|
PR LIG DIV&STRPG LONG SAPH SAPHFEM JUNCT KNE/BELW
|
Professional
|
Both
|
$948.00
|
|
|
Service Code
|
HCPCS 37722
|
| Min. Negotiated Rate |
$289.25 |
| Max. Negotiated Rate |
$724.88 |
| Rate for Payer: Aetna Commercial |
$630.45
|
| Rate for Payer: Aetna Medicare |
$474.00
|
| Rate for Payer: BCBS Complete |
$303.71
|
| Rate for Payer: BCBS Trust/PPO |
$407.85
|
| Rate for Payer: BCN Commercial |
$669.00
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Meridian Medicaid |
$303.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$289.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$724.88
|
| Rate for Payer: Priority Health Narrow Network |
$724.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$626.50
|
| Rate for Payer: UHC Exchange |
$626.50
|
| Rate for Payer: UHCCP Medicaid |
$289.25
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 37785
|
| Min. Negotiated Rate |
$159.75 |
| Max. Negotiated Rate |
$629.85 |
| Rate for Payer: Aetna Commercial |
$342.53
|
| Rate for Payer: Aetna Medicare |
$484.50
|
| Rate for Payer: BCBS Complete |
$167.74
|
| Rate for Payer: BCBS Trust/PPO |
$583.24
|
| Rate for Payer: BCN Commercial |
$510.66
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Meridian Medicaid |
$167.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$403.12
|
| Rate for Payer: Priority Health Narrow Network |
$403.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$333.64
|
| Rate for Payer: UHC Exchange |
$333.64
|
| Rate for Payer: UHCCP Medicaid |
$159.75
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
CPT 37785
|
| Hospital Charge Code |
37785
|
| Min. Negotiated Rate |
$629.85 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: ASR ASR |
$939.93
|
| Rate for Payer: ASR Commercial |
$939.93
|
| Rate for Payer: BCBS Trust/PPO |
$789.64
|
| Rate for Payer: BCN Commercial |
$751.27
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$910.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$969.00
|
| Rate for Payer: Healthscope Whirlpool |
$939.93
|
| Rate for Payer: Mclaren Commercial |
$872.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: Nomi Health Commercial |
$794.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$852.72
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
CPT 37785
|
| Hospital Charge Code |
37785
|
| Min. Negotiated Rate |
$629.85 |
| Max. Negotiated Rate |
$4,779.98 |
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: Aetna Medicare |
$3,083.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: ASR ASR |
$939.93
|
| Rate for Payer: ASR Commercial |
$939.93
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$793.51
|
| Rate for Payer: BCN Commercial |
$751.27
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$910.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$969.00
|
| Rate for Payer: Healthscope Whirlpool |
$939.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$872.10
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: Nomi Health Commercial |
$794.58
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Commercial |
$3,392.25
|
| Rate for Payer: PHP Medicaid |
$1,652.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$849.04
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$679.27
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$852.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$4,779.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP DNSP |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 37785
|
| Hospital Charge Code |
37785
|
| Min. Negotiated Rate |
$159.75 |
| Max. Negotiated Rate |
$629.85 |
| Rate for Payer: Aetna Commercial |
$342.53
|
| Rate for Payer: Aetna Medicare |
$484.50
|
| Rate for Payer: BCBS Complete |
$167.74
|
| Rate for Payer: BCBS Trust/PPO |
$583.24
|
| Rate for Payer: BCN Commercial |
$510.66
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Meridian Medicaid |
$167.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$403.12
|
| Rate for Payer: Priority Health Narrow Network |
$403.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$333.64
|
| Rate for Payer: UHC Exchange |
$333.64
|
| Rate for Payer: UHCCP Medicaid |
$159.75
|
|
|
PR LIGJ & DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
HCPCS 37780
|
| Min. Negotiated Rate |
$149.95 |
| Max. Negotiated Rate |
$438.49 |
| Rate for Payer: Aetna Commercial |
$313.05
|
| Rate for Payer: Aetna Medicare |
$241.50
|
| Rate for Payer: BCBS Complete |
$157.45
|
| Rate for Payer: BCBS Trust/PPO |
$438.49
|
| Rate for Payer: BCN Commercial |
$339.14
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Meridian Medicaid |
$157.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$149.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$372.82
|
| Rate for Payer: Priority Health Narrow Network |
$372.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$333.19
|
| Rate for Payer: UHC Exchange |
$333.19
|
| Rate for Payer: UHCCP Medicaid |
$149.95
|
|
|
PR LIGMOUS RCNSTJ AGMNTJ KNE INTRA-ARTICULAR XTR
|
Professional
|
Both
|
$2,234.00
|
|
|
Service Code
|
HCPCS 27429
|
| Min. Negotiated Rate |
$819.84 |
| Max. Negotiated Rate |
$2,210.41 |
| Rate for Payer: Aetna Commercial |
$1,675.57
|
| Rate for Payer: Aetna Medicare |
$1,117.00
|
| Rate for Payer: BCBS Complete |
$860.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,210.41
|
| Rate for Payer: BCN Commercial |
$1,846.72
|
| Rate for Payer: Cash Price |
$1,787.20
|
| Rate for Payer: Cash Price |
$1,787.20
|
| Rate for Payer: Meridian Medicaid |
$860.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$819.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,452.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,940.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,940.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,429.52
|
| Rate for Payer: UHC Exchange |
$1,429.52
|
| Rate for Payer: UHCCP Medicaid |
$819.84
|
|
|
PR LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG
|
Professional
|
Both
|
$1,126.00
|
|
|
Service Code
|
HCPCS 37761
|
| Min. Negotiated Rate |
$336.11 |
| Max. Negotiated Rate |
$898.64 |
| Rate for Payer: Aetna Commercial |
$717.95
|
| Rate for Payer: Aetna Medicare |
$563.00
|
| Rate for Payer: BCBS Complete |
$352.92
|
| Rate for Payer: BCBS Trust/PPO |
$898.64
|
| Rate for Payer: BCN Commercial |
$778.46
|
| Rate for Payer: Cash Price |
$900.80
|
| Rate for Payer: Cash Price |
$900.80
|
| Rate for Payer: Meridian Medicaid |
$352.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.60
|
| Rate for Payer: Priority Health Narrow Network |
$845.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$730.80
|
| Rate for Payer: UHC Exchange |
$730.80
|
| Rate for Payer: UHCCP Medicaid |
$336.11
|
|
|
PR LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 58611
|
| Min. Negotiated Rate |
$47.93 |
| Max. Negotiated Rate |
$219.05 |
| Rate for Payer: Aetna Commercial |
$91.50
|
| Rate for Payer: Aetna Medicare |
$168.50
|
| Rate for Payer: BCBS Complete |
$50.33
|
| Rate for Payer: BCBS Trust/PPO |
$194.94
|
| Rate for Payer: BCN Commercial |
$110.45
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Meridian Medicaid |
$50.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.62
|
| Rate for Payer: Priority Health Narrow Network |
$111.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.73
|
| Rate for Payer: UHC Exchange |
$89.73
|
| Rate for Payer: UHCCP Medicaid |
$47.93
|
|
|
PR LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 58600
|
| Min. Negotiated Rate |
$78.19 |
| Max. Negotiated Rate |
$835.25 |
| Rate for Payer: Aetna Commercial |
$442.01
|
| Rate for Payer: Aetna Medicare |
$642.50
|
| Rate for Payer: BCBS Complete |
$250.49
|
| Rate for Payer: BCBS Trust/PPO |
$78.19
|
| Rate for Payer: BCN Commercial |
$545.36
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Meridian Medicaid |
$250.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$238.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$835.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$557.06
|
| Rate for Payer: Priority Health Narrow Network |
$557.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$414.31
|
| Rate for Payer: UHC Exchange |
$414.31
|
| Rate for Payer: UHCCP Medicaid |
$238.56
|
|
|
PR LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 58605
|
| Min. Negotiated Rate |
$216.62 |
| Max. Negotiated Rate |
$562.25 |
| Rate for Payer: Aetna Commercial |
$400.03
|
| Rate for Payer: Aetna Medicare |
$432.50
|
| Rate for Payer: BCBS Complete |
$227.45
|
| Rate for Payer: BCBS Trust/PPO |
$264.15
|
| Rate for Payer: BCN Commercial |
$496.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Meridian Medicaid |
$227.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$216.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$506.47
|
| Rate for Payer: Priority Health Narrow Network |
$506.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$374.49
|
| Rate for Payer: UHC Exchange |
$374.49
|
| Rate for Payer: UHCCP Medicaid |
$216.62
|
|
|
PR LILETTA, 52 MG
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
HCPCS J7297
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$1,037.01 |
| Rate for Payer: Aetna Commercial |
$845.10
|
| Rate for Payer: Aetna Medicare |
$440.00
|
| Rate for Payer: BCBS Complete |
$1,037.01
|
| Rate for Payer: BCBS Trust/PPO |
$856.93
|
| Rate for Payer: BCN Commercial |
$856.93
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Meridian Medicaid |
$1,037.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$987.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$572.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$913.98
|
| Rate for Payer: UHC Exchange |
$913.98
|
| Rate for Payer: UHCCP Medicaid |
$987.63
|
|
|
PR LIMITED VISUAL FIELD XM UNI/BI I&R
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 92081
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$1,007.47 |
| Rate for Payer: Aetna Commercial |
$35.34
|
| Rate for Payer: Aetna Medicare |
$39.00
|
| Rate for Payer: BCBS Complete |
$10.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,007.47
|
| Rate for Payer: BCN Commercial |
$48.38
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Meridian Medicaid |
$10.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.52
|
| Rate for Payer: Priority Health Narrow Network |
$19.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
| Rate for Payer: UHC Exchange |
$54.93
|
| Rate for Payer: UHCCP Medicaid |
$10.01
|
|
|
PR LINCOMYCIN INJECTION
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J2010
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$10.14
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$7.48
|
| Rate for Payer: BCN Commercial |
$7.86
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.95
|
| Rate for Payer: UHC Exchange |
$9.95
|
|
|
PR LITHOLAPAXY COMP/LG > 2.5 CM
|
Professional
|
Both
|
$936.00
|
|
|
Service Code
|
HCPCS 52318
|
| Min. Negotiated Rate |
$298.63 |
| Max. Negotiated Rate |
$1,353.50 |
| Rate for Payer: Aetna Commercial |
$607.33
|
| Rate for Payer: Aetna Medicare |
$468.00
|
| Rate for Payer: BCBS Complete |
$313.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,353.50
|
| Rate for Payer: BCN Commercial |
$674.37
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Meridian Medicaid |
$313.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$742.45
|
| Rate for Payer: Priority Health Narrow Network |
$742.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$579.03
|
| Rate for Payer: UHC Exchange |
$579.03
|
| Rate for Payer: UHCCP Medicaid |
$298.63
|
|
|
PR LITHOLAPAXY SMPL/SM <2.5 CM
|
Professional
|
Both
|
$1,658.00
|
|
|
Service Code
|
HCPCS 52317
|
| Min. Negotiated Rate |
$218.96 |
| Max. Negotiated Rate |
$1,298.41 |
| Rate for Payer: Aetna Commercial |
$444.33
|
| Rate for Payer: Aetna Medicare |
$829.00
|
| Rate for Payer: BCBS Complete |
$229.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,148.52
|
| Rate for Payer: BCN Commercial |
$1,298.41
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Meridian Medicaid |
$229.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$218.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$543.25
|
| Rate for Payer: Priority Health Narrow Network |
$543.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$424.87
|
| Rate for Payer: UHC Exchange |
$424.87
|
| Rate for Payer: UHCCP Medicaid |
$218.96
|
|
|
PR LITHOTRIPSY XTRCORP SHOCK WAVE
|
Professional
|
Both
|
$1,547.00
|
|
|
Service Code
|
HCPCS 50590
|
| Min. Negotiated Rate |
$367.43 |
| Max. Negotiated Rate |
$1,184.30 |
| Rate for Payer: Aetna Commercial |
$730.18
|
| Rate for Payer: Aetna Medicare |
$773.50
|
| Rate for Payer: BCBS Complete |
$385.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,004.83
|
| Rate for Payer: BCN Commercial |
$1,184.30
|
| Rate for Payer: Cash Price |
$1,237.60
|
| Rate for Payer: Cash Price |
$1,237.60
|
| Rate for Payer: Meridian Medicaid |
$385.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$913.41
|
| Rate for Payer: Priority Health Narrow Network |
$913.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$678.95
|
| Rate for Payer: UHC Exchange |
$678.95
|
| Rate for Payer: UHCCP Medicaid |
$367.43
|
|
|
PR LMTD LMPHADEC STAGING SPX PEL&PARA-AORTIC
|
Professional
|
Both
|
$3,942.00
|
|
|
Service Code
|
HCPCS 38562
|
| Min. Negotiated Rate |
$456.89 |
| Max. Negotiated Rate |
$2,562.30 |
| Rate for Payer: Aetna Commercial |
$873.15
|
| Rate for Payer: Aetna Medicare |
$1,971.00
|
| Rate for Payer: BCBS Complete |
$479.73
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$1,029.16
|
| Rate for Payer: Cash Price |
$3,153.60
|
| Rate for Payer: Cash Price |
$3,153.60
|
| Rate for Payer: Meridian Medicaid |
$479.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$456.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,562.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,416.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,416.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$785.99
|
| Rate for Payer: UHC Exchange |
$785.99
|
| Rate for Payer: UHCCP Medicaid |
$456.89
|
|
|
PR LMTD LMPHADEC STAGING SPX RPR AORTIC&/SPLENIC
|
Professional
|
Both
|
$2,831.00
|
|
|
Service Code
|
HCPCS 38564
|
| Min. Negotiated Rate |
$452.84 |
| Max. Negotiated Rate |
$1,840.15 |
| Rate for Payer: Aetna Commercial |
$878.57
|
| Rate for Payer: Aetna Medicare |
$1,415.50
|
| Rate for Payer: BCBS Complete |
$475.48
|
| Rate for Payer: BCBS Trust/PPO |
$543.62
|
| Rate for Payer: BCN Commercial |
$1,024.27
|
| Rate for Payer: Cash Price |
$2,264.80
|
| Rate for Payer: Cash Price |
$2,264.80
|
| Rate for Payer: Meridian Medicaid |
$475.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$452.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,840.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,402.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,402.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$788.81
|
| Rate for Payer: UHC Exchange |
$788.81
|
| Rate for Payer: UHCCP Medicaid |
$452.84
|
|
|
PR LMTD OPH XM&EVAL GENERAL ANES W/WO MNPJ GLOBE
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 92019
|
| Min. Negotiated Rate |
$46.22 |
| Max. Negotiated Rate |
$1,793.58 |
| Rate for Payer: Aetna Commercial |
$77.34
|
| Rate for Payer: Aetna Medicare |
$73.50
|
| Rate for Payer: BCBS Complete |
$48.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,793.58
|
| Rate for Payer: BCN Commercial |
$75.59
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Meridian Medicaid |
$48.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.28
|
| Rate for Payer: Priority Health Narrow Network |
$89.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.67
|
| Rate for Payer: UHC Exchange |
$73.67
|
| Rate for Payer: UHCCP Medicaid |
$46.22
|
|
|
PR LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN
|
Professional
|
Both
|
$1,620.00
|
|
|
Service Code
|
HCPCS 25280
|
| Min. Negotiated Rate |
$372.54 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Aetna Commercial |
$754.53
|
| Rate for Payer: Aetna Medicare |
$810.00
|
| Rate for Payer: BCBS Complete |
$391.17
|
| Rate for Payer: BCBS Trust/PPO |
$760.22
|
| Rate for Payer: BCN Commercial |
$837.11
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Meridian Medicaid |
$391.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,053.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$881.35
|
| Rate for Payer: Priority Health Narrow Network |
$881.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$686.17
|
| Rate for Payer: UHC Exchange |
$686.17
|
| Rate for Payer: UHCCP Medicaid |
$372.54
|
|
|
PR LNGTH/SHRT TDN LEG/ANKLE MLT TDN SAME INC EA
|
Professional
|
Both
|
$1,362.00
|
|
|
Service Code
|
HCPCS 27686
|
| Min. Negotiated Rate |
$345.70 |
| Max. Negotiated Rate |
$2,402.18 |
| Rate for Payer: Aetna Commercial |
$714.76
|
| Rate for Payer: Aetna Medicare |
$681.00
|
| Rate for Payer: BCBS Complete |
$362.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,402.18
|
| Rate for Payer: BCN Commercial |
$773.09
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Meridian Medicaid |
$362.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$345.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$822.33
|
| Rate for Payer: Priority Health Narrow Network |
$822.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$639.58
|
| Rate for Payer: UHC Exchange |
$639.58
|
| Rate for Payer: UHCCP Medicaid |
$345.70
|
|
|
PR LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX
|
Professional
|
Both
|
$1,821.00
|
|
|
Service Code
|
HCPCS 27685
|
| Min. Negotiated Rate |
$303.74 |
| Max. Negotiated Rate |
$3,119.66 |
| Rate for Payer: Aetna Commercial |
$616.27
|
| Rate for Payer: Aetna Medicare |
$910.50
|
| Rate for Payer: BCBS Complete |
$318.93
|
| Rate for Payer: BCBS Trust/PPO |
$3,119.66
|
| Rate for Payer: BCN Commercial |
$962.69
|
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Meridian Medicaid |
$318.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$303.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,183.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$721.05
|
| Rate for Payer: Priority Health Narrow Network |
$721.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$540.10
|
| Rate for Payer: UHC Exchange |
$540.10
|
| Rate for Payer: UHCCP Medicaid |
$303.74
|
|
|
PR LOCM 250-299MG/ML IODINE,1ML
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS Q9948
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
|
|
PR LORAZEPAM INJECTION
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J2060
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.46
|
| Rate for Payer: UHC Exchange |
$1.46
|
|
