|
PR PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 34713
|
| Min. Negotiated Rate |
$76.68 |
| Max. Negotiated Rate |
$1,464.98 |
| Rate for Payer: Aetna Commercial |
$167.72
|
| Rate for Payer: Aetna Medicare |
$133.50
|
| Rate for Payer: BCBS Complete |
$80.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,464.98
|
| Rate for Payer: BCN Commercial |
$175.44
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Meridian Medicaid |
$80.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.92
|
| Rate for Payer: Priority Health Narrow Network |
$190.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.05
|
| Rate for Payer: UHC Exchange |
$173.05
|
| Rate for Payer: UHCCP Medicaid |
$76.68
|
|
|
PR PERQ ART TRLUML M-THROMBEC &/NFS INTRACRANIAL
|
Professional
|
Both
|
$1,615.00
|
|
|
Service Code
|
HCPCS 61645
|
| Min. Negotiated Rate |
$117.81 |
| Max. Negotiated Rate |
$1,431.46 |
| Rate for Payer: Aetna Commercial |
$1,083.12
|
| Rate for Payer: Aetna Medicare |
$807.50
|
| Rate for Payer: BCBS Complete |
$568.07
|
| Rate for Payer: BCBS Trust/PPO |
$117.81
|
| Rate for Payer: BCN Commercial |
$1,222.18
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Meridian Medicaid |
$568.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$541.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,049.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,431.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,431.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,003.07
|
| Rate for Payer: UHC Exchange |
$1,003.07
|
| Rate for Payer: UHCCP Medicaid |
$541.02
|
|
|
PR PERQ BALO DILA IC VSPSM EA VSL DIFF VASC TER
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 61642
|
| Min. Negotiated Rate |
$109.36 |
| Max. Negotiated Rate |
$559.62 |
| Rate for Payer: Aetna Commercial |
$445.23
|
| Rate for Payer: Aetna Medicare |
$346.50
|
| Rate for Payer: BCBS Complete |
$277.20
|
| Rate for Payer: BCBS Trust/PPO |
$109.36
|
| Rate for Payer: BCN Commercial |
$480.86
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$559.62
|
| Rate for Payer: Priority Health Narrow Network |
$559.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$532.87
|
| Rate for Payer: UHC Exchange |
$532.87
|
|
|
PR PERQ BALO DILA IC VSPSM EA VSL SM VASC TER
|
Professional
|
Both
|
$347.00
|
|
|
Service Code
|
HCPCS 61641
|
| Min. Negotiated Rate |
$105.66 |
| Max. Negotiated Rate |
$279.80 |
| Rate for Payer: Aetna Commercial |
$222.61
|
| Rate for Payer: Aetna Medicare |
$173.50
|
| Rate for Payer: BCBS Complete |
$138.80
|
| Rate for Payer: BCBS Trust/PPO |
$105.66
|
| Rate for Payer: BCN Commercial |
$240.43
|
| Rate for Payer: Cash Price |
$277.60
|
| Rate for Payer: Cash Price |
$277.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$279.80
|
| Rate for Payer: Priority Health Narrow Network |
$279.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.89
|
| Rate for Payer: UHC Exchange |
$266.89
|
|
|
PR PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 19285
|
| Min. Negotiated Rate |
$52.82 |
| Max. Negotiated Rate |
$2,904.75 |
| Rate for Payer: Aetna Commercial |
$92.57
|
| Rate for Payer: Aetna Medicare |
$112.00
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,904.75
|
| Rate for Payer: BCN Commercial |
$548.78
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Meridian Medicaid |
$55.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.52
|
| Rate for Payer: Priority Health Narrow Network |
$111.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.34
|
| Rate for Payer: UHC Exchange |
$101.34
|
| Rate for Payer: UHCCP Medicaid |
$52.82
|
|
|
PR PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 19286
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna Commercial |
$46.85
|
| Rate for Payer: Aetna Medicare |
$34.00
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$450.56
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.99
|
| Rate for Payer: Priority Health Narrow Network |
$55.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.68
|
| Rate for Payer: UHC Exchange |
$48.68
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
|
|
PR PERQ CLSR TCAT L ATR APNDGE W/ENDOCARDIAL IMPLNT
|
Professional
|
Both
|
$1,663.00
|
|
|
Service Code
|
HCPCS 33340
|
| Min. Negotiated Rate |
$487.13 |
| Max. Negotiated Rate |
$1,214.69 |
| Rate for Payer: Aetna Commercial |
$1,058.20
|
| Rate for Payer: Aetna Medicare |
$831.50
|
| Rate for Payer: BCBS Complete |
$511.49
|
| Rate for Payer: BCBS Trust/PPO |
$775.02
|
| Rate for Payer: BCN Commercial |
$1,122.01
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Meridian Medicaid |
$511.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$487.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,080.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,214.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,214.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,071.26
|
| Rate for Payer: UHC Exchange |
$1,071.26
|
| Rate for Payer: UHCCP Medicaid |
$487.13
|
|
|
PR PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
HCPCS 19281
|
| Min. Negotiated Rate |
$61.77 |
| Max. Negotiated Rate |
$354.78 |
| Rate for Payer: Aetna Commercial |
$107.95
|
| Rate for Payer: Aetna Medicare |
$183.00
|
| Rate for Payer: BCBS Complete |
$64.86
|
| Rate for Payer: BCBS Trust/PPO |
$100.60
|
| Rate for Payer: BCN Commercial |
$354.78
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Meridian Medicaid |
$64.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.49
|
| Rate for Payer: Priority Health Narrow Network |
$130.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.34
|
| Rate for Payer: UHC Exchange |
$118.34
|
| Rate for Payer: UHCCP Medicaid |
$61.77
|
|
|
PR PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 19282
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$32.43
|
| Rate for Payer: BCBS Trust/PPO |
$2,700.00
|
| Rate for Payer: BCN Commercial |
$252.16
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Meridian Medicaid |
$32.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.47
|
| Rate for Payer: Priority Health Narrow Network |
$65.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.32
|
| Rate for Payer: UHC Exchange |
$56.32
|
| Rate for Payer: UHCCP Medicaid |
$30.89
|
|
|
PR PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 50436
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$1,729.65 |
| Rate for Payer: Aetna Commercial |
$192.23
|
| Rate for Payer: Aetna Medicare |
$152.50
|
| Rate for Payer: BCBS Complete |
$100.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,729.65
|
| Rate for Payer: BCN Commercial |
$213.06
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Meridian Medicaid |
$100.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.28
|
| Rate for Payer: Priority Health Narrow Network |
$233.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.13
|
| Rate for Payer: UHC Exchange |
$184.13
|
| Rate for Payer: UHCCP Medicaid |
$95.64
|
|
|
PR PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 50437
|
| Min. Negotiated Rate |
$158.90 |
| Max. Negotiated Rate |
$553.15 |
| Rate for Payer: Aetna Commercial |
$319.74
|
| Rate for Payer: Aetna Medicare |
$425.50
|
| Rate for Payer: BCBS Complete |
$166.84
|
| Rate for Payer: BCN Commercial |
$355.26
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Meridian Medicaid |
$166.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$386.13
|
| Rate for Payer: Priority Health Narrow Network |
$386.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$307.50
|
| Rate for Payer: UHC Exchange |
$307.50
|
| Rate for Payer: UHCCP Medicaid |
$158.90
|
|
|
PR PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING
|
Professional
|
Both
|
$984.00
|
|
|
Service Code
|
HCPCS 32557
|
| Min. Negotiated Rate |
$93.29 |
| Max. Negotiated Rate |
$980.78 |
| Rate for Payer: Aetna Commercial |
$193.57
|
| Rate for Payer: Aetna Medicare |
$492.00
|
| Rate for Payer: BCBS Complete |
$97.95
|
| Rate for Payer: BCBS Trust/PPO |
$656.15
|
| Rate for Payer: BCN Commercial |
$980.78
|
| Rate for Payer: Cash Price |
$787.20
|
| Rate for Payer: Cash Price |
$787.20
|
| Rate for Payer: Meridian Medicaid |
$97.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$639.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.54
|
| Rate for Payer: Priority Health Narrow Network |
$202.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.63
|
| Rate for Payer: UHC Exchange |
$207.63
|
| Rate for Payer: UHCCP Medicaid |
$93.29
|
|
|
PR PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
HCPCS 32556
|
| Min. Negotiated Rate |
$78.60 |
| Max. Negotiated Rate |
$1,091.21 |
| Rate for Payer: Aetna Commercial |
$159.78
|
| Rate for Payer: Aetna Medicare |
$442.00
|
| Rate for Payer: BCBS Complete |
$82.53
|
| Rate for Payer: BCBS Trust/PPO |
$507.70
|
| Rate for Payer: BCN Commercial |
$1,091.21
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Meridian Medicaid |
$82.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.63
|
| Rate for Payer: Priority Health Narrow Network |
$169.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.98
|
| Rate for Payer: UHC Exchange |
$152.98
|
| Rate for Payer: UHCCP Medicaid |
$78.60
|
|
|
PR PERQ NL/PL LITHOTRP COMPLEX >2 CM MLT LOCATIONS
|
Professional
|
Both
|
$2,448.00
|
|
|
Service Code
|
HCPCS 50081
|
| Min. Negotiated Rate |
$716.11 |
| Max. Negotiated Rate |
$2,246.86 |
| Rate for Payer: Aetna Commercial |
$1,639.65
|
| Rate for Payer: Aetna Medicare |
$1,224.00
|
| Rate for Payer: BCBS Complete |
$751.92
|
| Rate for Payer: BCBS Trust/PPO |
$2,246.86
|
| Rate for Payer: BCN Commercial |
$1,618.01
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Meridian Medicaid |
$751.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$716.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,591.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,781.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,781.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,547.35
|
| Rate for Payer: UHC Exchange |
$1,547.35
|
| Rate for Payer: UHCCP Medicaid |
$716.11
|
|
|
PR PERQ NL/PL LITHOTRP SIMPLE UP TO 2 CM 1 LOCATION
|
Professional
|
Both
|
$1,664.00
|
|
|
Service Code
|
HCPCS 50080
|
| Min. Negotiated Rate |
$445.81 |
| Max. Negotiated Rate |
$1,115.07 |
| Rate for Payer: Aetna Commercial |
$1,115.07
|
| Rate for Payer: Aetna Medicare |
$832.00
|
| Rate for Payer: BCBS Complete |
$468.10
|
| Rate for Payer: BCBS Trust/PPO |
$652.45
|
| Rate for Payer: BCN Commercial |
$1,004.24
|
| Rate for Payer: Cash Price |
$1,331.20
|
| Rate for Payer: Cash Price |
$1,331.20
|
| Rate for Payer: Meridian Medicaid |
$468.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,081.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,107.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,107.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,052.25
|
| Rate for Payer: UHC Exchange |
$1,052.25
|
| Rate for Payer: UHCCP Medicaid |
$445.81
|
|
|
PR PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
HCPCS 33017
|
| Min. Negotiated Rate |
$154.43 |
| Max. Negotiated Rate |
$750.19 |
| Rate for Payer: Aetna Commercial |
$328.72
|
| Rate for Payer: Aetna Medicare |
$254.00
|
| Rate for Payer: BCBS Complete |
$162.15
|
| Rate for Payer: BCBS Trust/PPO |
$750.19
|
| Rate for Payer: BCN Commercial |
$351.85
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Meridian Medicaid |
$162.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$385.57
|
| Rate for Payer: Priority Health Narrow Network |
$385.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.93
|
| Rate for Payer: UHC Exchange |
$327.93
|
| Rate for Payer: UHCCP Medicaid |
$154.43
|
|
|
PR PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 43762
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$334.75 |
| Rate for Payer: Aetna Commercial |
$51.19
|
| Rate for Payer: Aetna Medicare |
$215.50
|
| Rate for Payer: BCBS Complete |
$25.05
|
| Rate for Payer: BCBS Trust/PPO |
$210.26
|
| Rate for Payer: BCN Commercial |
$334.75
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Meridian Medicaid |
$25.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.22
|
| Rate for Payer: Priority Health Narrow Network |
$66.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.26
|
| Rate for Payer: UHC Exchange |
$50.26
|
| Rate for Payer: UHCCP Medicaid |
$23.86
|
|
|
PR PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC
|
Professional
|
Both
|
$643.00
|
|
|
Service Code
|
HCPCS 43763
|
| Min. Negotiated Rate |
$56.02 |
| Max. Negotiated Rate |
$750.19 |
| Rate for Payer: Aetna Commercial |
$112.71
|
| Rate for Payer: Aetna Medicare |
$321.50
|
| Rate for Payer: BCBS Complete |
$58.82
|
| Rate for Payer: BCBS Trust/PPO |
$750.19
|
| Rate for Payer: BCN Commercial |
$496.49
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Meridian Medicaid |
$58.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.71
|
| Rate for Payer: Priority Health Narrow Network |
$155.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.44
|
| Rate for Payer: UHC Exchange |
$110.44
|
| Rate for Payer: UHCCP Medicaid |
$56.02
|
|
|
PR PERQ SAC AGMNTJ BI W/WO BALO/MCHNL DEV 2/> NDLS
|
Professional
|
Both
|
$2,444.00
|
|
|
Service Code
|
HCPCS 0201T
|
| Min. Negotiated Rate |
$237.73 |
| Max. Negotiated Rate |
$6,118.53 |
| Rate for Payer: Aetna Commercial |
$2,396.07
|
| Rate for Payer: Aetna Medicare |
$1,222.00
|
| Rate for Payer: BCBS Complete |
$249.62
|
| Rate for Payer: BCBS Trust/PPO |
$3,600.00
|
| Rate for Payer: BCN Commercial |
$6,118.53
|
| Rate for Payer: Cash Price |
$1,955.20
|
| Rate for Payer: Cash Price |
$1,955.20
|
| Rate for Payer: Meridian Medicaid |
$249.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$237.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,588.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$740.68
|
| Rate for Payer: UHC Exchange |
$740.68
|
| Rate for Payer: UHCCP Medicaid |
$237.73
|
|
|
PR PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> NDL
|
Professional
|
Both
|
$2,317.00
|
|
|
Service Code
|
HCPCS 0200T
|
| Min. Negotiated Rate |
$64.33 |
| Max. Negotiated Rate |
$6,118.53 |
| Rate for Payer: Aetna Commercial |
$2,325.11
|
| Rate for Payer: Aetna Medicare |
$1,158.50
|
| Rate for Payer: BCBS Complete |
$249.62
|
| Rate for Payer: BCBS Trust/PPO |
$64.33
|
| Rate for Payer: BCN Commercial |
$6,118.53
|
| Rate for Payer: Cash Price |
$1,853.60
|
| Rate for Payer: Cash Price |
$1,853.60
|
| Rate for Payer: Meridian Medicaid |
$249.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$237.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,506.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$600.02
|
| Rate for Payer: UHC Exchange |
$600.02
|
| Rate for Payer: UHCCP Medicaid |
$237.73
|
|
|
PR PERQ SKELETAL FIXATION PST PELVIC BONE FX&/DIS
|
Professional
|
Both
|
$3,172.00
|
|
|
Service Code
|
HCPCS 27216
|
| Min. Negotiated Rate |
$573.40 |
| Max. Negotiated Rate |
$2,061.80 |
| Rate for Payer: Aetna Commercial |
$1,191.27
|
| Rate for Payer: Aetna Medicare |
$1,586.00
|
| Rate for Payer: BCBS Complete |
$602.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,616.07
|
| Rate for Payer: BCN Commercial |
$1,302.33
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Meridian Medicaid |
$602.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,365.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,365.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,130.38
|
| Rate for Payer: UHC Exchange |
$1,130.38
|
| Rate for Payer: UHCCP Medicaid |
$573.40
|
|
|
PR PERQ SKELETAL FIXATION ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 25651
|
| Min. Negotiated Rate |
$324.40 |
| Max. Negotiated Rate |
$1,380.45 |
| Rate for Payer: Aetna Commercial |
$650.17
|
| Rate for Payer: Aetna Medicare |
$433.50
|
| Rate for Payer: BCBS Complete |
$340.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,380.45
|
| Rate for Payer: BCN Commercial |
$727.64
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Meridian Medicaid |
$340.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$324.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$768.88
|
| Rate for Payer: Priority Health Narrow Network |
$768.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$535.13
|
| Rate for Payer: UHC Exchange |
$535.13
|
| Rate for Payer: UHCCP Medicaid |
$324.40
|
|
|
PR PERQ SKELETAL FIXJ DISTAL RADIOULNAR DISLOCATION
|
Professional
|
Both
|
$1,428.00
|
|
|
Service Code
|
HCPCS 25671
|
| Min. Negotiated Rate |
$354.01 |
| Max. Negotiated Rate |
$1,651.47 |
| Rate for Payer: Aetna Commercial |
$708.23
|
| Rate for Payer: Aetna Medicare |
$714.00
|
| Rate for Payer: BCBS Complete |
$371.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,651.47
|
| Rate for Payer: BCN Commercial |
$788.24
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Meridian Medicaid |
$371.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$837.58
|
| Rate for Payer: Priority Health Narrow Network |
$837.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$587.51
|
| Rate for Payer: UHC Exchange |
$587.51
|
| Rate for Payer: UHCCP Medicaid |
$354.01
|
|
|
PR PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP
|
Professional
|
Both
|
$1,944.00
|
|
|
Service Code
|
HCPCS 25606
|
| Min. Negotiated Rate |
$72.38 |
| Max. Negotiated Rate |
$1,263.60 |
| Rate for Payer: Aetna Commercial |
$885.42
|
| Rate for Payer: Aetna Medicare |
$972.00
|
| Rate for Payer: BCBS Complete |
$462.74
|
| Rate for Payer: BCBS Trust/PPO |
$72.38
|
| Rate for Payer: BCN Commercial |
$988.59
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Meridian Medicaid |
$462.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,042.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,042.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$750.30
|
| Rate for Payer: UHC Exchange |
$750.30
|
| Rate for Payer: UHCCP Medicaid |
$440.70
|
|
|
PR PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT
|
Professional
|
Both
|
$1,542.00
|
|
|
Service Code
|
HCPCS 36906
|
| Min. Negotiated Rate |
$317.58 |
| Max. Negotiated Rate |
$7,992.80 |
| Rate for Payer: Aetna Commercial |
$685.46
|
| Rate for Payer: Aetna Medicare |
$771.00
|
| Rate for Payer: BCBS Complete |
$333.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,420.60
|
| Rate for Payer: BCN Commercial |
$7,992.80
|
| Rate for Payer: Cash Price |
$1,233.60
|
| Rate for Payer: Cash Price |
$1,233.60
|
| Rate for Payer: Meridian Medicaid |
$333.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$317.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,002.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$790.29
|
| Rate for Payer: Priority Health Narrow Network |
$790.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$668.05
|
| Rate for Payer: UHC Exchange |
$668.05
|
| Rate for Payer: UHCCP Medicaid |
$317.58
|
|
