|
PR URINARY LEG OR ABDOMEN BAG
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS A4358
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$6.46 |
| Rate for Payer: Aetna Commercial |
$5.46
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCN Commercial |
$6.46
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
|
|
PR URTP W/TUBULARIZATION POST URT&/LWR BLDR
|
Professional
|
Both
|
$2,163.00
|
|
|
Service Code
|
HCPCS 53431
|
| Min. Negotiated Rate |
$730.16 |
| Max. Negotiated Rate |
$2,997.57 |
| Rate for Payer: Aetna Commercial |
$1,506.35
|
| Rate for Payer: Aetna Medicare |
$1,124.14
|
| Rate for Payer: BCBS Complete |
$766.67
|
| Rate for Payer: BCBS MAPPO |
$1,124.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,997.57
|
| Rate for Payer: BCN Commercial |
$1,656.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,124.14
|
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cofinity Commercial |
$1,618.76
|
| Rate for Payer: Cofinity Commercial |
$1,506.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,124.14
|
| Rate for Payer: Healthscope Commercial |
$1,348.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,348.97
|
| Rate for Payer: Meridian Medicaid |
$766.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,180.35
|
| Rate for Payer: PACE SWMI |
$1,124.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,124.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$730.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,514.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,831.28
|
| Rate for Payer: Priority Health Medicare |
$1,124.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,831.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,157.86
|
|
|
PR URTROLITHOTOMY MIDDLE ONE-THIRD URETER
|
Professional
|
Both
|
$1,594.00
|
|
|
Service Code
|
HCPCS 50620
|
| Min. Negotiated Rate |
$572.97 |
| Max. Negotiated Rate |
$1,436.81 |
| Rate for Payer: Aetna Commercial |
$1,181.05
|
| Rate for Payer: Aetna Medicare |
$881.38
|
| Rate for Payer: BCBS Complete |
$601.62
|
| Rate for Payer: BCBS MAPPO |
$881.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,273.73
|
| Rate for Payer: BCN Commercial |
$1,299.39
|
| Rate for Payer: BCN Medicare Advantage |
$881.38
|
| Rate for Payer: Cash Price |
$1,275.20
|
| Rate for Payer: Cash Price |
$1,275.20
|
| Rate for Payer: Cofinity Commercial |
$1,269.19
|
| Rate for Payer: Cofinity Commercial |
$1,181.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.38
|
| Rate for Payer: Healthscope Commercial |
$1,057.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,057.66
|
| Rate for Payer: Meridian Medicaid |
$601.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$925.45
|
| Rate for Payer: PACE SWMI |
$881.38
|
| Rate for Payer: PHP Medicare Advantage |
$881.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$572.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,115.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,436.81
|
| Rate for Payer: Priority Health Medicare |
$881.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,436.81
|
| Rate for Payer: UHC Medicare Advantage |
$907.82
|
|
|
PR URTRONEOCSTOST W/VESICO-PSOAS HITCH/BLDR FLAP
|
Professional
|
Both
|
$4,561.00
|
|
|
Service Code
|
HCPCS 50785
|
| Min. Negotiated Rate |
$768.08 |
| Max. Negotiated Rate |
$3,192.70 |
| Rate for Payer: Aetna Commercial |
$1,590.65
|
| Rate for Payer: Aetna Medicare |
$1,187.05
|
| Rate for Payer: BCBS Complete |
$806.48
|
| Rate for Payer: BCBS MAPPO |
$1,187.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,101.12
|
| Rate for Payer: BCN Commercial |
$1,747.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,187.05
|
| Rate for Payer: Cash Price |
$3,648.80
|
| Rate for Payer: Cash Price |
$3,648.80
|
| Rate for Payer: Cofinity Commercial |
$1,590.65
|
| Rate for Payer: Cofinity Commercial |
$1,709.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,187.05
|
| Rate for Payer: Healthscope Commercial |
$1,424.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,424.46
|
| Rate for Payer: Meridian Medicaid |
$806.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,246.40
|
| Rate for Payer: PACE SWMI |
$1,187.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,187.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$768.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,192.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,932.33
|
| Rate for Payer: Priority Health Medicare |
$1,187.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,932.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,222.66
|
|
|
PR URTT/URTS XTRNL SPX PENDULOUS URETHRA
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 53000
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$283.70 |
| Rate for Payer: Aetna Commercial |
$193.04
|
| Rate for Payer: Aetna Medicare |
$144.06
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS MAPPO |
$144.06
|
| Rate for Payer: BCBS Trust/PPO |
$283.70
|
| Rate for Payer: BCN Commercial |
$214.53
|
| Rate for Payer: BCN Medicare Advantage |
$144.06
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$207.45
|
| Rate for Payer: Cofinity Commercial |
$193.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.06
|
| Rate for Payer: Healthscope Commercial |
$172.87
|
| Rate for Payer: Healthscope Whirlpool |
$172.87
|
| Rate for Payer: Meridian Medicaid |
$99.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$151.26
|
| Rate for Payer: PACE SWMI |
$144.06
|
| Rate for Payer: PHP Medicare Advantage |
$144.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$237.21
|
| Rate for Payer: Priority Health Medicare |
$144.06
|
| Rate for Payer: Priority Health Narrow Network |
$237.21
|
| Rate for Payer: UHC Medicare Advantage |
$148.38
|
|
|
PR USE OF ECHO CONTRAST AGENT DURING STRESS ECHO
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 93352
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$1,312.83 |
| Rate for Payer: Aetna Commercial |
$42.69
|
| Rate for Payer: Aetna Medicare |
$31.86
|
| Rate for Payer: BCBS Complete |
$25.60
|
| Rate for Payer: BCBS MAPPO |
$31.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,312.83
|
| Rate for Payer: BCN Commercial |
$49.36
|
| Rate for Payer: BCN Medicare Advantage |
$31.86
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$45.88
|
| Rate for Payer: Cofinity Commercial |
$42.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.86
|
| Rate for Payer: Healthscope Commercial |
$38.23
|
| Rate for Payer: Healthscope Whirlpool |
$38.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.45
|
| Rate for Payer: PACE SWMI |
$31.86
|
| Rate for Payer: PHP Medicare Advantage |
$31.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.77
|
| Rate for Payer: Priority Health Medicare |
$31.86
|
| Rate for Payer: Priority Health Narrow Network |
$47.77
|
| Rate for Payer: UHC Medicare Advantage |
$32.82
|
|
|
PR USE VERTICAL ELECTRODES
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 92547
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$1,085.66 |
| Rate for Payer: Aetna Commercial |
$13.24
|
| Rate for Payer: Aetna Medicare |
$9.88
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS MAPPO |
$9.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,085.66
|
| Rate for Payer: BCN Commercial |
$15.64
|
| Rate for Payer: BCN Medicare Advantage |
$9.88
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cofinity Commercial |
$13.24
|
| Rate for Payer: Cofinity Commercial |
$14.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.88
|
| Rate for Payer: Healthscope Commercial |
$11.86
|
| Rate for Payer: Healthscope Whirlpool |
$11.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.37
|
| Rate for Payer: PACE SWMI |
$9.88
|
| Rate for Payer: PHP Medicare Advantage |
$9.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.37
|
| Rate for Payer: Priority Health Medicare |
$9.88
|
| Rate for Payer: Priority Health Narrow Network |
$14.37
|
| Rate for Payer: UHC Medicare Advantage |
$10.18
|
|
|
PR UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 59870
|
| Min. Negotiated Rate |
$347.62 |
| Max. Negotiated Rate |
$794.10 |
| Rate for Payer: Aetna Commercial |
$713.54
|
| Rate for Payer: Aetna Medicare |
$532.49
|
| Rate for Payer: BCBS Complete |
$365.00
|
| Rate for Payer: BCBS MAPPO |
$532.49
|
| Rate for Payer: BCBS Trust/PPO |
$547.32
|
| Rate for Payer: BCN Commercial |
$794.10
|
| Rate for Payer: BCN Medicare Advantage |
$532.49
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cofinity Commercial |
$713.54
|
| Rate for Payer: Cofinity Commercial |
$766.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$532.49
|
| Rate for Payer: Healthscope Commercial |
$638.99
|
| Rate for Payer: Healthscope Whirlpool |
$638.99
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$559.11
|
| Rate for Payer: PACE SWMI |
$532.49
|
| Rate for Payer: PHP Medicare Advantage |
$532.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$539.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$767.29
|
| Rate for Payer: Priority Health Medicare |
$532.49
|
| Rate for Payer: Priority Health Narrow Network |
$767.29
|
| Rate for Payer: UHC Medicare Advantage |
$548.46
|
|
|
PR UTERINE SUSPENSION W/WO SHORTENING LIGAMENTS SPX
|
Professional
|
Both
|
$847.00
|
|
|
Service Code
|
HCPCS 58400
|
| Min. Negotiated Rate |
$298.84 |
| Max. Negotiated Rate |
$680.73 |
| Rate for Payer: Aetna Commercial |
$613.05
|
| Rate for Payer: Aetna Medicare |
$457.50
|
| Rate for Payer: BCBS Complete |
$313.78
|
| Rate for Payer: BCBS MAPPO |
$457.50
|
| Rate for Payer: BCBS Trust/PPO |
$568.45
|
| Rate for Payer: BCN Commercial |
$680.73
|
| Rate for Payer: BCN Medicare Advantage |
$457.50
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cofinity Commercial |
$658.80
|
| Rate for Payer: Cofinity Commercial |
$613.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$457.50
|
| Rate for Payer: Healthscope Commercial |
$549.00
|
| Rate for Payer: Healthscope Whirlpool |
$549.00
|
| Rate for Payer: Meridian Medicaid |
$313.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$480.38
|
| Rate for Payer: PACE SWMI |
$457.50
|
| Rate for Payer: PHP Medicare Advantage |
$457.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$659.48
|
| Rate for Payer: Priority Health Medicare |
$457.50
|
| Rate for Payer: Priority Health Narrow Network |
$659.48
|
| Rate for Payer: UHC Medicare Advantage |
$471.22
|
|
|
PR U-TUBE HEPATICOENTEROSTOMY
|
Professional
|
Both
|
$2,680.00
|
|
|
Service Code
|
HCPCS 47802
|
| Min. Negotiated Rate |
$974.26 |
| Max. Negotiated Rate |
$3,097.42 |
| Rate for Payer: Aetna Commercial |
$2,032.20
|
| Rate for Payer: Aetna Medicare |
$1,516.57
|
| Rate for Payer: BCBS Complete |
$1,022.97
|
| Rate for Payer: BCBS MAPPO |
$1,516.57
|
| Rate for Payer: BCBS Trust/PPO |
$3,097.42
|
| Rate for Payer: BCN Commercial |
$2,226.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,516.57
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Cofinity Commercial |
$2,183.86
|
| Rate for Payer: Cofinity Commercial |
$2,032.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,516.57
|
| Rate for Payer: Healthscope Commercial |
$1,819.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,819.88
|
| Rate for Payer: Meridian Medicaid |
$1,022.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,592.40
|
| Rate for Payer: PACE SWMI |
$1,516.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,516.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$974.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,876.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,678.80
|
| Rate for Payer: Priority Health Medicare |
$1,516.57
|
| Rate for Payer: Priority Health Narrow Network |
$2,678.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,562.07
|
|
|
PR UVULECTOMY EXCISION UVULA
|
Professional
|
Both
|
$562.00
|
|
|
Service Code
|
HCPCS 42140
|
| Min. Negotiated Rate |
$105.44 |
| Max. Negotiated Rate |
$596.98 |
| Rate for Payer: Aetna Commercial |
$210.62
|
| Rate for Payer: Aetna Medicare |
$157.18
|
| Rate for Payer: BCBS Complete |
$110.71
|
| Rate for Payer: BCBS MAPPO |
$157.18
|
| Rate for Payer: BCBS Trust/PPO |
$596.98
|
| Rate for Payer: BCN Commercial |
$461.32
|
| Rate for Payer: BCN Medicare Advantage |
$157.18
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cofinity Commercial |
$226.34
|
| Rate for Payer: Cofinity Commercial |
$210.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.18
|
| Rate for Payer: Healthscope Commercial |
$188.62
|
| Rate for Payer: Healthscope Whirlpool |
$188.62
|
| Rate for Payer: Meridian Medicaid |
$110.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$165.04
|
| Rate for Payer: PACE SWMI |
$157.18
|
| Rate for Payer: PHP Medicare Advantage |
$157.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$286.93
|
| Rate for Payer: Priority Health Medicare |
$157.18
|
| Rate for Payer: Priority Health Narrow Network |
$286.93
|
| Rate for Payer: UHC Medicare Advantage |
$161.90
|
|
|
PR VAG HYST > 250 GM RMVL TUBE&/OVARY
|
Professional
|
Both
|
$3,063.00
|
|
|
Service Code
|
HCPCS 58291
|
| Min. Negotiated Rate |
$190.19 |
| Max. Negotiated Rate |
$2,144.10 |
| Rate for Payer: Aetna Commercial |
$1,659.92
|
| Rate for Payer: Aetna Medicare |
$1,238.75
|
| Rate for Payer: BCBS Complete |
$836.67
|
| Rate for Payer: BCBS MAPPO |
$1,238.75
|
| Rate for Payer: BCBS Trust/PPO |
$190.19
|
| Rate for Payer: BCN Commercial |
$1,823.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,238.75
|
| Rate for Payer: Cash Price |
$2,450.40
|
| Rate for Payer: Cash Price |
$2,450.40
|
| Rate for Payer: Cofinity Commercial |
$1,659.92
|
| Rate for Payer: Cofinity Commercial |
$1,783.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,238.75
|
| Rate for Payer: Healthscope Commercial |
$1,486.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,486.50
|
| Rate for Payer: Meridian Medicaid |
$836.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,300.69
|
| Rate for Payer: PACE SWMI |
$1,238.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,238.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$796.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,144.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,766.34
|
| Rate for Payer: Priority Health Medicare |
$1,238.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,766.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,275.91
|
|
|
PR VAG HYST > 250 GM RMVL TUBE&/OVARY W/RPR ENTRCLE
|
Professional
|
Both
|
$3,389.00
|
|
|
Service Code
|
HCPCS 58292
|
| Min. Negotiated Rate |
$213.96 |
| Max. Negotiated Rate |
$2,372.30 |
| Rate for Payer: Aetna Commercial |
$1,749.93
|
| Rate for Payer: Aetna Medicare |
$1,305.92
|
| Rate for Payer: BCBS Complete |
$881.63
|
| Rate for Payer: BCBS MAPPO |
$1,305.92
|
| Rate for Payer: BCBS Trust/PPO |
$213.96
|
| Rate for Payer: BCN Commercial |
$1,921.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,305.92
|
| Rate for Payer: Cash Price |
$2,711.20
|
| Rate for Payer: Cash Price |
$2,711.20
|
| Rate for Payer: Cofinity Commercial |
$1,749.93
|
| Rate for Payer: Cofinity Commercial |
$1,880.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,305.92
|
| Rate for Payer: Healthscope Commercial |
$1,567.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,567.10
|
| Rate for Payer: Meridian Medicaid |
$881.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,371.22
|
| Rate for Payer: PACE SWMI |
$1,305.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,305.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$839.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,372.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,861.50
|
| Rate for Payer: Priority Health Medicare |
$1,305.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,861.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,345.10
|
|
|
PR VAG HYST 250 GM/< W/RMVL TUBE&/OVARY
|
Professional
|
Both
|
$2,915.00
|
|
|
Service Code
|
HCPCS 58262
|
| Min. Negotiated Rate |
$266.26 |
| Max. Negotiated Rate |
$2,040.50 |
| Rate for Payer: Aetna Commercial |
$1,234.10
|
| Rate for Payer: Aetna Medicare |
$920.97
|
| Rate for Payer: BCBS Complete |
$625.33
|
| Rate for Payer: BCBS MAPPO |
$920.97
|
| Rate for Payer: BCBS Trust/PPO |
$266.26
|
| Rate for Payer: BCN Commercial |
$1,359.01
|
| Rate for Payer: BCN Medicare Advantage |
$920.97
|
| Rate for Payer: Cash Price |
$2,332.00
|
| Rate for Payer: Cash Price |
$2,332.00
|
| Rate for Payer: Cofinity Commercial |
$1,326.20
|
| Rate for Payer: Cofinity Commercial |
$1,234.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$920.97
|
| Rate for Payer: Healthscope Commercial |
$1,105.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,105.16
|
| Rate for Payer: Meridian Medicaid |
$625.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$967.02
|
| Rate for Payer: PACE SWMI |
$920.97
|
| Rate for Payer: PHP Medicare Advantage |
$920.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$595.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,040.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,316.59
|
| Rate for Payer: Priority Health Medicare |
$920.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,316.59
|
| Rate for Payer: UHC Medicare Advantage |
$948.60
|
|
|
PR VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RPR NTRCL
|
Professional
|
Both
|
$3,181.00
|
|
|
Service Code
|
HCPCS 58263
|
| Min. Negotiated Rate |
$192.83 |
| Max. Negotiated Rate |
$2,226.70 |
| Rate for Payer: Aetna Commercial |
$1,324.60
|
| Rate for Payer: Aetna Medicare |
$988.51
|
| Rate for Payer: BCBS Complete |
$670.06
|
| Rate for Payer: BCBS MAPPO |
$988.51
|
| Rate for Payer: BCBS Trust/PPO |
$192.83
|
| Rate for Payer: BCN Commercial |
$1,457.73
|
| Rate for Payer: BCN Medicare Advantage |
$988.51
|
| Rate for Payer: Cash Price |
$2,544.80
|
| Rate for Payer: Cash Price |
$2,544.80
|
| Rate for Payer: Cofinity Commercial |
$1,423.45
|
| Rate for Payer: Cofinity Commercial |
$1,324.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$988.51
|
| Rate for Payer: Healthscope Commercial |
$1,186.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,186.21
|
| Rate for Payer: Meridian Medicaid |
$670.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,037.94
|
| Rate for Payer: PACE SWMI |
$988.51
|
| Rate for Payer: PHP Medicare Advantage |
$988.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$638.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,226.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,412.23
|
| Rate for Payer: Priority Health Medicare |
$988.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,412.23
|
| Rate for Payer: UHC Medicare Advantage |
$1,018.17
|
|
|
PR VAG HYSTER W/TOT/PRTL VAGINECT W/RPR ENTEROCELE
|
Professional
|
Both
|
$3,659.00
|
|
|
Service Code
|
HCPCS 58280
|
| Min. Negotiated Rate |
$237.74 |
| Max. Negotiated Rate |
$2,561.30 |
| Rate for Payer: Aetna Commercial |
$1,413.10
|
| Rate for Payer: Aetna Medicare |
$1,054.55
|
| Rate for Payer: BCBS Complete |
$714.34
|
| Rate for Payer: BCBS MAPPO |
$1,054.55
|
| Rate for Payer: BCBS Trust/PPO |
$237.74
|
| Rate for Payer: BCN Commercial |
$1,554.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,054.55
|
| Rate for Payer: Cash Price |
$2,927.20
|
| Rate for Payer: Cash Price |
$2,927.20
|
| Rate for Payer: Cofinity Commercial |
$1,518.55
|
| Rate for Payer: Cofinity Commercial |
$1,413.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,054.55
|
| Rate for Payer: Healthscope Commercial |
$1,265.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,265.46
|
| Rate for Payer: Meridian Medicaid |
$714.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,107.28
|
| Rate for Payer: PACE SWMI |
$1,054.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,054.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$680.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,561.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,506.43
|
| Rate for Payer: Priority Health Medicare |
$1,054.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,506.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,086.19
|
|
|
PR VAGINAL DELIVERY AFTER CESAREAN DELIVERY
|
Professional
|
Both
|
$2,103.00
|
|
|
Service Code
|
HCPCS 59612
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,636.60 |
| Rate for Payer: Aetna Commercial |
$1,222.95
|
| Rate for Payer: Aetna Medicare |
$912.65
|
| Rate for Payer: BCBS Complete |
$885.38
|
| Rate for Payer: BCBS MAPPO |
$912.65
|
| Rate for Payer: BCBS Trust/PPO |
$187.55
|
| Rate for Payer: BCN Commercial |
$1,636.60
|
| Rate for Payer: BCN Medicare Advantage |
$912.65
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cofinity Commercial |
$1,222.95
|
| Rate for Payer: Cofinity Commercial |
$1,314.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$912.65
|
| Rate for Payer: Healthscope Commercial |
$1,095.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,095.18
|
| Rate for Payer: Meridian Medicaid |
$885.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$958.28
|
| Rate for Payer: PACE SWMI |
$912.65
|
| Rate for Payer: PHP Medicare Advantage |
$912.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$843.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,472.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,280.53
|
| Rate for Payer: Priority Health Medicare |
$912.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,280.53
|
| Rate for Payer: UHC Medicare Advantage |
$940.03
|
|
|
PR VAGINAL DELIVERY ONLY
|
Professional
|
Both
|
$1,931.00
|
|
|
Service Code
|
HCPCS 59409
|
| Min. Negotiated Rate |
$45.96 |
| Max. Negotiated Rate |
$1,558.66 |
| Rate for Payer: Aetna Commercial |
$1,077.94
|
| Rate for Payer: Aetna Medicare |
$804.43
|
| Rate for Payer: BCBS Complete |
$777.93
|
| Rate for Payer: BCBS MAPPO |
$804.43
|
| Rate for Payer: BCBS Trust/PPO |
$45.96
|
| Rate for Payer: BCN Commercial |
$1,558.66
|
| Rate for Payer: BCN Medicare Advantage |
$804.43
|
| Rate for Payer: Cash Price |
$1,544.80
|
| Rate for Payer: Cash Price |
$1,544.80
|
| Rate for Payer: Cofinity Commercial |
$1,077.94
|
| Rate for Payer: Cofinity Commercial |
$1,158.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$804.43
|
| Rate for Payer: Healthscope Commercial |
$965.32
|
| Rate for Payer: Healthscope Whirlpool |
$965.32
|
| Rate for Payer: Meridian Medicaid |
$777.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$844.65
|
| Rate for Payer: PACE SWMI |
$804.43
|
| Rate for Payer: PHP Medicare Advantage |
$804.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$740.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,351.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,131.33
|
| Rate for Payer: Priority Health Medicare |
$804.43
|
| Rate for Payer: Priority Health Narrow Network |
$1,131.33
|
| Rate for Payer: UHC Medicare Advantage |
$828.56
|
|
|
PR VAGINAL DELIVERY ONLY W/POSTPARTUM CARE
|
Professional
|
Both
|
$2,198.00
|
|
|
Service Code
|
HCPCS 59410
|
| Min. Negotiated Rate |
$52.30 |
| Max. Negotiated Rate |
$1,809.19 |
| Rate for Payer: Aetna Commercial |
$1,424.14
|
| Rate for Payer: Aetna Medicare |
$1,062.79
|
| Rate for Payer: BCBS Complete |
$1,050.64
|
| Rate for Payer: BCBS MAPPO |
$1,062.79
|
| Rate for Payer: BCBS Trust/PPO |
$52.30
|
| Rate for Payer: BCN Commercial |
$1,809.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,062.79
|
| Rate for Payer: Cash Price |
$1,758.40
|
| Rate for Payer: Cash Price |
$1,758.40
|
| Rate for Payer: Cofinity Commercial |
$1,530.42
|
| Rate for Payer: Cofinity Commercial |
$1,424.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,062.79
|
| Rate for Payer: Healthscope Commercial |
$1,275.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,275.35
|
| Rate for Payer: Meridian Medicaid |
$1,050.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,115.93
|
| Rate for Payer: PACE SWMI |
$1,062.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,062.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,000.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,538.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,498.68
|
| Rate for Payer: Priority Health Medicare |
$1,062.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,498.68
|
| Rate for Payer: UHC Medicare Advantage |
$1,094.67
|
|
|
PR VAGINAL DELIVERY & POSTPARTUM CARE VBAC
|
Professional
|
Both
|
$2,370.00
|
|
|
Service Code
|
HCPCS 59614
|
| Min. Negotiated Rate |
$325.96 |
| Max. Negotiated Rate |
$1,899.65 |
| Rate for Payer: Aetna Commercial |
$1,544.93
|
| Rate for Payer: Aetna Medicare |
$1,152.93
|
| Rate for Payer: BCBS Complete |
$1,142.37
|
| Rate for Payer: BCBS MAPPO |
$1,152.93
|
| Rate for Payer: BCBS Trust/PPO |
$325.96
|
| Rate for Payer: BCN Commercial |
$1,899.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,152.93
|
| Rate for Payer: Cash Price |
$1,896.00
|
| Rate for Payer: Cash Price |
$1,896.00
|
| Rate for Payer: Cofinity Commercial |
$1,660.22
|
| Rate for Payer: Cofinity Commercial |
$1,544.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,152.93
|
| Rate for Payer: Healthscope Commercial |
$1,383.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,383.52
|
| Rate for Payer: Meridian Medicaid |
$1,142.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,210.58
|
| Rate for Payer: PACE SWMI |
$1,152.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,152.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,087.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,659.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,619.55
|
| Rate for Payer: Priority Health Medicare |
$1,152.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,619.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,187.52
|
|
|
PR VAGINAL HYSTERECTOMY >250 GM RPR ENTEROCELE
|
Professional
|
Both
|
$2,194.00
|
|
|
Service Code
|
HCPCS 58294
|
| Min. Negotiated Rate |
$327.55 |
| Max. Negotiated Rate |
$1,784.65 |
| Rate for Payer: Aetna Commercial |
$1,624.58
|
| Rate for Payer: Aetna Medicare |
$1,212.37
|
| Rate for Payer: BCBS Complete |
$818.78
|
| Rate for Payer: BCBS MAPPO |
$1,212.37
|
| Rate for Payer: BCBS Trust/PPO |
$327.55
|
| Rate for Payer: BCN Commercial |
$1,784.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,212.37
|
| Rate for Payer: Cash Price |
$1,755.20
|
| Rate for Payer: Cash Price |
$1,755.20
|
| Rate for Payer: Cofinity Commercial |
$1,745.81
|
| Rate for Payer: Cofinity Commercial |
$1,624.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,212.37
|
| Rate for Payer: Healthscope Commercial |
$1,454.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,454.84
|
| Rate for Payer: Meridian Medicaid |
$818.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,272.99
|
| Rate for Payer: PACE SWMI |
$1,212.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,212.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$779.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,535.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,728.94
|
| Rate for Payer: Priority Health Medicare |
$1,212.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,728.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,248.74
|
|
|
PR VAGINAL HYSTERECTOMY 250 GM/< W/RPR ENTEROCELE
|
Professional
|
Both
|
$2,703.00
|
|
|
Service Code
|
HCPCS 58270
|
| Min. Negotiated Rate |
$233.51 |
| Max. Negotiated Rate |
$1,892.10 |
| Rate for Payer: Aetna Commercial |
$1,192.52
|
| Rate for Payer: Aetna Medicare |
$889.94
|
| Rate for Payer: BCBS Complete |
$602.74
|
| Rate for Payer: BCBS MAPPO |
$889.94
|
| Rate for Payer: BCBS Trust/PPO |
$233.51
|
| Rate for Payer: BCN Commercial |
$1,313.56
|
| Rate for Payer: BCN Medicare Advantage |
$889.94
|
| Rate for Payer: Cash Price |
$2,162.40
|
| Rate for Payer: Cash Price |
$2,162.40
|
| Rate for Payer: Cofinity Commercial |
$1,281.51
|
| Rate for Payer: Cofinity Commercial |
$1,192.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$889.94
|
| Rate for Payer: Healthscope Commercial |
$1,067.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,067.93
|
| Rate for Payer: Meridian Medicaid |
$602.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$934.44
|
| Rate for Payer: PACE SWMI |
$889.94
|
| Rate for Payer: PHP Medicare Advantage |
$889.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,892.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,272.57
|
| Rate for Payer: Priority Health Medicare |
$889.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,272.57
|
| Rate for Payer: UHC Medicare Advantage |
$916.64
|
|
|
PR VAGINAL HYSTERECTOMY UTERUS > 250 GM
|
Professional
|
Both
|
$2,860.00
|
|
|
Service Code
|
HCPCS 58290
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,002.00 |
| Rate for Payer: Aetna Commercial |
$1,535.44
|
| Rate for Payer: Aetna Medicare |
$1,145.85
|
| Rate for Payer: BCBS Complete |
$774.72
|
| Rate for Payer: BCBS MAPPO |
$1,145.85
|
| Rate for Payer: BCBS Trust/PPO |
$137.36
|
| Rate for Payer: BCN Commercial |
$1,687.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,145.85
|
| Rate for Payer: Cash Price |
$2,288.00
|
| Rate for Payer: Cash Price |
$2,288.00
|
| Rate for Payer: Cofinity Commercial |
$1,650.02
|
| Rate for Payer: Cofinity Commercial |
$1,535.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,145.85
|
| Rate for Payer: Healthscope Commercial |
$1,375.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,375.02
|
| Rate for Payer: Meridian Medicaid |
$774.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,203.14
|
| Rate for Payer: PACE SWMI |
$1,145.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,145.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$737.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,002.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,634.74
|
| Rate for Payer: Priority Health Medicare |
$1,145.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,634.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,180.23
|
|
|
PR VAGINAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$2,631.00
|
|
|
Service Code
|
HCPCS 58260
|
| Min. Negotiated Rate |
$240.90 |
| Max. Negotiated Rate |
$1,841.70 |
| Rate for Payer: Aetna Commercial |
$1,117.02
|
| Rate for Payer: Aetna Medicare |
$833.60
|
| Rate for Payer: BCBS Complete |
$566.06
|
| Rate for Payer: BCBS MAPPO |
$833.60
|
| Rate for Payer: BCBS Trust/PPO |
$240.90
|
| Rate for Payer: BCN Commercial |
$1,231.47
|
| Rate for Payer: BCN Medicare Advantage |
$833.60
|
| Rate for Payer: Cash Price |
$2,104.80
|
| Rate for Payer: Cash Price |
$2,104.80
|
| Rate for Payer: Cofinity Commercial |
$1,200.38
|
| Rate for Payer: Cofinity Commercial |
$1,117.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$833.60
|
| Rate for Payer: Healthscope Commercial |
$1,000.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,000.32
|
| Rate for Payer: Meridian Medicaid |
$566.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$875.28
|
| Rate for Payer: PACE SWMI |
$833.60
|
| Rate for Payer: PHP Medicare Advantage |
$833.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$539.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,193.03
|
| Rate for Payer: Priority Health Medicare |
$833.60
|
| Rate for Payer: Priority Health Narrow Network |
$1,193.03
|
| Rate for Payer: UHC Medicare Advantage |
$858.61
|
|
|
PR VAGINAL HYSTERECTOMY W/TOT/PRTL VAGINECTOMY
|
Professional
|
Both
|
$2,369.00
|
|
|
Service Code
|
HCPCS 58275
|
| Min. Negotiated Rate |
$263.09 |
| Max. Negotiated Rate |
$1,658.30 |
| Rate for Payer: Aetna Commercial |
$1,315.93
|
| Rate for Payer: Aetna Medicare |
$982.04
|
| Rate for Payer: BCBS Complete |
$667.82
|
| Rate for Payer: BCBS MAPPO |
$982.04
|
| Rate for Payer: BCBS Trust/PPO |
$263.09
|
| Rate for Payer: BCN Commercial |
$1,449.42
|
| Rate for Payer: BCN Medicare Advantage |
$982.04
|
| Rate for Payer: Cash Price |
$1,895.20
|
| Rate for Payer: Cash Price |
$1,895.20
|
| Rate for Payer: Cofinity Commercial |
$1,414.14
|
| Rate for Payer: Cofinity Commercial |
$1,315.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$982.04
|
| Rate for Payer: Healthscope Commercial |
$1,178.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,178.45
|
| Rate for Payer: Meridian Medicaid |
$667.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,031.14
|
| Rate for Payer: PACE SWMI |
$982.04
|
| Rate for Payer: PHP Medicare Advantage |
$982.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$636.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,404.17
|
| Rate for Payer: Priority Health Medicare |
$982.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,404.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,011.50
|
|
