|
PR PHYS/QHP ATTN&SUPVJ HYPRBARIC OXYGEN TX/SESSION
|
Professional
|
Both
|
$373.00
|
|
|
Service Code
|
HCPCS 99183
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$242.45 |
| Rate for Payer: Aetna Commercial |
$120.18
|
| Rate for Payer: Aetna Medicare |
$186.50
|
| Rate for Payer: BCBS Complete |
$70.68
|
| Rate for Payer: BCBS Trust/PPO |
$201.28
|
| Rate for Payer: BCN Commercial |
$153.45
|
| Rate for Payer: Cash Price |
$298.40
|
| Rate for Payer: Cash Price |
$298.40
|
| Rate for Payer: Meridian Medicaid |
$70.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.02
|
| Rate for Payer: Priority Health Narrow Network |
$142.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.27
|
| Rate for Payer: UHC Exchange |
$124.27
|
| Rate for Payer: UHCCP Medicaid |
$67.31
|
|
|
PR PHYS/QHP DIRECTION EMERGENCY MEDICAL SYSTEMS
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 99288
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$1,059.24 |
| Rate for Payer: Aetna Commercial |
$48.75
|
| Rate for Payer: Aetna Medicare |
$125.00
|
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,059.24
|
| Rate for Payer: BCN Commercial |
$47.74
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.00
|
| Rate for Payer: Priority Health Narrow Network |
$72.00
|
|
|
PR PHYS/QHP EDUCATION SVCS RENDERED PTS GRP SETTING
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 99078
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$434.79 |
| Rate for Payer: Aetna Commercial |
$25.00
|
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: BCBS Complete |
$47.25
|
| Rate for Payer: BCBS Trust/PPO |
$434.79
|
| Rate for Payer: BCN Commercial |
$34.16
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Meridian Medicaid |
$47.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.89
|
| Rate for Payer: Priority Health Narrow Network |
$31.89
|
| Rate for Payer: UHCCP Medicaid |
$45.00
|
|
|
PR PHYS/QHP ONLINE EVALUATION & MANAGEMENT SERVICE
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 99444
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna Medicare |
$25.00
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCN Commercial |
$49.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
|
|
PR PHYS/QHP O/P CARDIAC RHAB W/O CONT ECG MONITOR
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 93797
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$118.87 |
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$118.87
|
| Rate for Payer: BCN Commercial |
$24.44
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Meridian Medicaid |
$5.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.24
|
| Rate for Payer: Priority Health Narrow Network |
$12.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.36
|
| Rate for Payer: UHC Exchange |
$10.36
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
|
|
PR PHYS/QHP TELEPHONE EVALUATION 11-20 MIN
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 99442
|
| Min. Negotiated Rate |
$28.18 |
| Max. Negotiated Rate |
$1,711.16 |
| Rate for Payer: Aetna Commercial |
$67.27
|
| Rate for Payer: Aetna Medicare |
$74.50
|
| Rate for Payer: BCBS Complete |
$59.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,711.16
|
| Rate for Payer: BCN Commercial |
$39.42
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.18
|
| Rate for Payer: UHC Exchange |
$28.18
|
|
|
PR PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 99443
|
| Min. Negotiated Rate |
$42.32 |
| Max. Negotiated Rate |
$1,049.20 |
| Rate for Payer: Aetna Commercial |
$99.17
|
| Rate for Payer: Aetna Medicare |
$108.00
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.20
|
| Rate for Payer: BCN Commercial |
$57.62
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.32
|
| Rate for Payer: UHC Exchange |
$42.32
|
|
|
PR PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 99441
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$1,561.13 |
| Rate for Payer: Aetna Commercial |
$35.71
|
| Rate for Payer: Aetna Medicare |
$45.00
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,561.13
|
| Rate for Payer: BCN Commercial |
$20.21
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.71
|
| Rate for Payer: UHC Exchange |
$13.71
|
|
|
PR PHYS STANDBY SVC PROLNG PHYS ATTN EA 30 MINUTES
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 99360
|
| Min. Negotiated Rate |
$60.51 |
| Max. Negotiated Rate |
$169.65 |
| Rate for Payer: Aetna Commercial |
$60.51
|
| Rate for Payer: Aetna Medicare |
$130.50
|
| Rate for Payer: BCBS Complete |
$104.40
|
| Rate for Payer: BCBS Trust/PPO |
$102.49
|
| Rate for Payer: BCN Commercial |
$84.55
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.08
|
| Rate for Payer: Priority Health Narrow Network |
$78.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.69
|
| Rate for Payer: UHC Exchange |
$67.69
|
|
|
PR PINCH GRAFT 1/MLT SM ULCER TIP/OTH AR UP TO 2 CM
|
Professional
|
Both
|
$917.00
|
|
|
Service Code
|
HCPCS 15050
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$870.82 |
| Rate for Payer: Aetna Commercial |
$494.38
|
| Rate for Payer: Aetna Medicare |
$458.50
|
| Rate for Payer: BCBS Complete |
$312.00
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$870.82
|
| Rate for Payer: Cash Price |
$733.60
|
| Rate for Payer: Cash Price |
$733.60
|
| Rate for Payer: Meridian Medicaid |
$312.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$297.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$622.19
|
| Rate for Payer: Priority Health Narrow Network |
$622.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$462.50
|
| Rate for Payer: UHC Exchange |
$462.50
|
| Rate for Payer: UHCCP Medicaid |
$297.14
|
|
|
PR PLACE CATH BRACHIAL ART
|
Professional
|
Both
|
$761.00
|
|
|
Service Code
|
HCPCS 36120
|
| Min. Negotiated Rate |
$304.40 |
| Max. Negotiated Rate |
$494.65 |
| Rate for Payer: Aetna Medicare |
$380.50
|
| Rate for Payer: BCBS Complete |
$304.40
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.65
|
|
|
PR PLACE DRAIN PERIPANCREATIC ACUTE PANCREATITIS
|
Professional
|
Both
|
$3,283.00
|
|
|
Service Code
|
HCPCS 48000
|
| Min. Negotiated Rate |
$1,206.01 |
| Max. Negotiated Rate |
$3,361.81 |
| Rate for Payer: Aetna Commercial |
$2,551.38
|
| Rate for Payer: Aetna Medicare |
$1,641.50
|
| Rate for Payer: BCBS Complete |
$1,266.31
|
| Rate for Payer: BCBS Trust/PPO |
$3,234.25
|
| Rate for Payer: BCN Commercial |
$2,742.95
|
| Rate for Payer: Cash Price |
$2,626.40
|
| Rate for Payer: Cash Price |
$2,626.40
|
| Rate for Payer: Meridian Medicaid |
$1,266.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,206.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,133.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,361.81
|
| Rate for Payer: Priority Health Narrow Network |
$3,361.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,254.36
|
| Rate for Payer: UHC Exchange |
$2,254.36
|
| Rate for Payer: UHCCP Medicaid |
$1,206.01
|
|
|
PR PLACEMENT CHOLEDOCHAL STENT
|
Professional
|
Both
|
$2,547.00
|
|
|
Service Code
|
HCPCS 47801
|
| Min. Negotiated Rate |
$711.85 |
| Max. Negotiated Rate |
$2,000.97 |
| Rate for Payer: Aetna Commercial |
$1,511.06
|
| Rate for Payer: Aetna Medicare |
$1,273.50
|
| Rate for Payer: BCBS Complete |
$747.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,198.18
|
| Rate for Payer: BCN Commercial |
$1,632.18
|
| Rate for Payer: Cash Price |
$2,037.60
|
| Rate for Payer: Cash Price |
$2,037.60
|
| Rate for Payer: Meridian Medicaid |
$747.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$711.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,655.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,000.97
|
| Rate for Payer: Priority Health Narrow Network |
$2,000.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,289.41
|
| Rate for Payer: UHC Exchange |
$1,289.41
|
| Rate for Payer: UHCCP Medicaid |
$711.85
|
|
|
PR PLACEMENT ENTEROSTOMY/CECOSTOMY TUBE OPEN
|
Professional
|
Both
|
$1,971.00
|
|
|
Service Code
|
HCPCS 44300
|
| Min. Negotiated Rate |
$541.45 |
| Max. Negotiated Rate |
$3,186.71 |
| Rate for Payer: Aetna Commercial |
$1,135.71
|
| Rate for Payer: Aetna Medicare |
$985.50
|
| Rate for Payer: BCBS Complete |
$568.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,186.71
|
| Rate for Payer: BCN Commercial |
$1,228.54
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Meridian Medicaid |
$568.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$541.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,281.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,509.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,509.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,014.60
|
| Rate for Payer: UHC Exchange |
$1,014.60
|
| Rate for Payer: UHCCP Medicaid |
$541.45
|
|
|
PR PLACEMENT NEEDLE INTRAOSSEOUS INFUSION
|
Professional
|
Both
|
$565.00
|
|
|
Service Code
|
HCPCS 36680
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$835.77 |
| Rate for Payer: Aetna Commercial |
$79.98
|
| Rate for Payer: Aetna Medicare |
$282.50
|
| Rate for Payer: BCBS Complete |
$39.81
|
| Rate for Payer: BCBS Trust/PPO |
$835.77
|
| Rate for Payer: BCN Commercial |
$86.01
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Meridian Medicaid |
$39.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.13
|
| Rate for Payer: Priority Health Narrow Network |
$94.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.49
|
| Rate for Payer: UHC Exchange |
$77.49
|
| Rate for Payer: UHCCP Medicaid |
$37.91
|
|
|
PR PLACEMENT SETON
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
HCPCS 46020
|
| Min. Negotiated Rate |
$75.19 |
| Max. Negotiated Rate |
$1,247.84 |
| Rate for Payer: Aetna Commercial |
$315.96
|
| Rate for Payer: Aetna Medicare |
$195.00
|
| Rate for Payer: BCBS Complete |
$78.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,247.84
|
| Rate for Payer: BCN Commercial |
$169.57
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Meridian Medicaid |
$78.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.81
|
| Rate for Payer: Priority Health Narrow Network |
$208.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.65
|
| Rate for Payer: UHC Exchange |
$264.65
|
| Rate for Payer: UHCCP Medicaid |
$75.19
|
|
|
PR PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR
|
Professional
|
Both
|
$681.00
|
|
|
Service Code
|
HCPCS 34709
|
| Min. Negotiated Rate |
$200.22 |
| Max. Negotiated Rate |
$2,173.43 |
| Rate for Payer: Aetna Commercial |
$435.90
|
| Rate for Payer: Aetna Medicare |
$340.50
|
| Rate for Payer: BCBS Complete |
$210.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,173.43
|
| Rate for Payer: BCN Commercial |
$458.86
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Meridian Medicaid |
$210.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$499.38
|
| Rate for Payer: Priority Health Narrow Network |
$499.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.04
|
| Rate for Payer: UHC Exchange |
$435.04
|
| Rate for Payer: UHCCP Medicaid |
$200.22
|
|
|
PR PLACE NEEDLE/CATH A-V DIALYSIS SHUNT,1ST ACCESS W/ RAD EVAL
|
Professional
|
Both
|
$1,510.00
|
|
|
Service Code
|
HCPCS 36147
|
| Min. Negotiated Rate |
$604.00 |
| Max. Negotiated Rate |
$981.50 |
| Rate for Payer: Aetna Medicare |
$755.00
|
| Rate for Payer: BCBS Complete |
$604.00
|
| Rate for Payer: Cash Price |
$1,208.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$981.50
|
|
|
PR PLACE NEEDLE/CATH A-V DIALYSIS SHUNT,ADDL ACCESS FOR THERAPY
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
HCPCS 36148
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$437.45 |
| Rate for Payer: Aetna Medicare |
$336.50
|
| Rate for Payer: BCBS Complete |
$269.20
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.45
|
|
|
PR PLASTIC OPERATION PENIS INJURY
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 54440
|
| Min. Negotiated Rate |
$711.74 |
| Max. Negotiated Rate |
$2,964.74 |
| Rate for Payer: Aetna Commercial |
$711.74
|
| Rate for Payer: Aetna Medicare |
$991.50
|
| Rate for Payer: BCBS Complete |
$777.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,537.35
|
| Rate for Payer: BCN Commercial |
$2,964.74
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Meridian Medicaid |
$777.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$740.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$892.64
|
| Rate for Payer: Priority Health Narrow Network |
$892.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,346.35
|
| Rate for Payer: UHC Exchange |
$1,346.35
|
| Rate for Payer: UHCCP Medicaid |
$740.06
|
|
|
PR PLASTIC REPAIR INTROITUS
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
HCPCS 56800
|
| Min. Negotiated Rate |
$163.16 |
| Max. Negotiated Rate |
$1,759.77 |
| Rate for Payer: Aetna Commercial |
$298.27
|
| Rate for Payer: Aetna Medicare |
$449.50
|
| Rate for Payer: BCBS Complete |
$171.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,759.77
|
| Rate for Payer: BCN Commercial |
$372.37
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Meridian Medicaid |
$171.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$379.97
|
| Rate for Payer: Priority Health Narrow Network |
$379.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$276.35
|
| Rate for Payer: UHC Exchange |
$276.35
|
| Rate for Payer: UHCCP Medicaid |
$163.16
|
|
|
PR PLASTIC REPAIR URETHROCELE
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 57230
|
| Min. Negotiated Rate |
$268.59 |
| Max. Negotiated Rate |
$629.98 |
| Rate for Payer: Aetna Commercial |
$495.89
|
| Rate for Payer: Aetna Medicare |
$404.50
|
| Rate for Payer: BCBS Complete |
$282.02
|
| Rate for Payer: BCBS Trust/PPO |
$286.34
|
| Rate for Payer: BCN Commercial |
$618.18
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Meridian Medicaid |
$282.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$629.98
|
| Rate for Payer: Priority Health Narrow Network |
$629.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.16
|
| Rate for Payer: UHC Exchange |
$457.16
|
| Rate for Payer: UHCCP Medicaid |
$268.59
|
|
|
PR PLASTIC RPR PENIS CORRECT ANGULATION
|
Professional
|
Both
|
$3,801.00
|
|
|
Service Code
|
HCPCS 54360
|
| Min. Negotiated Rate |
$462.21 |
| Max. Negotiated Rate |
$2,470.65 |
| Rate for Payer: Aetna Commercial |
$925.58
|
| Rate for Payer: Aetna Medicare |
$1,900.50
|
| Rate for Payer: BCBS Complete |
$485.32
|
| Rate for Payer: BCBS Trust/PPO |
$602.79
|
| Rate for Payer: BCN Commercial |
$1,040.88
|
| Rate for Payer: Cash Price |
$3,040.80
|
| Rate for Payer: Cash Price |
$3,040.80
|
| Rate for Payer: Meridian Medicaid |
$485.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$462.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,470.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,148.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,148.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$876.20
|
| Rate for Payer: UHC Exchange |
$876.20
|
| Rate for Payer: UHCCP Medicaid |
$462.21
|
|
|
PR PLASTICS COSMETIC CONSULT OFFICE VISIT
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 00690
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna Medicare |
$36.00
|
| Rate for Payer: BCBS Complete |
$28.80
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.80
|
|
|
PR PLASTICS COSMETIC FAT GRAFTING
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 00691
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$1,625.00 |
| Rate for Payer: Aetna Medicare |
$1,250.00
|
| Rate for Payer: BCBS Complete |
$1,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,625.00
|
|
