|
PR PLASTIC URETHRAL SPHINCTER VAGINAL APPROACH
|
Professional
|
Both
|
$1,097.00
|
|
|
Service Code
|
HCPCS 57220
|
| Min. Negotiated Rate |
$223.22 |
| Max. Negotiated Rate |
$2,103.16 |
| Rate for Payer: Aetna Commercial |
$406.21
|
| Rate for Payer: Aetna Medicare |
$548.50
|
| Rate for Payer: BCBS Complete |
$234.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,103.16
|
| Rate for Payer: BCN Commercial |
$509.20
|
| Rate for Payer: Cash Price |
$877.60
|
| Rate for Payer: Cash Price |
$877.60
|
| Rate for Payer: Meridian Medicaid |
$234.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$520.36
|
| Rate for Payer: Priority Health Narrow Network |
$520.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.29
|
| Rate for Payer: UHC Exchange |
$363.29
|
| Rate for Payer: UHCCP Medicaid |
$223.22
|
|
|
PR PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 94726
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$369.28 |
| Rate for Payer: Aetna Commercial |
$57.59
|
| Rate for Payer: Aetna Commercial |
$57.59
|
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS Trust/PPO |
$369.28
|
| Rate for Payer: BCBS Trust/PPO |
$369.28
|
| Rate for Payer: BCN Commercial |
$79.16
|
| Rate for Payer: BCN Commercial |
$79.16
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Meridian Medicaid |
$7.83
|
| Rate for Payer: Meridian Medicaid |
$7.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.83
|
| Rate for Payer: Priority Health Narrow Network |
$15.83
|
| Rate for Payer: Priority Health Narrow Network |
$15.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.37
|
| Rate for Payer: UHC Exchange |
$59.37
|
| Rate for Payer: UHC Exchange |
$59.37
|
| Rate for Payer: UHCCP Medicaid |
$7.46
|
| Rate for Payer: UHCCP Medicaid |
$7.46
|
|
|
PR PLEURAL SCARIFICATION REPEAT PNEUMOTHORAX
|
Professional
|
Both
|
$2,177.00
|
|
|
Service Code
|
HCPCS 32215
|
| Min. Negotiated Rate |
$509.28 |
| Max. Negotiated Rate |
$1,415.05 |
| Rate for Payer: Aetna Commercial |
$1,032.67
|
| Rate for Payer: Aetna Medicare |
$1,088.50
|
| Rate for Payer: BCBS Complete |
$536.98
|
| Rate for Payer: BCBS Trust/PPO |
$509.28
|
| Rate for Payer: BCN Commercial |
$1,159.15
|
| Rate for Payer: Cash Price |
$1,741.60
|
| Rate for Payer: Cash Price |
$1,741.60
|
| Rate for Payer: Meridian Medicaid |
$536.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$511.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,415.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,107.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,107.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$937.71
|
| Rate for Payer: UHC Exchange |
$937.71
|
| Rate for Payer: UHCCP Medicaid |
$511.41
|
|
|
PR PLEURECTOMY PARIETAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,949.00
|
|
|
Service Code
|
HCPCS 32310
|
| Min. Negotiated Rate |
$409.96 |
| Max. Negotiated Rate |
$1,916.85 |
| Rate for Payer: Aetna Commercial |
$1,182.92
|
| Rate for Payer: Aetna Medicare |
$1,474.50
|
| Rate for Payer: BCBS Complete |
$613.47
|
| Rate for Payer: BCBS Trust/PPO |
$409.96
|
| Rate for Payer: BCN Commercial |
$1,325.29
|
| Rate for Payer: Cash Price |
$2,359.20
|
| Rate for Payer: Cash Price |
$2,359.20
|
| Rate for Payer: Meridian Medicaid |
$613.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,916.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,264.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,264.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,078.07
|
| Rate for Payer: UHC Exchange |
$1,078.07
|
| Rate for Payer: UHCCP Medicaid |
$584.26
|
|
|
PR PL GLYCOLIC 35/70
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 00067
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
|
|
PR PL ILLUMINIZE
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 00069
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$53.30 |
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
|
|
PR PL JESSNERS
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 00068
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
|
|
PR PLMT ACCESS THRU BILIARY TREE INTO SMALL BWL NEW
|
Professional
|
Both
|
$2,142.00
|
|
|
Service Code
|
HCPCS 47541
|
| Min. Negotiated Rate |
$209.17 |
| Max. Negotiated Rate |
$1,714.77 |
| Rate for Payer: Aetna Commercial |
$442.75
|
| Rate for Payer: Aetna Medicare |
$1,071.00
|
| Rate for Payer: BCBS Complete |
$219.63
|
| Rate for Payer: BCN Commercial |
$1,714.77
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Meridian Medicaid |
$219.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$581.08
|
| Rate for Payer: Priority Health Narrow Network |
$581.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.09
|
| Rate for Payer: UHC Exchange |
$377.09
|
| Rate for Payer: UHCCP Medicaid |
$209.17
|
|
|
PR PLMT EXPANDABLE CATH BRST FOLLOWING PRTL MAST
|
Professional
|
Both
|
$10,186.00
|
|
|
Service Code
|
HCPCS 19296
|
| Min. Negotiated Rate |
$134.62 |
| Max. Negotiated Rate |
$6,620.90 |
| Rate for Payer: Aetna Commercial |
$230.34
|
| Rate for Payer: Aetna Medicare |
$5,093.00
|
| Rate for Payer: BCBS Complete |
$141.35
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$5,484.92
|
| Rate for Payer: Cash Price |
$8,148.80
|
| Rate for Payer: Cash Price |
$8,148.80
|
| Rate for Payer: Meridian Medicaid |
$141.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,620.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.56
|
| Rate for Payer: Priority Health Narrow Network |
$283.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.36
|
| Rate for Payer: UHC Exchange |
$226.36
|
| Rate for Payer: UHCCP Medicaid |
$134.62
|
|
|
PR PLMT FEM-FEM PROSTC GRF EVASC AORTIC ARYSM RPR
|
Professional
|
Both
|
$1,219.00
|
|
|
Service Code
|
HCPCS 34813
|
| Min. Negotiated Rate |
$145.91 |
| Max. Negotiated Rate |
$792.35 |
| Rate for Payer: Aetna Commercial |
$319.87
|
| Rate for Payer: Aetna Medicare |
$609.50
|
| Rate for Payer: BCBS Complete |
$153.21
|
| Rate for Payer: BCBS Trust/PPO |
$304.83
|
| Rate for Payer: BCN Commercial |
$335.23
|
| Rate for Payer: Cash Price |
$975.20
|
| Rate for Payer: Cash Price |
$975.20
|
| Rate for Payer: Meridian Medicaid |
$153.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$792.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$364.30
|
| Rate for Payer: Priority Health Narrow Network |
$364.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.95
|
| Rate for Payer: UHC Exchange |
$321.95
|
| Rate for Payer: UHCCP Medicaid |
$145.91
|
|
|
PR PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 55876
|
| Min. Negotiated Rate |
$65.39 |
| Max. Negotiated Rate |
$2,499.92 |
| Rate for Payer: Aetna Commercial |
$128.17
|
| Rate for Payer: Aetna Medicare |
$138.50
|
| Rate for Payer: BCBS Complete |
$68.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,499.92
|
| Rate for Payer: BCN Commercial |
$220.88
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Meridian Medicaid |
$68.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.45
|
| Rate for Payer: Priority Health Narrow Network |
$162.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.52
|
| Rate for Payer: UHC Exchange |
$122.52
|
| Rate for Payer: UHCCP Medicaid |
$65.39
|
|
|
PR PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I
|
Professional
|
Both
|
$1,616.00
|
|
|
Service Code
|
HCPCS 50432
|
| Min. Negotiated Rate |
$128.01 |
| Max. Negotiated Rate |
$2,416.97 |
| Rate for Payer: Aetna Commercial |
$261.42
|
| Rate for Payer: Aetna Medicare |
$808.00
|
| Rate for Payer: BCBS Complete |
$134.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,416.97
|
| Rate for Payer: BCN Commercial |
$1,340.94
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Meridian Medicaid |
$134.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$317.42
|
| Rate for Payer: Priority Health Narrow Network |
$317.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$269.81
|
| Rate for Payer: UHC Exchange |
$269.81
|
| Rate for Payer: UHCCP Medicaid |
$128.01
|
|
|
PR PLMT PROX XTN PROSTH EVASC RPR DTA 1ST XTN
|
Professional
|
Both
|
$2,278.00
|
|
|
Service Code
|
HCPCS 33883
|
| Min. Negotiated Rate |
$692.68 |
| Max. Negotiated Rate |
$1,732.69 |
| Rate for Payer: Aetna Commercial |
$1,495.47
|
| Rate for Payer: Aetna Medicare |
$1,139.00
|
| Rate for Payer: BCBS Complete |
$727.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.39
|
| Rate for Payer: BCN Commercial |
$1,586.25
|
| Rate for Payer: Cash Price |
$1,822.40
|
| Rate for Payer: Cash Price |
$1,822.40
|
| Rate for Payer: Meridian Medicaid |
$727.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$692.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,732.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,732.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,507.86
|
| Rate for Payer: UHC Exchange |
$1,507.86
|
| Rate for Payer: UHCCP Medicaid |
$692.68
|
|
|
PR PLMT PROX XTN PROSTH EVASC RPR DTA EA PROX XTN
|
Professional
|
Both
|
$877.00
|
|
|
Service Code
|
HCPCS 33884
|
| Min. Negotiated Rate |
$245.80 |
| Max. Negotiated Rate |
$1,597.58 |
| Rate for Payer: Aetna Commercial |
$532.47
|
| Rate for Payer: Aetna Medicare |
$438.50
|
| Rate for Payer: BCBS Complete |
$258.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,597.58
|
| Rate for Payer: BCN Commercial |
$561.00
|
| Rate for Payer: Cash Price |
$701.60
|
| Rate for Payer: Cash Price |
$701.60
|
| Rate for Payer: Meridian Medicaid |
$258.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$245.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$612.66
|
| Rate for Payer: Priority Health Narrow Network |
$612.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$552.64
|
| Rate for Payer: UHC Exchange |
$552.64
|
| Rate for Payer: UHCCP Medicaid |
$245.80
|
|
|
PR PLMT SFT TISS LOCLZJ DEV PERQ 1ST LESION
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 10035
|
| Min. Negotiated Rate |
$52.82 |
| Max. Negotiated Rate |
$543.90 |
| Rate for Payer: Aetna Commercial |
$92.22
|
| Rate for Payer: Aetna Medicare |
$118.50
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCN Commercial |
$543.90
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Meridian Medicaid |
$55.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.05
|
| 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 |
$101.00
|
| Rate for Payer: UHC Exchange |
$101.00
|
| Rate for Payer: UHCCP Medicaid |
$52.82
|
|
|
PR PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 50693
|
| Min. Negotiated Rate |
$127.37 |
| Max. Negotiated Rate |
$3,785.27 |
| Rate for Payer: Aetna Commercial |
$260.02
|
| Rate for Payer: Aetna Medicare |
$281.50
|
| Rate for Payer: BCBS Complete |
$133.74
|
| Rate for Payer: BCBS Trust/PPO |
$3,785.27
|
| Rate for Payer: BCN Commercial |
$1,468.96
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Meridian Medicaid |
$133.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$315.82
|
| Rate for Payer: Priority Health Narrow Network |
$315.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.90
|
| Rate for Payer: UHC Exchange |
$266.90
|
| Rate for Payer: UHCCP Medicaid |
$127.37
|
|
|
PR PLMT VEIN PATCH/CUFF DSTL ANAST BYP CONDUIT
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
HCPCS 35685
|
| Min. Negotiated Rate |
$123.33 |
| Max. Negotiated Rate |
$2,230.82 |
| Rate for Payer: Aetna Commercial |
$268.12
|
| Rate for Payer: Aetna Medicare |
$221.50
|
| Rate for Payer: BCBS Complete |
$129.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,230.82
|
| Rate for Payer: BCN Commercial |
$281.48
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Meridian Medicaid |
$129.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$306.86
|
| Rate for Payer: Priority Health Narrow Network |
$306.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.59
|
| Rate for Payer: UHC Exchange |
$271.59
|
| Rate for Payer: UHCCP Medicaid |
$123.33
|
|
|
PR PLNNING PT SPEC FENEST VISCERAL AORTIC GRAFT
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 34839
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$1,815.77 |
| Rate for Payer: Aetna Commercial |
$240.00
|
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,815.77
|
| Rate for Payer: BCN Commercial |
$145.07
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.18
|
| Rate for Payer: UHC Exchange |
$315.18
|
|
|
PR PL REJUV/PERFECT
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 00071
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
|
|
PR PLSTC RPR CL LIP/NSL DFRM SEC RECRTJ DFCT & RECL
|
Professional
|
Both
|
$1,883.00
|
|
|
Service Code
|
HCPCS 40720
|
| Min. Negotiated Rate |
$662.43 |
| Max. Negotiated Rate |
$1,837.52 |
| Rate for Payer: Aetna Commercial |
$1,363.02
|
| Rate for Payer: Aetna Medicare |
$941.50
|
| Rate for Payer: BCBS Complete |
$695.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,487.69
|
| Rate for Payer: BCN Commercial |
$1,500.24
|
| Rate for Payer: Cash Price |
$1,506.40
|
| Rate for Payer: Cash Price |
$1,506.40
|
| Rate for Payer: Meridian Medicaid |
$695.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$662.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,223.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,837.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,837.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,222.91
|
| Rate for Payer: UHC Exchange |
$1,222.91
|
| Rate for Payer: UHCCP Medicaid |
$662.43
|
|
|
PR PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 42500
|
| Min. Negotiated Rate |
$223.86 |
| Max. Negotiated Rate |
$1,052.90 |
| Rate for Payer: Aetna Commercial |
$454.70
|
| Rate for Payer: Aetna Medicare |
$436.00
|
| Rate for Payer: BCBS Complete |
$235.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,052.90
|
| Rate for Payer: BCN Commercial |
$664.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Meridian Medicaid |
$235.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$624.63
|
| Rate for Payer: Priority Health Narrow Network |
$624.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.35
|
| Rate for Payer: UHC Exchange |
$412.35
|
| Rate for Payer: UHCCP Medicaid |
$223.86
|
|
|
PR PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY SEC/COMP
|
Professional
|
Both
|
$1,112.00
|
|
|
Service Code
|
HCPCS 42505
|
| Min. Negotiated Rate |
$296.07 |
| Max. Negotiated Rate |
$848.84 |
| Rate for Payer: Aetna Commercial |
$603.00
|
| Rate for Payer: Aetna Medicare |
$556.00
|
| Rate for Payer: BCBS Complete |
$310.87
|
| Rate for Payer: BCBS Trust/PPO |
$318.04
|
| Rate for Payer: BCN Commercial |
$848.84
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Meridian Medicaid |
$310.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$296.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$829.27
|
| Rate for Payer: Priority Health Narrow Network |
$829.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$551.31
|
| Rate for Payer: UHC Exchange |
$551.31
|
| Rate for Payer: UHCCP Medicaid |
$296.07
|
|
|
PR PL VITALIZE
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 00070
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
|
|
PR PNCRTECT DSTL STOT W/O PNCRTCOJEJUNOSTOMY
|
Professional
|
Both
|
$3,664.00
|
|
|
Service Code
|
HCPCS 48140
|
| Min. Negotiated Rate |
$1,005.57 |
| Max. Negotiated Rate |
$2,802.80 |
| Rate for Payer: Aetna Commercial |
$2,112.86
|
| Rate for Payer: Aetna Medicare |
$1,832.00
|
| Rate for Payer: BCBS Complete |
$1,055.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,200.30
|
| Rate for Payer: BCN Commercial |
$2,284.57
|
| Rate for Payer: Cash Price |
$2,931.20
|
| Rate for Payer: Cash Price |
$2,931.20
|
| Rate for Payer: Meridian Medicaid |
$1,055.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,005.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,381.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,802.80
|
| Rate for Payer: Priority Health Narrow Network |
$2,802.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,887.78
|
| Rate for Payer: UHC Exchange |
$1,887.78
|
| Rate for Payer: UHCCP Medicaid |
$1,005.57
|
|
|
PR PNCRTECT PROX STOT W/PANCREATOJEJUNOSTOMY
|
Professional
|
Both
|
$5,562.00
|
|
|
Service Code
|
HCPCS 48150
|
| Min. Negotiated Rate |
$711.62 |
| Max. Negotiated Rate |
$5,560.26 |
| Rate for Payer: Aetna Commercial |
$4,213.34
|
| Rate for Payer: Aetna Medicare |
$2,781.00
|
| Rate for Payer: BCBS Complete |
$2,092.69
|
| Rate for Payer: BCBS Trust/PPO |
$711.62
|
| Rate for Payer: BCN Commercial |
$4,533.95
|
| Rate for Payer: Cash Price |
$4,449.60
|
| Rate for Payer: Cash Price |
$4,449.60
|
| Rate for Payer: Meridian Medicaid |
$2,092.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,993.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,615.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,560.26
|
| Rate for Payer: Priority Health Narrow Network |
$5,560.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,765.99
|
| Rate for Payer: UHC Exchange |
$3,765.99
|
| Rate for Payer: UHCCP Medicaid |
$1,993.04
|
|
