|
PR INJ, REMDESIVIR, 1 MG
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS J0248
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Aetna Commercial |
$5.51
|
| Rate for Payer: Aetna Medicare |
$8.50
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS Trust/PPO |
$6.17
|
| Rate for Payer: BCN Commercial |
$5.61
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
|
|
PR INJ, RIMABOTULINUMTOXINB
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS J0587
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$13.42 |
| Rate for Payer: Aetna Commercial |
$13.42
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$13.27
|
| Rate for Payer: BCN Commercial |
$12.93
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.06
|
| Rate for Payer: UHC Exchange |
$13.06
|
|
|
PR INJ RISPERDAL CONSTA, 0.5 MG
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J2794
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$12.52 |
| Rate for Payer: Aetna Commercial |
$12.52
|
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS Trust/PPO |
$12.06
|
| Rate for Payer: BCN Commercial |
$11.80
|
| 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 |
$12.16
|
| Rate for Payer: UHC Exchange |
$12.16
|
|
|
PR INJ. ROMOSOZUMAB-AQQG 1 MG
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS J3111
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$11.16 |
| Rate for Payer: Aetna Commercial |
$11.05
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: BCBS Trust/PPO |
$10.92
|
| Rate for Payer: BCN Commercial |
$10.08
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.16
|
| Rate for Payer: UHC Exchange |
$11.16
|
|
|
PR INJ TESTOSTERONE CYPIONATE
|
Professional
|
Both
|
$0.16
|
|
|
Service Code
|
HCPCS J1071
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Aetna Medicare |
$0.08
|
| Rate for Payer: BCBS Complete |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
|
|
PR INPT/ED TELECONSULT30
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS G0425
|
| Min. Negotiated Rate |
$58.58 |
| Max. Negotiated Rate |
$491.32 |
| Rate for Payer: Aetna Commercial |
$99.61
|
| Rate for Payer: Aetna Medicare |
$100.50
|
| Rate for Payer: BCBS Complete |
$61.51
|
| Rate for Payer: BCBS Trust/PPO |
$491.32
|
| Rate for Payer: BCN Commercial |
$134.38
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Meridian Medicaid |
$61.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.40
|
| Rate for Payer: Priority Health Narrow Network |
$123.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.23
|
| Rate for Payer: UHC Exchange |
$106.23
|
| Rate for Payer: UHCCP Medicaid |
$58.58
|
|
|
PR INPT/ED TELECONSULT50
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS G0426
|
| Min. Negotiated Rate |
$82.86 |
| Max. Negotiated Rate |
$562.64 |
| Rate for Payer: Aetna Commercial |
$133.90
|
| Rate for Payer: Aetna Medicare |
$136.00
|
| Rate for Payer: BCBS Complete |
$87.00
|
| Rate for Payer: BCBS Trust/PPO |
$562.64
|
| Rate for Payer: BCN Commercial |
$188.63
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Meridian Medicaid |
$87.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.55
|
| Rate for Payer: Priority Health Narrow Network |
$174.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.63
|
| Rate for Payer: UHC Exchange |
$144.63
|
| Rate for Payer: UHCCP Medicaid |
$82.86
|
|
|
PR INPT/ED TELECONSULT70
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS G0427
|
| Min. Negotiated Rate |
$117.79 |
| Max. Negotiated Rate |
$348.68 |
| Rate for Payer: Aetna Commercial |
$197.06
|
| Rate for Payer: Aetna Medicare |
$202.00
|
| Rate for Payer: BCBS Complete |
$123.68
|
| Rate for Payer: BCBS Trust/PPO |
$348.68
|
| Rate for Payer: BCN Commercial |
$268.29
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Meridian Medicaid |
$123.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$246.79
|
| Rate for Payer: Priority Health Narrow Network |
$246.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.26
|
| Rate for Payer: UHC Exchange |
$212.26
|
| Rate for Payer: UHCCP Medicaid |
$117.79
|
|
|
PR INPT/TELE FOLLOW UP 25
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS G0407
|
| Min. Negotiated Rate |
$46.01 |
| Max. Negotiated Rate |
$104.58 |
| Rate for Payer: Aetna Commercial |
$70.74
|
| Rate for Payer: Aetna Medicare |
$74.50
|
| Rate for Payer: BCBS Complete |
$48.31
|
| Rate for Payer: BCN Commercial |
$104.58
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Meridian Medicaid |
$48.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.80
|
| Rate for Payer: Priority Health Narrow Network |
$96.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.09
|
| Rate for Payer: UHC Exchange |
$73.09
|
| Rate for Payer: UHCCP Medicaid |
$46.01
|
|
|
PR INPT/TELE FOLLOW UP 35
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS G0408
|
| Min. Negotiated Rate |
$66.46 |
| Max. Negotiated Rate |
$1,554.26 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Aetna Medicare |
$92.00
|
| Rate for Payer: BCBS Complete |
$69.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,554.26
|
| Rate for Payer: BCN Commercial |
$152.47
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Meridian Medicaid |
$69.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.13
|
| Rate for Payer: Priority Health Narrow Network |
$141.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.04
|
| Rate for Payer: UHC Exchange |
$105.04
|
| Rate for Payer: UHCCP Medicaid |
$66.46
|
|
|
PR INSERT CANNULA PROLONG CP INSUFF
|
Professional
|
Both
|
$1,582.00
|
|
|
Service Code
|
HCPCS 36822
|
| Min. Negotiated Rate |
$632.80 |
| Max. Negotiated Rate |
$1,028.30 |
| Rate for Payer: Aetna Medicare |
$791.00
|
| Rate for Payer: BCBS Complete |
$632.80
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,028.30
|
|
|
PR INSERT GASTROSTOMY TUBE PERCUTANEOUS
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 49440
|
| Min. Negotiated Rate |
$128.01 |
| Max. Negotiated Rate |
$1,231.95 |
| Rate for Payer: Aetna Commercial |
$270.42
|
| Rate for Payer: Aetna Medicare |
$191.50
|
| Rate for Payer: BCBS Complete |
$134.41
|
| Rate for Payer: BCBS Trust/PPO |
$583.24
|
| Rate for Payer: BCN Commercial |
$1,231.95
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Meridian Medicaid |
$134.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.77
|
| Rate for Payer: Priority Health Narrow Network |
$353.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.05
|
| Rate for Payer: UHC Exchange |
$293.05
|
| Rate for Payer: UHCCP Medicaid |
$128.01
|
|
|
PR INSERTION BREAST IMPLANT SAME DAY OF MASTECTOMY
|
Professional
|
Both
|
$1,714.00
|
|
|
Service Code
|
HCPCS 19340
|
| Min. Negotiated Rate |
$491.82 |
| Max. Negotiated Rate |
$1,114.10 |
| Rate for Payer: Aetna Commercial |
$818.17
|
| Rate for Payer: Aetna Medicare |
$857.00
|
| Rate for Payer: BCBS Complete |
$516.41
|
| Rate for Payer: BCBS Trust/PPO |
$562.50
|
| Rate for Payer: BCN Commercial |
$1,112.23
|
| Rate for Payer: Cash Price |
$1,371.20
|
| Rate for Payer: Cash Price |
$1,371.20
|
| Rate for Payer: Meridian Medicaid |
$516.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$491.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,114.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,032.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,032.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$859.45
|
| Rate for Payer: UHC Exchange |
$859.45
|
| Rate for Payer: UHCCP Medicaid |
$491.82
|
|
|
PR INSERTION CERVICAL DILATOR SEPARATE PROCEDURE
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 59200
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$155.89 |
| Rate for Payer: Aetna Commercial |
$49.05
|
| Rate for Payer: Aetna Medicare |
$79.00
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS Trust/PPO |
$90.87
|
| Rate for Payer: BCN Commercial |
$155.89
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.94
|
| Rate for Payer: Priority Health Narrow Network |
$61.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.33
|
| Rate for Payer: UHC Exchange |
$52.33
|
|
|
PR INSERTION DRUG DELIVERY IMPLANT
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 11981
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$977.96 |
| Rate for Payer: Aetna Commercial |
$69.83
|
| Rate for Payer: Aetna Medicare |
$113.50
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS Trust/PPO |
$977.96
|
| Rate for Payer: BCN Commercial |
$147.09
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.44
|
| Rate for Payer: Priority Health Narrow Network |
$84.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.52
|
| Rate for Payer: UHC Exchange |
$92.52
|
| Rate for Payer: UHCCP Medicaid |
$40.26
|
|
|
PR INSERTION EPICARDIAL ELECTRODE OPEN
|
Professional
|
Both
|
$2,372.00
|
|
|
Service Code
|
HCPCS 33202
|
| Min. Negotiated Rate |
$487.56 |
| Max. Negotiated Rate |
$1,541.80 |
| Rate for Payer: Aetna Commercial |
$1,033.14
|
| Rate for Payer: Aetna Medicare |
$1,186.00
|
| Rate for Payer: BCBS Complete |
$511.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,263.69
|
| Rate for Payer: BCN Commercial |
$1,110.28
|
| Rate for Payer: Cash Price |
$1,897.60
|
| Rate for Payer: Cash Price |
$1,897.60
|
| Rate for Payer: Meridian Medicaid |
$511.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$487.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,541.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,213.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,213.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,006.65
|
| Rate for Payer: UHC Exchange |
$1,006.65
|
| Rate for Payer: UHCCP Medicaid |
$487.56
|
|
|
PR INSERTION FLOW DIRECTED CATHETER FOR MONITORING
|
Professional
|
Both
|
$853.00
|
|
|
Service Code
|
HCPCS 93503
|
| Min. Negotiated Rate |
$54.95 |
| Max. Negotiated Rate |
$554.45 |
| Rate for Payer: Aetna Commercial |
$118.36
|
| Rate for Payer: Aetna Medicare |
$426.50
|
| Rate for Payer: BCBS Complete |
$57.70
|
| Rate for Payer: BCBS Trust/PPO |
$456.45
|
| Rate for Payer: BCN Commercial |
$126.08
|
| Rate for Payer: Cash Price |
$682.40
|
| Rate for Payer: Cash Price |
$682.40
|
| Rate for Payer: Meridian Medicaid |
$57.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.01
|
| Rate for Payer: Priority Health Narrow Network |
$121.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.25
|
| Rate for Payer: UHC Exchange |
$178.25
|
| Rate for Payer: UHCCP Medicaid |
$54.95
|
|
|
PR INSERTION INDWELLING TUNNELED PLEURAL CATHETER
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 32550
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$1,267.50 |
| Rate for Payer: Aetna Commercial |
$264.99
|
| Rate for Payer: Aetna Medicare |
$975.00
|
| Rate for Payer: BCBS Complete |
$134.64
|
| Rate for Payer: BCBS Trust/PPO |
$421.58
|
| Rate for Payer: BCN Commercial |
$1,161.10
|
| Rate for Payer: Cash Price |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,560.00
|
| Rate for Payer: Meridian Medicaid |
$134.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,267.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$278.09
|
| Rate for Payer: Priority Health Narrow Network |
$278.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$267.55
|
| Rate for Payer: UHC Exchange |
$267.55
|
| Rate for Payer: UHCCP Medicaid |
$128.23
|
|
|
PR INSERTION INTRA-AORTIC BALLOON ASSIST DEV PERQ
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
HCPCS 33967
|
| Min. Negotiated Rate |
$161.67 |
| Max. Negotiated Rate |
$815.17 |
| Rate for Payer: Aetna Commercial |
$349.07
|
| Rate for Payer: Aetna Medicare |
$375.50
|
| Rate for Payer: BCBS Complete |
$169.75
|
| Rate for Payer: BCBS Trust/PPO |
$815.17
|
| Rate for Payer: BCN Commercial |
$367.97
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Meridian Medicaid |
$169.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$402.60
|
| Rate for Payer: Priority Health Narrow Network |
$402.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$358.29
|
| Rate for Payer: UHC Exchange |
$358.29
|
| Rate for Payer: UHCCP Medicaid |
$161.67
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
58300
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$417.36 |
| Rate for Payer: Aetna Commercial |
$60.86
|
| Rate for Payer: Aetna Medicare |
$148.00
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS Trust/PPO |
$417.36
|
| Rate for Payer: BCN Commercial |
$130.36
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.41
|
| Rate for Payer: Priority Health Narrow Network |
$74.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.81
|
| Rate for Payer: UHC Exchange |
$59.81
|
| Rate for Payer: UHCCP Medicaid |
$32.16
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
58300
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$192.40 |
| Max. Negotiated Rate |
$296.00 |
| Rate for Payer: Aetna Commercial |
$266.40
|
| Rate for Payer: ASR ASR |
$287.12
|
| Rate for Payer: ASR Commercial |
$287.12
|
| Rate for Payer: BCBS Trust/PPO |
$241.21
|
| Rate for Payer: BCN Commercial |
$229.49
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cofinity Commercial |
$278.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.80
|
| Rate for Payer: Healthscope Commercial |
$296.00
|
| Rate for Payer: Healthscope Whirlpool |
$287.12
|
| Rate for Payer: Mclaren Commercial |
$266.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.60
|
| Rate for Payer: Nomi Health Commercial |
$242.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.48
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 58300
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$417.36 |
| Rate for Payer: Aetna Commercial |
$60.86
|
| Rate for Payer: Aetna Medicare |
$148.00
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS Trust/PPO |
$417.36
|
| Rate for Payer: BCN Commercial |
$130.36
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.41
|
| Rate for Payer: Priority Health Narrow Network |
$74.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.81
|
| Rate for Payer: UHC Exchange |
$59.81
|
| Rate for Payer: UHCCP Medicaid |
$32.16
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
58300
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$296.00 |
| Rate for Payer: Aetna Commercial |
$266.40
|
| Rate for Payer: Aetna Medicare |
$148.00
|
| Rate for Payer: ASR ASR |
$287.12
|
| Rate for Payer: ASR Commercial |
$287.12
|
| Rate for Payer: BCBS Complete |
$118.40
|
| Rate for Payer: BCBS Trust/PPO |
$242.39
|
| Rate for Payer: BCN Commercial |
$229.49
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cofinity Commercial |
$278.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.80
|
| Rate for Payer: Healthscope Commercial |
$296.00
|
| Rate for Payer: Healthscope Whirlpool |
$287.12
|
| Rate for Payer: Mclaren Commercial |
$266.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.60
|
| Rate for Payer: Nomi Health Commercial |
$242.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.36
|
| Rate for Payer: Priority Health Narrow Network |
$207.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.48
|
|
|
PR INSERTION PICC W/O IMG GDN < 5 YR
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
HCPCS 36568
|
| Min. Negotiated Rate |
$58.36 |
| Max. Negotiated Rate |
$967.32 |
| Rate for Payer: Aetna Commercial |
$123.67
|
| Rate for Payer: Aetna Medicare |
$87.00
|
| Rate for Payer: BCBS Complete |
$61.28
|
| Rate for Payer: BCBS Trust/PPO |
$967.32
|
| Rate for Payer: BCN Commercial |
$132.43
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$61.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.60
|
| Rate for Payer: Priority Health Narrow Network |
$143.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.36
|
| Rate for Payer: UHC Exchange |
$123.36
|
| Rate for Payer: UHCCP Medicaid |
$58.36
|
|
|
PR INSERTION PICC W/O IMG GDN 5 YR/>
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 36569
|
| Min. Negotiated Rate |
$59.85 |
| Max. Negotiated Rate |
$563.70 |
| Rate for Payer: Aetna Commercial |
$125.36
|
| Rate for Payer: Aetna Medicare |
$245.00
|
| Rate for Payer: BCBS Complete |
$62.84
|
| Rate for Payer: BCBS Trust/PPO |
$563.70
|
| Rate for Payer: BCN Commercial |
$134.38
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Meridian Medicaid |
$62.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.38
|
| Rate for Payer: Priority Health Narrow Network |
$148.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.53
|
| Rate for Payer: UHC Exchange |
$120.53
|
| Rate for Payer: UHCCP Medicaid |
$59.85
|
|
