|
PR TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 28455
|
| Min. Negotiated Rate |
$149.53 |
| Max. Negotiated Rate |
$1,001.66 |
| Rate for Payer: Aetna Commercial |
$343.50
|
| Rate for Payer: Aetna Medicare |
$256.34
|
| Rate for Payer: BCBS Complete |
$157.01
|
| Rate for Payer: BCBS MAPPO |
$256.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,001.66
|
| Rate for Payer: BCN Commercial |
$434.44
|
| Rate for Payer: BCN Medicare Advantage |
$256.34
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cofinity Commercial |
$369.13
|
| Rate for Payer: Cofinity Commercial |
$343.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$256.34
|
| Rate for Payer: Healthscope Commercial |
$307.61
|
| Rate for Payer: Healthscope Whirlpool |
$307.61
|
| Rate for Payer: Meridian Medicaid |
$157.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$269.16
|
| Rate for Payer: PACE SWMI |
$256.34
|
| Rate for Payer: PHP Medicare Advantage |
$256.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$149.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$404.44
|
| Rate for Payer: Priority Health Medicare |
$256.34
|
| Rate for Payer: Priority Health Narrow Network |
$404.44
|
| Rate for Payer: UHC Medicare Advantage |
$264.03
|
|
|
PR TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
HCPCS 28450
|
| Min. Negotiated Rate |
$126.52 |
| Max. Negotiated Rate |
$921.88 |
| Rate for Payer: Aetna Commercial |
$250.16
|
| Rate for Payer: Aetna Medicare |
$186.69
|
| Rate for Payer: BCBS Complete |
$132.85
|
| Rate for Payer: BCBS MAPPO |
$186.69
|
| Rate for Payer: BCBS Trust/PPO |
$921.88
|
| Rate for Payer: BCN Commercial |
$313.24
|
| Rate for Payer: BCN Medicare Advantage |
$186.69
|
| Rate for Payer: Cash Price |
$457.60
|
| Rate for Payer: Cash Price |
$457.60
|
| Rate for Payer: Cofinity Commercial |
$268.83
|
| Rate for Payer: Cofinity Commercial |
$250.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.69
|
| Rate for Payer: Healthscope Commercial |
$224.03
|
| Rate for Payer: Healthscope Whirlpool |
$224.03
|
| Rate for Payer: Meridian Medicaid |
$132.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$196.02
|
| Rate for Payer: PACE SWMI |
$186.69
|
| Rate for Payer: PHP Medicare Advantage |
$186.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$296.18
|
| Rate for Payer: Priority Health Medicare |
$186.69
|
| Rate for Payer: Priority Health Narrow Network |
$296.18
|
| Rate for Payer: UHC Medicare Advantage |
$192.29
|
|
|
PR TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA
|
Professional
|
Both
|
$4,181.00
|
|
|
Service Code
|
HCPCS 27759
|
| Min. Negotiated Rate |
$641.77 |
| Max. Negotiated Rate |
$2,926.70 |
| Rate for Payer: Aetna Commercial |
$1,317.21
|
| Rate for Payer: Aetna Medicare |
$982.99
|
| Rate for Payer: BCBS Complete |
$673.86
|
| Rate for Payer: BCBS MAPPO |
$982.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,209.30
|
| Rate for Payer: BCN Commercial |
$1,609.37
|
| Rate for Payer: BCN Medicare Advantage |
$982.99
|
| Rate for Payer: Cash Price |
$3,344.80
|
| Rate for Payer: Cash Price |
$3,344.80
|
| Rate for Payer: Cofinity Commercial |
$1,415.51
|
| Rate for Payer: Cofinity Commercial |
$1,317.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$982.99
|
| Rate for Payer: Healthscope Commercial |
$1,179.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,179.59
|
| Rate for Payer: Meridian Medicaid |
$673.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,032.14
|
| Rate for Payer: PACE SWMI |
$982.99
|
| Rate for Payer: PHP Medicare Advantage |
$982.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$641.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,926.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,527.36
|
| Rate for Payer: Priority Health Medicare |
$982.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,527.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,012.48
|
|
|
PR TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
HCPCS 69610
|
| Min. Negotiated Rate |
$184.67 |
| Max. Negotiated Rate |
$4,016.66 |
| Rate for Payer: Aetna Commercial |
$379.93
|
| Rate for Payer: Aetna Medicare |
$283.53
|
| Rate for Payer: BCBS Complete |
$193.90
|
| Rate for Payer: BCBS MAPPO |
$283.53
|
| Rate for Payer: BCBS Trust/PPO |
$4,016.66
|
| Rate for Payer: BCN Commercial |
$565.40
|
| Rate for Payer: BCN Medicare Advantage |
$283.53
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cofinity Commercial |
$408.28
|
| Rate for Payer: Cofinity Commercial |
$379.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$283.53
|
| Rate for Payer: Healthscope Commercial |
$340.24
|
| Rate for Payer: Healthscope Whirlpool |
$340.24
|
| Rate for Payer: Meridian Medicaid |
$193.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$297.71
|
| Rate for Payer: PACE SWMI |
$283.53
|
| Rate for Payer: PHP Medicare Advantage |
$283.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$184.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$406.87
|
| Rate for Payer: Priority Health Medicare |
$283.53
|
| Rate for Payer: Priority Health Narrow Network |
$406.87
|
| Rate for Payer: UHC Medicare Advantage |
$292.04
|
|
|
PR TYMPANOMETRY
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 92567
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$1,875.47 |
| Rate for Payer: Aetna Commercial |
$14.12
|
| Rate for Payer: Aetna Medicare |
$10.54
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS MAPPO |
$10.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,875.47
|
| Rate for Payer: BCN Commercial |
$23.95
|
| Rate for Payer: BCN Medicare Advantage |
$10.54
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$14.12
|
| Rate for Payer: Cofinity Commercial |
$15.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.54
|
| Rate for Payer: Healthscope Commercial |
$12.65
|
| Rate for Payer: Healthscope Whirlpool |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.07
|
| Rate for Payer: PACE SWMI |
$10.54
|
| Rate for Payer: PHP Medicare Advantage |
$10.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.37
|
| Rate for Payer: Priority Health Medicare |
$10.54
|
| Rate for Payer: Priority Health Narrow Network |
$14.37
|
| Rate for Payer: UHC Medicare Advantage |
$10.86
|
|
|
PR TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 92550
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$1,749.20 |
| Rate for Payer: Aetna Commercial |
$28.80
|
| Rate for Payer: Aetna Medicare |
$21.49
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$21.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,749.20
|
| Rate for Payer: BCN Commercial |
$32.25
|
| Rate for Payer: BCN Medicare Advantage |
$21.49
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$30.95
|
| Rate for Payer: Cofinity Commercial |
$28.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.49
|
| Rate for Payer: Healthscope Commercial |
$25.79
|
| Rate for Payer: Healthscope Whirlpool |
$25.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.56
|
| Rate for Payer: PACE SWMI |
$21.49
|
| Rate for Payer: PHP Medicare Advantage |
$21.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.65
|
| Rate for Payer: Priority Health Medicare |
$21.49
|
| Rate for Payer: Priority Health Narrow Network |
$29.65
|
| Rate for Payer: UHC Medicare Advantage |
$22.13
|
|
|
PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR
|
Professional
|
Both
|
$2,738.00
|
|
|
Service Code
|
HCPCS 69646
|
| Min. Negotiated Rate |
$1,007.28 |
| Max. Negotiated Rate |
$2,319.26 |
| Rate for Payer: Aetna Commercial |
$2,057.54
|
| Rate for Payer: Aetna Medicare |
$1,535.48
|
| Rate for Payer: BCBS Complete |
$1,057.64
|
| Rate for Payer: BCBS MAPPO |
$1,535.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,089.35
|
| Rate for Payer: BCN Commercial |
$2,319.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,535.48
|
| Rate for Payer: Cash Price |
$2,190.40
|
| Rate for Payer: Cash Price |
$2,190.40
|
| Rate for Payer: Cofinity Commercial |
$2,211.09
|
| Rate for Payer: Cofinity Commercial |
$2,057.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,535.48
|
| Rate for Payer: Healthscope Commercial |
$1,842.58
|
| Rate for Payer: Healthscope Whirlpool |
$1,842.58
|
| Rate for Payer: Meridian Medicaid |
$1,057.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,612.25
|
| Rate for Payer: PACE SWMI |
$1,535.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,535.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,007.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,916.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,237.55
|
| Rate for Payer: Priority Health Medicare |
$1,535.48
|
| Rate for Payer: Priority Health Narrow Network |
$2,237.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,581.54
|
|
|
PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 69645
|
| Min. Negotiated Rate |
$946.79 |
| Max. Negotiated Rate |
$2,184.39 |
| Rate for Payer: Aetna Commercial |
$1,934.49
|
| Rate for Payer: Aetna Medicare |
$1,443.65
|
| Rate for Payer: BCBS Complete |
$994.13
|
| Rate for Payer: BCBS MAPPO |
$1,443.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,502.49
|
| Rate for Payer: BCN Commercial |
$2,184.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,443.65
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Cofinity Commercial |
$2,078.86
|
| Rate for Payer: Cofinity Commercial |
$1,934.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,443.65
|
| Rate for Payer: Healthscope Commercial |
$1,732.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,732.38
|
| Rate for Payer: Meridian Medicaid |
$994.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,515.83
|
| Rate for Payer: PACE SWMI |
$1,443.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,443.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$946.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,820.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,107.43
|
| Rate for Payer: Priority Health Medicare |
$1,443.65
|
| Rate for Payer: Priority Health Narrow Network |
$2,107.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,486.96
|
|
|
PR TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP
|
Professional
|
Both
|
$1,851.00
|
|
|
Service Code
|
HCPCS 69633
|
| Min. Negotiated Rate |
$134.72 |
| Max. Negotiated Rate |
$1,553.99 |
| Rate for Payer: Aetna Commercial |
$1,378.79
|
| Rate for Payer: Aetna Medicare |
$1,028.95
|
| Rate for Payer: BCBS Complete |
$710.54
|
| Rate for Payer: BCBS MAPPO |
$1,028.95
|
| Rate for Payer: BCBS Trust/PPO |
$134.72
|
| Rate for Payer: BCN Commercial |
$1,553.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,028.95
|
| Rate for Payer: Cash Price |
$1,480.80
|
| Rate for Payer: Cash Price |
$1,480.80
|
| Rate for Payer: Cofinity Commercial |
$1,481.69
|
| Rate for Payer: Cofinity Commercial |
$1,378.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,028.95
|
| Rate for Payer: Healthscope Commercial |
$1,234.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,234.74
|
| Rate for Payer: Meridian Medicaid |
$710.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,080.40
|
| Rate for Payer: PACE SWMI |
$1,028.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,028.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$676.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,499.24
|
| Rate for Payer: Priority Health Medicare |
$1,028.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,499.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,059.82
|
|
|
PR TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ
|
Professional
|
Both
|
$3,083.00
|
|
|
Service Code
|
HCPCS 69631
|
| Min. Negotiated Rate |
$572.76 |
| Max. Negotiated Rate |
$2,248.97 |
| Rate for Payer: Aetna Commercial |
$1,166.34
|
| Rate for Payer: Aetna Medicare |
$870.40
|
| Rate for Payer: BCBS Complete |
$601.40
|
| Rate for Payer: BCBS MAPPO |
$870.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,248.97
|
| Rate for Payer: BCN Commercial |
$1,316.99
|
| Rate for Payer: BCN Medicare Advantage |
$870.40
|
| Rate for Payer: Cash Price |
$2,466.40
|
| Rate for Payer: Cash Price |
$2,466.40
|
| Rate for Payer: Cofinity Commercial |
$1,253.38
|
| Rate for Payer: Cofinity Commercial |
$1,166.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$870.40
|
| Rate for Payer: Healthscope Commercial |
$1,044.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,044.48
|
| Rate for Payer: Meridian Medicaid |
$601.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$913.92
|
| Rate for Payer: PACE SWMI |
$870.40
|
| Rate for Payer: PHP Medicare Advantage |
$870.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$572.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,158.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,270.58
|
| Rate for Payer: Priority Health Medicare |
$870.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,270.58
|
| Rate for Payer: UHC Medicare Advantage |
$896.51
|
|
|
PR TYMPANOSTOMY GENERAL ANESTHESIA
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 69436
|
| Min. Negotiated Rate |
$103.09 |
| Max. Negotiated Rate |
$2,059.84 |
| Rate for Payer: Aetna Commercial |
$208.70
|
| Rate for Payer: Aetna Medicare |
$155.75
|
| Rate for Payer: BCBS Complete |
$108.24
|
| Rate for Payer: BCBS MAPPO |
$155.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,059.84
|
| Rate for Payer: BCN Commercial |
$234.56
|
| Rate for Payer: BCN Medicare Advantage |
$155.75
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cofinity Commercial |
$224.28
|
| Rate for Payer: Cofinity Commercial |
$208.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.75
|
| Rate for Payer: Healthscope Commercial |
$186.90
|
| Rate for Payer: Healthscope Whirlpool |
$186.90
|
| Rate for Payer: Meridian Medicaid |
$108.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$163.54
|
| Rate for Payer: PACE SWMI |
$155.75
|
| Rate for Payer: PHP Medicare Advantage |
$155.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.30
|
| Rate for Payer: Priority Health Medicare |
$155.75
|
| Rate for Payer: Priority Health Narrow Network |
$226.30
|
| Rate for Payer: UHC Medicare Advantage |
$160.42
|
|
|
PR TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
HCPCS 69433
|
| Min. Negotiated Rate |
$85.63 |
| Max. Negotiated Rate |
$2,182.94 |
| Rate for Payer: Aetna Commercial |
$172.63
|
| Rate for Payer: Aetna Medicare |
$128.83
|
| Rate for Payer: BCBS Complete |
$89.91
|
| Rate for Payer: BCBS MAPPO |
$128.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,182.94
|
| Rate for Payer: BCN Commercial |
$239.92
|
| Rate for Payer: BCN Medicare Advantage |
$128.83
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$172.63
|
| Rate for Payer: Cofinity Commercial |
$185.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.83
|
| Rate for Payer: Healthscope Commercial |
$154.60
|
| Rate for Payer: Healthscope Whirlpool |
$154.60
|
| Rate for Payer: Meridian Medicaid |
$89.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$135.27
|
| Rate for Payer: PACE SWMI |
$128.83
|
| Rate for Payer: PHP Medicare Advantage |
$128.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.64
|
| Rate for Payer: Priority Health Medicare |
$128.83
|
| Rate for Payer: Priority Health Narrow Network |
$187.64
|
| Rate for Payer: UHC Medicare Advantage |
$132.69
|
|
|
PR TYMPNOPLSTY W/O MSTDC 1ST/REVJ W/OSICLE RECNSTJ
|
Professional
|
Both
|
$1,916.00
|
|
|
Service Code
|
HCPCS 69632
|
| Min. Negotiated Rate |
$124.68 |
| Max. Negotiated Rate |
$1,601.40 |
| Rate for Payer: Aetna Commercial |
$1,422.08
|
| Rate for Payer: Aetna Medicare |
$1,061.25
|
| Rate for Payer: BCBS Complete |
$729.32
|
| Rate for Payer: BCBS MAPPO |
$1,061.25
|
| Rate for Payer: BCBS Trust/PPO |
$124.68
|
| Rate for Payer: BCN Commercial |
$1,601.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,061.25
|
| Rate for Payer: Cash Price |
$1,532.80
|
| Rate for Payer: Cash Price |
$1,532.80
|
| Rate for Payer: Cofinity Commercial |
$1,528.20
|
| Rate for Payer: Cofinity Commercial |
$1,422.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,061.25
|
| Rate for Payer: Healthscope Commercial |
$1,273.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,273.50
|
| Rate for Payer: Meridian Medicaid |
$729.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,114.31
|
| Rate for Payer: PACE SWMI |
$1,061.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,061.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$694.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,341.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,544.97
|
| Rate for Payer: Priority Health Medicare |
$1,061.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,544.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,093.09
|
|
|
PR TYMPP ANTRT/MASTOID W/O OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$3,565.00
|
|
|
Service Code
|
HCPCS 69635
|
| Min. Negotiated Rate |
$329.13 |
| Max. Negotiated Rate |
$2,495.50 |
| Rate for Payer: Aetna Commercial |
$1,675.00
|
| Rate for Payer: Aetna Medicare |
$1,250.00
|
| Rate for Payer: BCBS Complete |
$862.62
|
| Rate for Payer: BCBS MAPPO |
$1,250.00
|
| Rate for Payer: BCBS Trust/PPO |
$329.13
|
| Rate for Payer: BCN Commercial |
$1,893.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,250.00
|
| Rate for Payer: Cash Price |
$2,852.00
|
| Rate for Payer: Cash Price |
$2,852.00
|
| Rate for Payer: Cofinity Commercial |
$1,800.00
|
| Rate for Payer: Cofinity Commercial |
$1,675.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,250.00
|
| Rate for Payer: Healthscope Commercial |
$1,500.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,500.00
|
| Rate for Payer: Meridian Medicaid |
$862.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,312.50
|
| Rate for Payer: PACE SWMI |
$1,250.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,250.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$821.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,495.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,826.43
|
| Rate for Payer: Priority Health Medicare |
$1,250.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,826.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,287.50
|
|
|
PR UMBILECTOMY OMPHALECTOMY EXC UMBILICUS SPX
|
Professional
|
Both
|
$1,967.00
|
|
|
Service Code
|
HCPCS 49250
|
| Min. Negotiated Rate |
$382.55 |
| Max. Negotiated Rate |
$1,376.90 |
| Rate for Payer: Aetna Commercial |
$788.75
|
| Rate for Payer: Aetna Medicare |
$588.62
|
| Rate for Payer: BCBS Complete |
$401.68
|
| Rate for Payer: BCBS MAPPO |
$588.62
|
| Rate for Payer: BCBS Trust/PPO |
$996.37
|
| Rate for Payer: BCN Commercial |
$870.33
|
| Rate for Payer: BCN Medicare Advantage |
$588.62
|
| Rate for Payer: Cash Price |
$1,573.60
|
| Rate for Payer: Cash Price |
$1,573.60
|
| Rate for Payer: Cofinity Commercial |
$847.61
|
| Rate for Payer: Cofinity Commercial |
$788.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.62
|
| Rate for Payer: Healthscope Commercial |
$706.34
|
| Rate for Payer: Healthscope Whirlpool |
$706.34
|
| Rate for Payer: Meridian Medicaid |
$401.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$618.05
|
| Rate for Payer: PACE SWMI |
$588.62
|
| Rate for Payer: PHP Medicare Advantage |
$588.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$382.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,376.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,047.18
|
| Rate for Payer: Priority Health Medicare |
$588.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,047.18
|
| Rate for Payer: UHC Medicare Advantage |
$606.28
|
|
|
PR UNILATERAL BREAST AUGMENTATION GEL
|
Professional
|
Both
|
$2,720.00
|
|
|
Service Code
|
HCPCS 00362
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,088.00 |
| Max. Negotiated Rate |
$1,904.00 |
| Rate for Payer: BCBS Complete |
$1,088.00
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,904.00
|
|
|
PR UNILATERAL BREAST AUGMENTATION SALINE
|
Professional
|
Both
|
$2,120.00
|
|
|
Service Code
|
HCPCS 00363
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$848.00 |
| Max. Negotiated Rate |
$1,484.00 |
| Rate for Payer: BCBS Complete |
$848.00
|
| Rate for Payer: Cash Price |
$1,696.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,484.00
|
|
|
PR UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 91299
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$749.66 |
| Rate for Payer: BCBS Complete |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$749.66
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.00
|
|
|
PR UNLISTED EVALUATION AND MANAGEMENT SERVICE
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 99499
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$75.02 |
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS Trust/PPO |
$75.02
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
|
|
PR UNLISTED PSYCHIATRIC SERVICE/PROCEDURE
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 90899
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$681.51 |
| Rate for Payer: BCBS Complete |
$52.00
|
| Rate for Payer: BCBS Trust/PPO |
$681.51
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
|
|
PR UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS
|
Professional
|
Both
|
$974.00
|
|
|
Service Code
|
HCPCS 33214
|
| Min. Negotiated Rate |
$300.97 |
| Max. Negotiated Rate |
$1,455.47 |
| Rate for Payer: Aetna Commercial |
$630.12
|
| Rate for Payer: Aetna Medicare |
$470.24
|
| Rate for Payer: BCBS Complete |
$316.02
|
| Rate for Payer: BCBS MAPPO |
$470.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,455.47
|
| Rate for Payer: BCN Commercial |
$693.44
|
| Rate for Payer: BCN Medicare Advantage |
$470.24
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Cofinity Commercial |
$677.15
|
| Rate for Payer: Cofinity Commercial |
$630.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$470.24
|
| Rate for Payer: Healthscope Commercial |
$564.29
|
| Rate for Payer: Healthscope Whirlpool |
$564.29
|
| Rate for Payer: Meridian Medicaid |
$316.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$493.75
|
| Rate for Payer: PACE SWMI |
$470.24
|
| Rate for Payer: PHP Medicare Advantage |
$470.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$300.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$681.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$754.85
|
| Rate for Payer: Priority Health Medicare |
$470.24
|
| Rate for Payer: Priority Health Narrow Network |
$754.85
|
| Rate for Payer: UHC Medicare Advantage |
$484.35
|
|
|
PR UPPER EXT FX ORTHOSIS RAD/UL
|
Professional
|
Both
|
$343.00
|
|
|
Service Code
|
HCPCS L3982
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$339.45 |
| Rate for Payer: Aetna Commercial |
$215.32
|
| Rate for Payer: BCBS Complete |
$137.20
|
| Rate for Payer: BCN Commercial |
$339.45
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.10
|
|
|
PR UPPER EXT FX ORTHOSIS WRIST
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS L3984
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$299.03 |
| Rate for Payer: Aetna Commercial |
$189.68
|
| Rate for Payer: BCBS Complete |
$120.80
|
| Rate for Payer: BCN Commercial |
$299.03
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.40
|
|
|
PR UPPER GI ENDOSCOPY,STENT PLACEMENT
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
HCPCS 43256
|
| Min. Negotiated Rate |
$434.80 |
| Max. Negotiated Rate |
$760.90 |
| Rate for Payer: BCBS Complete |
$434.80
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.90
|
|
|
PR UPPER GI ENDOSCOPY,TUMOR ABLATN
|
Professional
|
Both
|
$1,196.00
|
|
|
Service Code
|
HCPCS 43258
|
| Min. Negotiated Rate |
$478.40 |
| Max. Negotiated Rate |
$837.20 |
| Rate for Payer: BCBS Complete |
$478.40
|
| Rate for Payer: Cash Price |
$956.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$837.20
|
|
