACE SWMI |
$1,025.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,025.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$663.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,707.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,745.66
|
| Rate for Payer: Priority Health Medicare |
$1,025.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,745.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,055.83
|
|
|
PR STEREOTACTIC RADIOSURGERY 1 SPINAL LESION
|
Professional
|
Both
|
$2,290.00
|
|
|
Service Code
|
HCPCS 63620
|
| Min. Negotiated Rate |
$733.15 |
| Max. Negotiated Rate |
$1,929.70 |
| Rate for Payer: Aetna Commercial |
$1,520.20
|
| Rate for Payer: Aetna Medicare |
$1,134.48
|
| Rate for Payer: BCBS Complete |
$769.81
|
| Rate for Payer: BCBS MAPPO |
$1,134.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,093.05
|
| Rate for Payer: BCN Commercial |
$1,665.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,134.48
|
| Rate for Payer: Cash Price |
$1,832.00
|
| Rate for Payer: Cash Price |
$1,832.00
|
| Rate for Payer: Cofinity Commercial |
$1,633.65
|
| Rate for Payer: Cofinity Commercial |
$1,520.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,134.48
|
| Rate for Payer: Healthscope Commercial |
$1,361.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,361.38
|
| Rate for Payer: Meridian Medicaid |
$769.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,191.20
|
| Rate for Payer: PACE SWMI |
$1,134.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,134.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$733.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,603.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,929.70
|
| Rate for Payer: Priority Health Medicare |
$1,134.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,929.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,168.51
|
|
|
PR STERILE SALINE OR WATER
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS A4218
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCN Commercial |
$1.04
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
|
|
PR STERNAL DEBRIDEMENT
|
Professional
|
Both
|
$4,067.00
|
|
|
Service Code
|
HCPCS 21627
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$2,846.90 |
| Rate for Payer: Aetna Commercial |
$717.66
|
| Rate for Payer: Aetna Medicare |
$535.57
|
| Rate for Payer: BCBS Complete |
$369.92
|
| Rate for Payer: BCBS MAPPO |
$535.57
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$798.50
|
| Rate for Payer: BCN Medicare Advantage |
$535.57
|
| Rate for Payer: Cash Price |
$3,253.60
|
| Rate for Payer: Cash Price |
$3,253.60
|
| Rate for Payer: Cofinity Commercial |
$771.22
|
| Rate for Payer: Cofinity Commercial |
$717.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$535.57
|
| Rate for Payer: Healthscope Commercial |
$642.68
|
| Rate for Payer: Healthscope Whirlpool |
$642.68
|
| Rate for Payer: Meridian Medicaid |
$369.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$562.35
|
| Rate for Payer: PACE SWMI |
$535.57
|
| Rate for Payer: PHP Medicare Advantage |
$535.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$352.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,846.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$834.41
|
| Rate for Payer: Priority Health Medicare |
$535.57
|
| Rate for Payer: Priority Health Narrow Network |
$834.41
|
| Rate for Payer: UHC Medicare Advantage |
$551.64
|
|
|
PR STOT/TOT HYSTERECTOMY AFTER CESAREAN DELIVERY
|
Professional
|
Both
|
$1,120.00
|
|
|
Service Code
|
HCPCS 59525
|
| Min. Negotiated Rate |
$106.19 |
| Max. Negotiated Rate |
$784.00 |
| Rate for Payer: Aetna Commercial |
$648.02
|
| Rate for Payer: Aetna Medicare |
$483.60
|
| Rate for Payer: BCBS Complete |
$322.95
|
| Rate for Payer: BCBS MAPPO |
$483.60
|
| Rate for Payer: BCBS Trust/PPO |
$106.19
|
| Rate for Payer: BCN Commercial |
$702.23
|
| Rate for Payer: BCN Medicare Advantage |
$483.60
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cofinity Commercial |
$648.02
|
| Rate for Payer: Cofinity Commercial |
$696.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$483.60
|
| Rate for Payer: Healthscope Commercial |
$580.32
|
| Rate for Payer: Healthscope Whirlpool |
$580.32
|
| Rate for Payer: Meridian Medicaid |
$322.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$507.78
|
| Rate for Payer: PACE SWMI |
$483.60
|
| Rate for Payer: PHP Medicare Advantage |
$483.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$307.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$784.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$678.51
|
| Rate for Payer: Priority Health Medicare |
$483.60
|
| Rate for Payer: Priority Health Narrow Network |
$678.51
|
| Rate for Payer: UHC Medicare Advantage |
$498.11
|
|
|
PR STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC
|
Professional
|
Both
|
$1,417.00
|
|
|
Service Code
|
HCPCS 67311
|
| Min. Negotiated Rate |
$288.62 |
| Max. Negotiated Rate |
$991.90 |
| Rate for Payer: Aetna Commercial |
$581.17
|
| Rate for Payer: Aetna Medicare |
$433.71
|
| Rate for Payer: BCBS Complete |
$303.05
|
| Rate for Payer: BCBS MAPPO |
$433.71
|
| Rate for Payer: BCBS Trust/PPO |
$310.11
|
| Rate for Payer: BCN Commercial |
$654.34
|
| Rate for Payer: BCN Medicare Advantage |
$433.71
|
| Rate for Payer: Cash Price |
$1,133.60
|
| Rate for Payer: Cash Price |
$1,133.60
|
| Rate for Payer: Cofinity Commercial |
$624.54
|
| Rate for Payer: Cofinity Commercial |
$581.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.71
|
| Rate for Payer: Healthscope Commercial |
$520.45
|
| Rate for Payer: Healthscope Whirlpool |
$520.45
|
| Rate for Payer: Meridian Medicaid |
$303.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$455.40
|
| Rate for Payer: PACE SWMI |
$433.71
|
| Rate for Payer: PHP Medicare Advantage |
$433.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$783.88
|
| Rate for Payer: Priority Health Medicare |
$433.71
|
| Rate for Payer: Priority Health Narrow Network |
$783.88
|
| Rate for Payer: UHC Medicare Advantage |
$446.72
|
|
|
PR STRAIGHT TIP URINE CATHETER
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS A4351
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna Commercial |
$1.69
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCN Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
|
|
PR STRAPPING ANKLE &/FOOT
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 29540
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$984.22 |
| Rate for Payer: Aetna Commercial |
$23.38
|
| Rate for Payer: Aetna Medicare |
$17.45
|
| Rate for Payer: BCBS Complete |
$11.40
|
| Rate for Payer: BCBS MAPPO |
$17.45
|
| Rate for Payer: BCBS Trust/PPO |
$984.22
|
| Rate for Payer: BCN Commercial |
$32.99
|
| Rate for Payer: BCN Medicare Advantage |
$17.45
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$23.38
|
| Rate for Payer: Cofinity Commercial |
$25.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.45
|
| Rate for Payer: Healthscope Commercial |
$20.94
|
| Rate for Payer: Healthscope Whirlpool |
$20.94
|
| Rate for Payer: Meridian Medicaid |
$11.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.32
|
| Rate for Payer: PACE SWMI |
$17.45
|
| Rate for Payer: PHP Medicare Advantage |
$17.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.55
|
| Rate for Payer: Priority Health Medicare |
$17.45
|
| Rate for Payer: Priority Health Narrow Network |
$26.55
|
| Rate for Payer: UHC Medicare Advantage |
$17.97
|
|
|
PR STRAPPING ELBOW/WRIST
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 29260
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$1,354.56 |
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna Medicare |
$19.00
|
| Rate for Payer: BCBS Complete |
$12.53
|
| Rate for Payer: BCBS MAPPO |
$19.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,354.56
|
| Rate for Payer: BCN Commercial |
$43.00
|
| Rate for Payer: BCN Medicare Advantage |
$19.00
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$27.36
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.00
|
| Rate for Payer: Healthscope Commercial |
$22.80
|
| Rate for Payer: Healthscope Whirlpool |
$22.80
|
| Rate for Payer: Meridian Medicaid |
$12.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.95
|
| Rate for Payer: PACE SWMI |
$19.00
|
| Rate for Payer: PHP Medicare Advantage |
$19.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.11
|
| Rate for Payer: Priority Health Medicare |
$19.00
|
| Rate for Payer: Priority Health Narrow Network |
$29.11
|
| Rate for Payer: UHC Medicare Advantage |
$19.57
|
|
|
PR STRAPPING TOES
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 29550
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$958.34 |
| Rate for Payer: Aetna Commercial |
$14.81
|
| Rate for Payer: Aetna Medicare |
$11.05
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS MAPPO |
$11.05
|
| Rate for Payer: BCBS Trust/PPO |
$958.34
|
| Rate for Payer: BCN Commercial |
$22.39
|
| Rate for Payer: BCN Medicare Advantage |
$11.05
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Cofinity Commercial |
$14.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.05
|
| Rate for Payer: Healthscope Commercial |
$13.26
|
| Rate for Payer: Healthscope Whirlpool |
$13.26
|
| Rate for Payer: Meridian Medicaid |
$7.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.60
|
| Rate for Payer: PACE SWMI |
$11.05
|
| Rate for Payer: PHP Medicare Advantage |
$11.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.85
|
| Rate for Payer: Priority Health Medicare |
$11.05
|
| Rate for Payer: Priority Health Narrow Network |
$16.85
|
| Rate for Payer: UHC Medicare Advantage |
$11.38
|
|
|
PR STRAPPING UNNA BOOT
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 29580
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$1,192.37 |
| Rate for Payer: Aetna Commercial |
$35.01
|
| Rate for Payer: Aetna Medicare |
$26.13
|
| Rate for Payer: BCBS Complete |
$17.44
|
| Rate for Payer: BCBS MAPPO |
$26.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,192.37
|
| Rate for Payer: BCN Commercial |
$74.21
|
| Rate for Payer: BCN Medicare Advantage |
$26.13
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$37.63
|
| Rate for Payer: Cofinity Commercial |
$35.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.13
|
| Rate for Payer: Healthscope Commercial |
$31.36
|
| Rate for Payer: Healthscope Whirlpool |
$31.36
|
| Rate for Payer: Meridian Medicaid |
$17.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.44
|
| Rate for Payer: PACE SWMI |
$26.13
|
| Rate for Payer: PHP Medicare Advantage |
$26.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.83
|
| Rate for Payer: Priority Health Medicare |
$26.13
|
| Rate for Payer: Priority Health Narrow Network |
$39.83
|
| Rate for Payer: UHC Medicare Advantage |
$26.91
|
|
|
PR STRTCTC BX ASPIR/EXC BURR ICRA LESION W/CT&I/MR
|
Professional
|
Both
|
$6,896.00
|
|
|
Service Code
|
HCPCS 61751
|
| Min. Negotiated Rate |
$741.20 |
| Max. Negotiated Rate |
$4,827.20 |
| Rate for Payer: Aetna Commercial |
$1,870.16
|
| Rate for Payer: Aetna Medicare |
$1,395.64
|
| Rate for Payer: BCBS Complete |
$949.17
|
| Rate for Payer: BCBS MAPPO |
$1,395.64
|
| Rate for Payer: BCBS Trust/PPO |
$741.20
|
| Rate for Payer: BCN Commercial |
$2,847.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,395.64
|
| Rate for Payer: Cash Price |
$5,516.80
|
| Rate for Payer: Cash Price |
$5,516.80
|
| Rate for Payer: Cofinity Commercial |
$1,870.16
|
| Rate for Payer: Cofinity Commercial |
$2,009.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,395.64
|
| Rate for Payer: Healthscope Commercial |
$1,674.77
|
| Rate for Payer: Healthscope Whirlpool |
$1,674.77
|
| Rate for Payer: Meridian Medicaid |
$949.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,465.42
|
| Rate for Payer: PACE SWMI |
$1,395.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,395.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$903.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,827.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,378.13
|
| Rate for Payer: Priority Health Medicare |
$1,395.64
|
| Rate for Payer: Priority Health Narrow Network |
$2,378.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,437.51
|
|
|
PR STRTCTC CPTR ASSTD PX CRANIAL INTRADURAL
|
Professional
|
Both
|
$728.00
|
|
|
Service Code
|
HCPCS 61781
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$698.41 |
| Rate for Payer: Aetna Commercial |
$318.52
|
| Rate for Payer: Aetna Medicare |
$237.70
|
| Rate for Payer: BCBS Complete |
$158.34
|
| Rate for Payer: BCBS MAPPO |
$237.70
|
| Rate for Payer: BCBS Trust/PPO |
$698.41
|
| Rate for Payer: BCN Commercial |
$345.01
|
| Rate for Payer: BCN Medicare Advantage |
$237.70
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Cofinity Commercial |
$318.52
|
| Rate for Payer: Cofinity Commercial |
$342.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.70
|
| Rate for Payer: Healthscope Commercial |
$285.24
|
| Rate for Payer: Healthscope Whirlpool |
$285.24
|
| Rate for Payer: Meridian Medicaid |
$158.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$249.58
|
| Rate for Payer: PACE SWMI |
$237.70
|
| Rate for Payer: PHP Medicare Advantage |
$237.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$509.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$399.75
|
| Rate for Payer: Priority Health Medicare |
$237.70
|
| Rate for Payer: Priority Health Narrow Network |
$399.75
|
| Rate for Payer: UHC Medicare Advantage |
$244.83
|
|
|
PR STRTCTC CPTR ASSTD PX EXTRADURAL CRANIAL
|
Professional
|
Both
|
$728.00
|
|
|
Service Code
|
HCPCS 61782
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$892.30 |
| Rate for Payer: Aetna Commercial |
$228.93
|
| Rate for Payer: Aetna Medicare |
$170.84
|
| Rate for Payer: BCBS Complete |
$114.73
|
| Rate for Payer: BCBS MAPPO |
$170.84
|
| Rate for Payer: BCBS Trust/PPO |
$892.30
|
| Rate for Payer: BCN Commercial |
$251.18
|
| Rate for Payer: BCN Medicare Advantage |
$170.84
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Cofinity Commercial |
$228.93
|
| Rate for Payer: Cofinity Commercial |
$246.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.84
|
| Rate for Payer: Healthscope Commercial |
$205.01
|
| Rate for Payer: Healthscope Whirlpool |
$205.01
|
| Rate for Payer: Meridian Medicaid |
$114.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$179.38
|
| Rate for Payer: PACE SWMI |
$170.84
|
| Rate for Payer: PHP Medicare Advantage |
$170.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$509.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$291.04
|
| Rate for Payer: Priority Health Medicare |
$170.84
|
| Rate for Payer: Priority Health Narrow Network |
$291.04
|
| Rate for Payer: UHC Medicare Advantage |
$175.97
|
|
|
PR STRTCTC RADIOSURGERY EA ADDL CRANIAL LES COMPLEX
|
Professional
|
Both
|
$8,153.00
|
|
|
Service Code
|
HCPCS 61799
|
| Min. Negotiated Rate |
$194.26 |
| Max. Negotiated Rate |
$5,707.10 |
| Rate for Payer: Aetna Commercial |
$408.27
|
| Rate for Payer: Aetna Medicare |
$304.68
|
| Rate for Payer: BCBS Complete |
$203.97
|
| Rate for Payer: BCBS MAPPO |
$304.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,112.60
|
| Rate for Payer: BCN Commercial |
$442.25
|
| Rate for Payer: BCN Medicare Advantage |
$304.68
|
| Rate for Payer: Cash Price |
$6,522.40
|
| Rate for Payer: Cash Price |
$6,522.40
|
| Rate for Payer: Cofinity Commercial |
$408.27
|
| Rate for Payer: Cofinity Commercial |
$438.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$304.68
|
| Rate for Payer: Healthscope Commercial |
$365.62
|
| Rate for Payer: Healthscope Whirlpool |
$365.62
|
| Rate for Payer: Meridian Medicaid |
$203.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$319.91
|
| Rate for Payer: PACE SWMI |
$304.68
|
| Rate for Payer: PHP Medicare Advantage |
$304.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,707.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$512.43
|
| Rate for Payer: Priority Health Medicare |
$304.68
|
| Rate for Payer: Priority Health Narrow Network |
$512.43
|
| Rate for Payer: UHC Medicare Advantage |
$313.82
|
|
|
PR STRTCTC RADIOSURGERY EA ADDL CRANIAL LES SIMPLE
|
Professional
|
Both
|
$8,153.00
|
|
|
Service Code
|
HCPCS 61797
|
| Min. Negotiated Rate |
$140.58 |
| Max. Negotiated Rate |
$5,707.10 |
| Rate for Payer: Aetna Commercial |
$295.03
|
| Rate for Payer: Aetna Medicare |
$220.17
|
| Rate for Payer: BCBS Complete |
$147.61
|
| Rate for Payer: BCBS MAPPO |
$220.17
|
| Rate for Payer: BCBS Trust/PPO |
$828.37
|
| Rate for Payer: BCN Commercial |
$319.60
|
| Rate for Payer: BCN Medicare Advantage |
$220.17
|
| Rate for Payer: Cash Price |
$6,522.40
|
| Rate for Payer: Cash Price |
$6,522.40
|
| Rate for Payer: Cofinity Commercial |
$317.04
|
| Rate for Payer: Cofinity Commercial |
$295.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.17
|
| Rate for Payer: Healthscope Commercial |
$264.20
|
| Rate for Payer: Healthscope Whirlpool |
$264.20
|
| Rate for Payer: Meridian Medicaid |
$147.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$231.18
|
| Rate for Payer: PACE SWMI |
$220.17
|
| Rate for Payer: PHP Medicare Advantage |
$220.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,707.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$370.31
|
| Rate for Payer: Priority Health Medicare |
$220.17
|
| Rate for Payer: Priority Health Narrow Network |
$370.31
|
| Rate for Payer: UHC Medicare Advantage |
$226.78
|
|
|
PR SUBCUTANEOUS HORMONE PELLET IMPLANTATION
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS 11980
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$137.81 |
| Rate for Payer: Aetna Commercial |
$74.38
|
| Rate for Payer: Aetna Medicare |
$55.51
|
| Rate for Payer: BCBS Complete |
$36.91
|
| Rate for Payer: BCBS MAPPO |
$55.51
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$137.81
|
| Rate for Payer: BCN Medicare Advantage |
$55.51
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cofinity Commercial |
$74.38
|
| Rate for Payer: Cofinity Commercial |
$79.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.51
|
| Rate for Payer: Healthscope Commercial |
$66.61
|
| Rate for Payer: Healthscope Whirlpool |
$66.61
|
| Rate for Payer: Meridian Medicaid |
$36.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$58.29
|
| Rate for Payer: PACE SWMI |
$55.51
|
| Rate for Payer: PHP Medicare Advantage |
$55.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.23
|
| Rate for Payer: Priority Health Medicare |
$55.51
|
| Rate for Payer: Priority Health Narrow Network |
$68.23
|
| Rate for Payer: UHC Medicare Advantage |
$57.18
|
|
|
PR SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI INIT
|
Professional
|
Both
|
$457.00
|
|
|
Service Code
|
HCPCS 61000
|
| Min. Negotiated Rate |
$73.49 |
| Max. Negotiated Rate |
$461.73 |
| Rate for Payer: Aetna Commercial |
$152.32
|
| Rate for Payer: Aetna Medicare |
$113.67
|
| Rate for Payer: BCBS Complete |
$77.16
|
| Rate for Payer: BCBS MAPPO |
$113.67
|
| Rate for Payer: BCBS Trust/PPO |
$461.73
|
| Rate for Payer: BCN Commercial |
$231.18
|
| Rate for Payer: BCN Medicare Advantage |
$113.67
|
| Rate for Payer: Cash Price |
$365.60
|
| Rate for Payer: Cash Price |
$365.60
|
| Rate for Payer: Cofinity Commercial |
$163.68
|
| Rate for Payer: Cofinity Commercial |
$152.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.67
|
| Rate for Payer: Healthscope Commercial |
$136.40
|
| Rate for Payer: Healthscope Whirlpool |
$136.40
|
| Rate for Payer: Meridian Medicaid |
$77.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.35
|
| Rate for Payer: PACE SWMI |
$113.67
|
| Rate for Payer: PHP Medicare Advantage |
$113.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.09
|
| Rate for Payer: Priority Health Medicare |
$113.67
|
| Rate for Payer: Priority Health Narrow Network |
$193.09
|
| Rate for Payer: UHC Medicare Advantage |
$117.08
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM 1ST 100SQ CM
|
Professional
|
Both
|
$481.00
|
|
|
Service Code
|
HCPCS 15277
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$505.29 |
| Rate for Payer: Aetna Commercial |
$296.65
|
| Rate for Payer: Aetna Medicare |
$221.38
|
| Rate for Payer: BCBS Complete |
$147.83
|
| Rate for Payer: BCBS MAPPO |
$221.38
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$505.29
|
| Rate for Payer: BCN Medicare Advantage |
$221.38
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Cofinity Commercial |
$318.79
|
| Rate for Payer: Cofinity Commercial |
$296.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.38
|
| Rate for Payer: Healthscope Commercial |
$265.66
|
| Rate for Payer: Healthscope Whirlpool |
$265.66
|
| Rate for Payer: Meridian Medicaid |
$147.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$232.45
|
| Rate for Payer: PACE SWMI |
$221.38
|
| Rate for Payer: PHP Medicare Advantage |
$221.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.34
|
| Rate for Payer: Priority Health Medicare |
$221.38
|
| Rate for Payer: Priority Health Narrow Network |
$273.34
|
| Rate for Payer: UHC Medicare Advantage |
$228.02
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 15278
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$139.76 |
| Rate for Payer: Aetna Commercial |
$73.73
|
| Rate for Payer: Aetna Medicare |
$55.02
|
| Rate for Payer: BCBS Complete |
$36.91
|
| Rate for Payer: BCBS MAPPO |
$55.02
|
| Rate for Payer: BCBS Trust/PPO |
$13.97
|
| Rate for Payer: BCN Commercial |
$139.76
|
| Rate for Payer: BCN Medicare Advantage |
$55.02
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$73.73
|
| Rate for Payer: Cofinity Commercial |
$79.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.02
|
| Rate for Payer: Healthscope Commercial |
$66.02
|
| Rate for Payer: Healthscope Whirlpool |
$66.02
|
| Rate for Payer: Meridian Medicaid |
$36.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.77
|
| Rate for Payer: PACE SWMI |
$55.02
|
| Rate for Payer: PHP Medicare Advantage |
$55.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.82
|
| Rate for Payer: Priority Health Medicare |
$55.02
|
| Rate for Payer: Priority Health Narrow Network |
$67.82
|
| Rate for Payer: UHC Medicare Advantage |
$56.67
|
|
