|
PR PARTICAL EXCISION BONE PHALANX TOE
|
Professional
|
Both
|
$914.00
|
|
|
Service Code
|
HCPCS 28124
|
| Min. Negotiated Rate |
$218.54 |
| Max. Negotiated Rate |
$805.13 |
| Rate for Payer: Aetna Commercial |
$438.66
|
| Rate for Payer: Aetna Medicare |
$457.00
|
| Rate for Payer: BCBS Complete |
$229.47
|
| Rate for Payer: BCBS Trust/PPO |
$805.13
|
| Rate for Payer: BCN Commercial |
$690.50
|
| Rate for Payer: Cash Price |
$731.20
|
| Rate for Payer: Cash Price |
$731.20
|
| Rate for Payer: Meridian Medicaid |
$229.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$218.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$594.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$515.99
|
| Rate for Payer: Priority Health Narrow Network |
$515.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$387.62
|
| Rate for Payer: UHC Exchange |
$387.62
|
| Rate for Payer: UHCCP Medicaid |
$218.54
|
|
|
PR PATELLECTOMY/HEMIPATELLECTOMY
|
Professional
|
Both
|
$2,101.00
|
|
|
Service Code
|
HCPCS 27350
|
| Min. Negotiated Rate |
$428.77 |
| Max. Negotiated Rate |
$1,365.65 |
| Rate for Payer: Aetna Commercial |
$871.76
|
| Rate for Payer: Aetna Medicare |
$1,050.50
|
| Rate for Payer: BCBS Complete |
$450.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,339.24
|
| Rate for Payer: BCN Commercial |
$966.61
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Meridian Medicaid |
$450.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$428.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,365.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,015.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,015.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$739.28
|
| Rate for Payer: UHC Exchange |
$739.28
|
| Rate for Payer: UHCCP Medicaid |
$428.77
|
|
|
PR PATIENT-INITIATED SPIROMETRIC RECORDING
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 94015
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$1,168.60 |
| Rate for Payer: Aetna Commercial |
$32.07
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,168.60
|
| Rate for Payer: BCN Commercial |
$44.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.43
|
| Rate for Payer: Priority Health Narrow Network |
$43.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.89
|
| Rate for Payer: UHC Exchange |
$23.89
|
|
|
PR PCV13 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 90670
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$309.59 |
| Rate for Payer: Aetna Commercial |
$257.99
|
| Rate for Payer: Aetna Medicare |
$145.00
|
| Rate for Payer: BCBS Complete |
$116.00
|
| Rate for Payer: BCBS Trust/PPO |
$270.00
|
| Rate for Payer: BCN Commercial |
$231.18
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.59
|
| Rate for Payer: UHC Exchange |
$309.59
|
|
|
PR PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
HCPCS 90677
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$313.87 |
| Rate for Payer: Aetna Commercial |
$288.66
|
| Rate for Payer: Aetna Medicare |
$197.50
|
| Rate for Payer: BCBS Complete |
$158.00
|
| Rate for Payer: BCBS Trust/PPO |
$298.65
|
| Rate for Payer: BCN Commercial |
$298.65
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.87
|
| Rate for Payer: UHC Exchange |
$313.87
|
|
|
PR PDT DSTR PRMLG LES SKN ILLUM/ACTIVJ BY PHYS/QHP
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 96573
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$1,125.28 |
| Rate for Payer: Aetna Commercial |
$247.38
|
| Rate for Payer: Aetna Medicare |
$182.50
|
| Rate for Payer: BCBS Complete |
$146.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,125.28
|
| Rate for Payer: BCN Commercial |
$337.19
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$307.58
|
| Rate for Payer: Priority Health Narrow Network |
$307.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.85
|
| Rate for Payer: UHC Exchange |
$200.85
|
|
|
PR PDT DSTR PRMLG LES SKN ILLUM/ACTIVJ PER DAY
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 96567
|
| Min. Negotiated Rate |
$87.20 |
| Max. Negotiated Rate |
$2,195.61 |
| Rate for Payer: Aetna Commercial |
$151.34
|
| Rate for Payer: Aetna Medicare |
$109.00
|
| Rate for Payer: BCBS Complete |
$87.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,195.61
|
| Rate for Payer: BCN Commercial |
$205.73
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.90
|
| Rate for Payer: Priority Health Narrow Network |
$185.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.10
|
| Rate for Payer: UHC Exchange |
$121.10
|
|
|
PR PEL LMPHADEC W/XTRNL ILIAC HYPOGSTR&OBTURATOR
|
Professional
|
Both
|
$1,298.00
|
|
|
Service Code
|
HCPCS 38770
|
| Min. Negotiated Rate |
$391.47 |
| Max. Negotiated Rate |
$1,609.78 |
| Rate for Payer: Aetna Commercial |
$995.43
|
| Rate for Payer: Aetna Medicare |
$649.00
|
| Rate for Payer: BCBS Complete |
$542.36
|
| Rate for Payer: BCBS Trust/PPO |
$391.47
|
| Rate for Payer: BCN Commercial |
$1,166.96
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Meridian Medicaid |
$542.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$516.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,609.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,609.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$935.33
|
| Rate for Payer: UHC Exchange |
$935.33
|
| Rate for Payer: UHCCP Medicaid |
$516.53
|
|
|
PR PELVIC EXAMINATION
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 99459
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$20.49
|
| Rate for Payer: Aetna Medicare |
$24.00
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.52
|
| Rate for Payer: Priority Health Narrow Network |
$30.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.53
|
| Rate for Payer: UHC Exchange |
$26.53
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
57410
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$1,808.90 |
| Rate for Payer: Aetna Commercial |
$125.13
|
| Rate for Payer: Aetna Medicare |
$98.00
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,808.90
|
| Rate for Payer: BCN Commercial |
$153.45
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$158.24
|
| Rate for Payer: Priority Health Narrow Network |
$158.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.79
|
| Rate for Payer: UHC Exchange |
$121.79
|
| Rate for Payer: UHCCP Medicaid |
$67.95
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 57410
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$1,808.90 |
| Rate for Payer: Aetna Commercial |
$125.13
|
| Rate for Payer: Aetna Medicare |
$98.00
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,808.90
|
| Rate for Payer: BCN Commercial |
$153.45
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$158.24
|
| Rate for Payer: Priority Health Narrow Network |
$158.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.79
|
| Rate for Payer: UHC Exchange |
$121.79
|
| Rate for Payer: UHCCP Medicaid |
$67.95
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
57410
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$4,828.62 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Aetna Medicare |
$3,115.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: ASR ASR |
$190.12
|
| Rate for Payer: ASR Commercial |
$190.12
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$160.50
|
| Rate for Payer: BCN Commercial |
$151.96
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$184.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Healthscope Commercial |
$196.00
|
| Rate for Payer: Healthscope Whirlpool |
$190.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,115.24
|
| Rate for Payer: Mclaren Commercial |
$176.40
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.60
|
| Rate for Payer: Nomi Health Commercial |
$160.72
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Commercial |
$3,426.76
|
| Rate for Payer: PHP Medicaid |
$1,669.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.74
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$137.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$4,828.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP DNSP |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
57410
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: ASR ASR |
$190.12
|
| Rate for Payer: ASR Commercial |
$190.12
|
| Rate for Payer: BCBS Trust/PPO |
$159.72
|
| Rate for Payer: BCN Commercial |
$151.96
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$184.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Healthscope Commercial |
$196.00
|
| Rate for Payer: Healthscope Whirlpool |
$190.12
|
| Rate for Payer: Mclaren Commercial |
$176.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.60
|
| Rate for Payer: Nomi Health Commercial |
$160.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.48
|
|
|
PR PELVIC FIXATION OTHER THAN SACRUM
|
Professional
|
Both
|
$1,791.00
|
|
|
Service Code
|
HCPCS 22848
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$1,164.15 |
| Rate for Payer: Aetna Commercial |
$484.23
|
| Rate for Payer: Aetna Medicare |
$895.50
|
| Rate for Payer: BCBS Complete |
$241.32
|
| Rate for Payer: BCBS Trust/PPO |
$65.80
|
| Rate for Payer: BCN Commercial |
$575.20
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Meridian Medicaid |
$241.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,164.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.52
|
| Rate for Payer: Priority Health Narrow Network |
$546.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.68
|
| Rate for Payer: UHC Exchange |
$432.68
|
| Rate for Payer: UHCCP Medicaid |
$229.83
|
|
|
PR PELVIC RING FRACTURE UNI/BIL
|
Professional
|
Both
|
$3,172.00
|
|
|
Service Code
|
HCPCS G0413
|
| Min. Negotiated Rate |
$238.26 |
| Max. Negotiated Rate |
$2,061.80 |
| Rate for Payer: Aetna Commercial |
$1,062.63
|
| Rate for Payer: Aetna Medicare |
$1,586.00
|
| Rate for Payer: BCBS Complete |
$723.95
|
| Rate for Payer: BCBS Trust/PPO |
$238.26
|
| Rate for Payer: BCN Commercial |
$1,557.90
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Meridian Medicaid |
$723.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$689.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,634.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,634.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,229.06
|
| Rate for Payer: UHC Exchange |
$1,229.06
|
| Rate for Payer: UHCCP Medicaid |
$689.48
|
|
|
PR PELVIC RING FX TREAT INT FIX
|
Professional
|
Both
|
$3,134.00
|
|
|
Service Code
|
HCPCS G0414
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$2,037.10 |
| Rate for Payer: Aetna Commercial |
$1,004.21
|
| Rate for Payer: Aetna Medicare |
$1,567.00
|
| Rate for Payer: BCBS Complete |
$683.92
|
| Rate for Payer: BCBS Trust/PPO |
$364.00
|
| Rate for Payer: BCN Commercial |
$1,469.46
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Meridian Medicaid |
$683.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$651.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,037.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,542.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,542.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,163.03
|
| Rate for Payer: UHC Exchange |
$1,163.03
|
| Rate for Payer: UHCCP Medicaid |
$651.35
|
|
|
PR PENG BENZATHINE/PROCAINE INJ
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS J0558
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$19.52 |
| Rate for Payer: Aetna Commercial |
$18.11
|
| Rate for Payer: Aetna Medicare |
$3.00
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$17.90
|
| Rate for Payer: BCN Commercial |
$14.68
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.52
|
| Rate for Payer: UHC Exchange |
$19.52
|
|
|
PR PENICILLIN G BENZATHINE INJ
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J0561
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$23.97 |
| Rate for Payer: Aetna Commercial |
$22.38
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS Trust/PPO |
$21.19
|
| Rate for Payer: BCN Commercial |
$16.84
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.97
|
| Rate for Payer: UHC Exchange |
$23.97
|
|
|
PR PENILE PLETHYSMOGRAPHY
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 54240
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$680.45 |
| Rate for Payer: Aetna Commercial |
$131.41
|
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: BCBS Complete |
$43.17
|
| Rate for Payer: BCBS Trust/PPO |
$680.45
|
| Rate for Payer: BCN Commercial |
$155.89
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Meridian Medicaid |
$43.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.20
|
| Rate for Payer: Priority Health Narrow Network |
$101.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.69
|
| Rate for Payer: UHC Exchange |
$116.69
|
| Rate for Payer: UHCCP Medicaid |
$41.11
|
|
|
PR PENIS CORRJ CHORDEE/1ST STAGE HYPOSPADIAS RPR
|
Professional
|
Both
|
$5,200.00
|
|
|
Service Code
|
HCPCS 54304
|
| Min. Negotiated Rate |
$316.45 |
| Max. Negotiated Rate |
$3,380.00 |
| Rate for Payer: Aetna Commercial |
$960.40
|
| Rate for Payer: Aetna Medicare |
$2,600.00
|
| Rate for Payer: BCBS Complete |
$502.76
|
| Rate for Payer: BCBS Trust/PPO |
$316.45
|
| Rate for Payer: BCN Commercial |
$1,078.02
|
| Rate for Payer: Cash Price |
$4,160.00
|
| Rate for Payer: Cash Price |
$4,160.00
|
| Rate for Payer: Meridian Medicaid |
$502.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$478.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,380.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,189.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,189.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$911.82
|
| Rate for Payer: UHC Exchange |
$911.82
|
| Rate for Payer: UHCCP Medicaid |
$478.82
|
|
|
PR PENIS STRAIGHTENING CHORDEE
|
Professional
|
Both
|
$1,336.00
|
|
|
Service Code
|
HCPCS 54300
|
| Min. Negotiated Rate |
$311.17 |
| Max. Negotiated Rate |
$1,028.98 |
| Rate for Payer: Aetna Commercial |
$828.72
|
| Rate for Payer: Aetna Medicare |
$668.00
|
| Rate for Payer: BCBS Complete |
$435.00
|
| Rate for Payer: BCBS Trust/PPO |
$311.17
|
| Rate for Payer: BCN Commercial |
$931.42
|
| Rate for Payer: Cash Price |
$1,068.80
|
| Rate for Payer: Cash Price |
$1,068.80
|
| Rate for Payer: Meridian Medicaid |
$435.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$868.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,028.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,028.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$778.85
|
| Rate for Payer: UHC Exchange |
$778.85
|
| Rate for Payer: UHCCP Medicaid |
$414.29
|
|
|
PR PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 94642
|
| Min. Negotiated Rate |
$18.04 |
| Max. Negotiated Rate |
$217.66 |
| Rate for Payer: Aetna Commercial |
$46.35
|
| Rate for Payer: Aetna Medicare |
$95.00
|
| Rate for Payer: BCBS Complete |
$18.94
|
| Rate for Payer: BCBS Trust/PPO |
$217.66
|
| Rate for Payer: BCN Commercial |
$177.14
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Meridian Medicaid |
$18.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.35
|
| Rate for Payer: Priority Health Narrow Network |
$58.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.98
|
| Rate for Payer: UHC Exchange |
$29.98
|
| Rate for Payer: UHCCP Medicaid |
$18.04
|
|
|
PR PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 92972
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$201.52 |
| Rate for Payer: Aetna Commercial |
$186.94
|
| Rate for Payer: Aetna Medicare |
$116.50
|
| Rate for Payer: BCBS Complete |
$96.39
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Meridian Medicaid |
$96.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.52
|
| Rate for Payer: Priority Health Narrow Network |
$201.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.38
|
| Rate for Payer: UHC Exchange |
$196.38
|
| Rate for Payer: UHCCP Medicaid |
$91.80
|
|
|
PR PERCUTANEOUS TX MALAR AREA FRACTURE
|
Professional
|
Both
|
$916.00
|
|
|
Service Code
|
HCPCS 21355
|
| Min. Negotiated Rate |
$32.75 |
| Max. Negotiated Rate |
$661.18 |
| Rate for Payer: Aetna Commercial |
$427.46
|
| Rate for Payer: Aetna Medicare |
$458.00
|
| Rate for Payer: BCBS Complete |
$223.43
|
| Rate for Payer: BCBS Trust/PPO |
$32.75
|
| Rate for Payer: BCN Commercial |
$661.18
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Meridian Medicaid |
$223.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$212.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$507.34
|
| Rate for Payer: Priority Health Narrow Network |
$507.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.19
|
| Rate for Payer: UHC Exchange |
$373.19
|
| Rate for Payer: UHCCP Medicaid |
$212.79
|
|
|
PR PERCUTANEOUS VERTEBROPLASTY EA ADDL THRC/LMBR
|
Professional
|
Both
|
$719.00
|
|
|
Service Code
|
HCPCS 22522
|
| Min. Negotiated Rate |
$287.60 |
| Max. Negotiated Rate |
$467.35 |
| Rate for Payer: Aetna Medicare |
$359.50
|
| Rate for Payer: BCBS Complete |
$287.60
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.35
|
|
