|
PR PNCRTECT W/PANCREATOJEJUNOSTOMY
|
Professional
|
Both
|
$8,303.00
|
|
|
Service Code
|
HCPCS 48153
|
| Min. Negotiated Rate |
$747.02 |
| Max. Negotiated Rate |
$5,536.98 |
| Rate for Payer: Aetna Commercial |
$4,201.24
|
| Rate for Payer: Aetna Medicare |
$4,151.50
|
| Rate for Payer: BCBS Complete |
$2,080.40
|
| Rate for Payer: BCBS Trust/PPO |
$747.02
|
| Rate for Payer: BCN Commercial |
$4,519.29
|
| Rate for Payer: Cash Price |
$6,642.40
|
| Rate for Payer: Cash Price |
$6,642.40
|
| Rate for Payer: Meridian Medicaid |
$2,080.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,981.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,396.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,536.98
|
| Rate for Payer: Priority Health Narrow Network |
$5,536.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,759.64
|
| Rate for Payer: UHC Exchange |
$3,759.64
|
| Rate for Payer: UHCCP Medicaid |
$1,981.33
|
|
|
PR PNEUMOCOCCAL CONJ VACCINE 7 VALENT IM
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 90669
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$75.40 |
| Rate for Payer: Aetna Medicare |
$58.00
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.40
|
|
|
PR PNEUMONOLYSIS XTRPRIOSTEAL W/FILLING/PACKING PX
|
Professional
|
Both
|
$2,574.00
|
|
|
Service Code
|
HCPCS 32940
|
| Min. Negotiated Rate |
$780.86 |
| Max. Negotiated Rate |
$1,774.88 |
| Rate for Payer: Aetna Commercial |
$1,590.96
|
| Rate for Payer: Aetna Medicare |
$1,287.00
|
| Rate for Payer: BCBS Complete |
$819.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.20
|
| Rate for Payer: BCN Commercial |
$1,774.88
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Meridian Medicaid |
$819.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$780.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,673.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,691.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,691.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,454.90
|
| Rate for Payer: UHC Exchange |
$1,454.90
|
| Rate for Payer: UHCCP Medicaid |
$780.86
|
|
|
PR PNEUMONOSTOMY W/OPEN DRAINAGE ABSCESS/CYST
|
Professional
|
Both
|
$2,729.00
|
|
|
Service Code
|
HCPCS 32200
|
| Min. Negotiated Rate |
$725.48 |
| Max. Negotiated Rate |
$1,773.85 |
| Rate for Payer: Aetna Commercial |
$1,465.11
|
| Rate for Payer: Aetna Medicare |
$1,364.50
|
| Rate for Payer: BCBS Complete |
$761.75
|
| Rate for Payer: BCBS Trust/PPO |
$897.05
|
| Rate for Payer: BCN Commercial |
$1,644.40
|
| Rate for Payer: Cash Price |
$2,183.20
|
| Rate for Payer: Cash Price |
$2,183.20
|
| Rate for Payer: Meridian Medicaid |
$761.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$725.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,773.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,570.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,570.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,319.40
|
| Rate for Payer: UHC Exchange |
$1,319.40
|
| Rate for Payer: UHCCP Medicaid |
$725.48
|
|
|
PR PNEUMOTHORAX THER INTRAPLEURAL INJECTION AIR
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
HCPCS 32960
|
| Min. Negotiated Rate |
$57.30 |
| Max. Negotiated Rate |
$1,588.07 |
| Rate for Payer: Aetna Commercial |
$117.78
|
| Rate for Payer: Aetna Medicare |
$154.50
|
| Rate for Payer: BCBS Complete |
$60.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,588.07
|
| Rate for Payer: BCN Commercial |
$184.23
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Meridian Medicaid |
$60.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.75
|
| Rate for Payer: Priority Health Narrow Network |
$123.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.04
|
| Rate for Payer: UHC Exchange |
$122.04
|
| Rate for Payer: UHCCP Medicaid |
$57.30
|
|
|
PR PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 55000
|
| Min. Negotiated Rate |
$54.10 |
| Max. Negotiated Rate |
$2,324.52 |
| Rate for Payer: Aetna Commercial |
$107.54
|
| Rate for Payer: Aetna Medicare |
$110.50
|
| Rate for Payer: BCBS Complete |
$56.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,324.52
|
| Rate for Payer: BCN Commercial |
$175.44
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Meridian Medicaid |
$56.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.75
|
| Rate for Payer: Priority Health Narrow Network |
$134.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.72
|
| Rate for Payer: UHC Exchange |
$100.72
|
| Rate for Payer: UHCCP Medicaid |
$54.10
|
|
|
PR POLIOVIRUS VACCINE INACTIVATED SUBQ/IM
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 90713
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$51.17 |
| Rate for Payer: Aetna Commercial |
$43.27
|
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$40.14
|
| Rate for Payer: BCN Commercial |
$40.14
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.17
|
| Rate for Payer: UHC Exchange |
$51.17
|
|
|
PR POLLICIZATION DIGIT
|
Professional
|
Both
|
$2,768.00
|
|
|
Service Code
|
HCPCS 26550
|
| Min. Negotiated Rate |
$136.83 |
| Max. Negotiated Rate |
$2,534.63 |
| Rate for Payer: Aetna Commercial |
$2,222.53
|
| Rate for Payer: Aetna Medicare |
$1,384.00
|
| Rate for Payer: BCBS Complete |
$1,113.78
|
| Rate for Payer: BCBS Trust/PPO |
$136.83
|
| Rate for Payer: BCN Commercial |
$2,434.10
|
| Rate for Payer: Cash Price |
$2,214.40
|
| Rate for Payer: Cash Price |
$2,214.40
|
| Rate for Payer: Meridian Medicaid |
$1,113.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,060.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,799.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,534.63
|
| Rate for Payer: Priority Health Narrow Network |
$2,534.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,755.43
|
| Rate for Payer: UHC Exchange |
$1,755.43
|
| Rate for Payer: UHCCP Medicaid |
$1,060.74
|
|
|
PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 95810
|
| Min. Negotiated Rate |
$73.91 |
| Max. Negotiated Rate |
$779.98 |
| Rate for Payer: Aetna Commercial |
$639.21
|
| Rate for Payer: Aetna Commercial |
$639.21
|
| Rate for Payer: Aetna Medicare |
$237.00
|
| Rate for Payer: Aetna Medicare |
$498.50
|
| Rate for Payer: BCBS Complete |
$77.61
|
| Rate for Payer: BCBS Complete |
$77.61
|
| Rate for Payer: BCBS Trust/PPO |
$634.49
|
| Rate for Payer: BCBS Trust/PPO |
$634.49
|
| Rate for Payer: BCN Commercial |
$712.68
|
| Rate for Payer: BCN Commercial |
$712.68
|
| Rate for Payer: Cash Price |
$797.60
|
| Rate for Payer: Cash Price |
$797.60
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Meridian Medicaid |
$77.61
|
| Rate for Payer: Meridian Medicaid |
$77.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.96
|
| Rate for Payer: Priority Health Narrow Network |
$156.96
|
| Rate for Payer: Priority Health Narrow Network |
$156.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$779.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$779.98
|
| Rate for Payer: UHC Exchange |
$779.98
|
| Rate for Payer: UHC Exchange |
$779.98
|
| Rate for Payer: UHCCP Medicaid |
$73.91
|
| Rate for Payer: UHCCP Medicaid |
$73.91
|
|
|
PR POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$1,736.00
|
|
|
Service Code
|
HCPCS 95782
|
| Min. Negotiated Rate |
$76.89 |
| Max. Negotiated Rate |
$1,387.84 |
| Rate for Payer: Aetna Commercial |
$958.65
|
| Rate for Payer: Aetna Commercial |
$958.65
|
| Rate for Payer: Aetna Medicare |
$868.00
|
| Rate for Payer: Aetna Medicare |
$129.00
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS Trust/PPO |
$567.92
|
| Rate for Payer: BCBS Trust/PPO |
$567.92
|
| Rate for Payer: BCN Commercial |
$1,387.84
|
| Rate for Payer: BCN Commercial |
$1,387.84
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$1,388.80
|
| Rate for Payer: Cash Price |
$1,388.80
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,128.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.18
|
| Rate for Payer: Priority Health Narrow Network |
$164.18
|
| Rate for Payer: Priority Health Narrow Network |
$164.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,149.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,149.36
|
| Rate for Payer: UHC Exchange |
$1,149.36
|
| Rate for Payer: UHC Exchange |
$1,149.36
|
| Rate for Payer: UHCCP Medicaid |
$76.89
|
| Rate for Payer: UHCCP Medicaid |
$76.89
|
|
|
PR POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$1,246.00
|
|
|
Service Code
|
HCPCS 95811
|
| Min. Negotiated Rate |
$77.11 |
| Max. Negotiated Rate |
$1,013.28 |
| Rate for Payer: Aetna Commercial |
$667.17
|
| Rate for Payer: Aetna Commercial |
$667.17
|
| Rate for Payer: Aetna Medicare |
$623.00
|
| Rate for Payer: Aetna Medicare |
$251.00
|
| Rate for Payer: BCBS Complete |
$80.97
|
| Rate for Payer: BCBS Complete |
$80.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,013.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,013.28
|
| Rate for Payer: BCN Commercial |
$745.67
|
| Rate for Payer: BCN Commercial |
$745.67
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cash Price |
$996.80
|
| Rate for Payer: Cash Price |
$996.80
|
| Rate for Payer: Meridian Medicaid |
$80.97
|
| Rate for Payer: Meridian Medicaid |
$80.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$809.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.29
|
| Rate for Payer: Priority Health Narrow Network |
$163.29
|
| Rate for Payer: Priority Health Narrow Network |
$163.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$860.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$860.97
|
| Rate for Payer: UHC Exchange |
$860.97
|
| Rate for Payer: UHC Exchange |
$860.97
|
| Rate for Payer: UHCCP Medicaid |
$77.11
|
| Rate for Payer: UHCCP Medicaid |
$77.11
|
|
|
PR POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
HCPCS 95783
|
| Min. Negotiated Rate |
$83.71 |
| Max. Negotiated Rate |
$1,470.43 |
| Rate for Payer: Aetna Commercial |
$1,016.43
|
| Rate for Payer: Aetna Commercial |
$1,016.43
|
| Rate for Payer: Aetna Medicare |
$926.50
|
| Rate for Payer: Aetna Medicare |
$141.00
|
| Rate for Payer: BCBS Complete |
$87.90
|
| Rate for Payer: BCBS Complete |
$87.90
|
| Rate for Payer: BCBS Trust/PPO |
$686.79
|
| Rate for Payer: BCBS Trust/PPO |
$686.79
|
| Rate for Payer: BCN Commercial |
$1,470.43
|
| Rate for Payer: BCN Commercial |
$1,470.43
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Meridian Medicaid |
$87.90
|
| Rate for Payer: Meridian Medicaid |
$87.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.12
|
| Rate for Payer: Priority Health Narrow Network |
$179.12
|
| Rate for Payer: Priority Health Narrow Network |
$179.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,226.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,226.99
|
| Rate for Payer: UHC Exchange |
$1,226.99
|
| Rate for Payer: UHC Exchange |
$1,226.99
|
| Rate for Payer: UHCCP Medicaid |
$83.71
|
| Rate for Payer: UHCCP Medicaid |
$83.71
|
|
|
PR POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND
|
Professional
|
Both
|
$1,740.00
|
|
|
Service Code
|
HCPCS 95808
|
| Min. Negotiated Rate |
$51.33 |
| Max. Negotiated Rate |
$1,131.00 |
| Rate for Payer: Aetna Commercial |
$682.59
|
| Rate for Payer: Aetna Commercial |
$682.59
|
| Rate for Payer: Aetna Medicare |
$215.00
|
| Rate for Payer: Aetna Medicare |
$870.00
|
| Rate for Payer: BCBS Complete |
$53.90
|
| Rate for Payer: BCBS Complete |
$53.90
|
| Rate for Payer: BCBS Trust/PPO |
$769.73
|
| Rate for Payer: BCBS Trust/PPO |
$769.73
|
| Rate for Payer: BCN Commercial |
$644.36
|
| Rate for Payer: BCN Commercial |
$644.36
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$1,392.00
|
| Rate for Payer: Cash Price |
$1,392.00
|
| Rate for Payer: Meridian Medicaid |
$53.90
|
| Rate for Payer: Meridian Medicaid |
$53.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,131.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.36
|
| Rate for Payer: Priority Health Narrow Network |
$110.36
|
| Rate for Payer: Priority Health Narrow Network |
$110.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$678.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$678.00
|
| Rate for Payer: UHC Exchange |
$678.00
|
| Rate for Payer: UHC Exchange |
$678.00
|
| Rate for Payer: UHCCP Medicaid |
$51.33
|
| Rate for Payer: UHCCP Medicaid |
$51.33
|
|
|
PR PORTOENETEROSTOMY
|
Professional
|
Both
|
$4,815.00
|
|
|
Service Code
|
HCPCS 47701
|
| Min. Negotiated Rate |
$362.41 |
| Max. Negotiated Rate |
$3,129.75 |
| Rate for Payer: Aetna Commercial |
$2,356.00
|
| Rate for Payer: Aetna Medicare |
$2,407.50
|
| Rate for Payer: BCBS Complete |
$1,167.90
|
| Rate for Payer: BCBS Trust/PPO |
$362.41
|
| Rate for Payer: BCN Commercial |
$2,534.28
|
| Rate for Payer: Cash Price |
$3,852.00
|
| Rate for Payer: Cash Price |
$3,852.00
|
| Rate for Payer: Meridian Medicaid |
$1,167.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,112.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,129.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,104.67
|
| Rate for Payer: Priority Health Narrow Network |
$3,104.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,135.38
|
| Rate for Payer: UHC Exchange |
$2,135.38
|
| Rate for Payer: UHCCP Medicaid |
$1,112.29
|
|
|
PR POSITIONAL NYSTAGMUS TEST
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 92542
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$1,840.07 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,840.07
|
| Rate for Payer: BCN Commercial |
$42.02
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.02
|
| Rate for Payer: Priority Health Narrow Network |
$33.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.10
|
| Rate for Payer: UHC Exchange |
$53.10
|
| Rate for Payer: UHCCP Medicaid |
$15.76
|
|
|
PR POST-CATARACT LASER SURGERY
|
Professional
|
Both
|
$574.00
|
|
|
Service Code
|
HCPCS 66821
|
| Min. Negotiated Rate |
$196.81 |
| Max. Negotiated Rate |
$543.38 |
| Rate for Payer: Aetna Commercial |
$402.65
|
| Rate for Payer: Aetna Medicare |
$287.00
|
| Rate for Payer: BCBS Complete |
$206.65
|
| Rate for Payer: BCBS Trust/PPO |
$417.89
|
| Rate for Payer: BCN Commercial |
$483.30
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Meridian Medicaid |
$206.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$543.38
|
| Rate for Payer: Priority Health Narrow Network |
$543.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$318.76
|
| Rate for Payer: UHC Exchange |
$318.76
|
| Rate for Payer: UHCCP Medicaid |
$196.81
|
|
|
PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Professional
|
Both
|
$1,407.00
|
|
|
Service Code
|
HCPCS 57250
|
| Min. Negotiated Rate |
$395.33 |
| Max. Negotiated Rate |
$1,809.43 |
| Rate for Payer: Aetna Commercial |
$731.56
|
| Rate for Payer: Aetna Medicare |
$703.50
|
| Rate for Payer: BCBS Complete |
$415.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,809.43
|
| Rate for Payer: BCN Commercial |
$904.06
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Meridian Medicaid |
$415.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$914.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$922.14
|
| Rate for Payer: Priority Health Narrow Network |
$922.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$762.28
|
| Rate for Payer: UHC Exchange |
$762.28
|
| Rate for Payer: UHCCP Medicaid |
$395.33
|
|
|
PR POSTERIOR NON-SEGMENTAL INSTRUMENTATION
|
Professional
|
Both
|
$3,333.00
|
|
|
Service Code
|
HCPCS 22840
|
| Min. Negotiated Rate |
$482.23 |
| Max. Negotiated Rate |
$21,897.63 |
| Rate for Payer: Aetna Commercial |
$1,021.35
|
| Rate for Payer: Aetna Medicare |
$1,666.50
|
| Rate for Payer: BCBS Complete |
$506.34
|
| Rate for Payer: BCBS Trust/PPO |
$21,897.63
|
| Rate for Payer: BCN Commercial |
$1,213.35
|
| Rate for Payer: Cash Price |
$2,666.40
|
| Rate for Payer: Cash Price |
$2,666.40
|
| Rate for Payer: Meridian Medicaid |
$506.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$482.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,166.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,150.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,150.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$918.43
|
| Rate for Payer: UHC Exchange |
$918.43
|
| Rate for Payer: UHCCP Medicaid |
$482.23
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SE
|
Professional
|
Both
|
$3,929.00
|
|
|
Service Code
|
HCPCS 22844
|
| Min. Negotiated Rate |
$53.49 |
| Max. Negotiated Rate |
$2,553.85 |
| Rate for Payer: Aetna Commercial |
$1,328.64
|
| Rate for Payer: Aetna Medicare |
$1,964.50
|
| Rate for Payer: BCBS Complete |
$662.00
|
| Rate for Payer: BCBS Trust/PPO |
$53.49
|
| Rate for Payer: BCN Commercial |
$1,576.55
|
| Rate for Payer: Cash Price |
$3,143.20
|
| Rate for Payer: Cash Price |
$3,143.20
|
| Rate for Payer: Meridian Medicaid |
$662.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$630.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,553.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,493.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,493.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,182.47
|
| Rate for Payer: UHC Exchange |
$1,182.47
|
| Rate for Payer: UHCCP Medicaid |
$630.48
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG
|
Professional
|
Both
|
$3,720.00
|
|
|
Service Code
|
HCPCS 22842
|
| Min. Negotiated Rate |
$483.43 |
| Max. Negotiated Rate |
$2,418.00 |
| Rate for Payer: Aetna Commercial |
$1,025.97
|
| Rate for Payer: Aetna Medicare |
$1,860.00
|
| Rate for Payer: BCBS Complete |
$512.61
|
| Rate for Payer: BCBS Trust/PPO |
$483.43
|
| Rate for Payer: BCN Commercial |
$1,222.50
|
| Rate for Payer: Cash Price |
$2,976.00
|
| Rate for Payer: Cash Price |
$2,976.00
|
| Rate for Payer: Meridian Medicaid |
$512.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$488.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,418.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,160.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,160.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$920.04
|
| Rate for Payer: UHC Exchange |
$920.04
|
| Rate for Payer: UHCCP Medicaid |
$488.20
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG
|
Professional
|
Both
|
$4,091.00
|
|
|
Service Code
|
HCPCS 22843
|
| Min. Negotiated Rate |
$145.43 |
| Max. Negotiated Rate |
$2,659.15 |
| Rate for Payer: Aetna Commercial |
$1,097.80
|
| Rate for Payer: Aetna Medicare |
$2,045.50
|
| Rate for Payer: BCBS Complete |
$549.29
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: BCN Commercial |
$1,308.59
|
| Rate for Payer: Cash Price |
$3,272.80
|
| Rate for Payer: Cash Price |
$3,272.80
|
| Rate for Payer: Meridian Medicaid |
$549.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$523.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,659.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,243.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,243.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$976.21
|
| Rate for Payer: UHC Exchange |
$976.21
|
| Rate for Payer: UHCCP Medicaid |
$523.13
|
|
|
PR POSTPARTUM CARE ONLY SEPARATE PROCEDURE
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 59430
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$198.09
|
| Rate for Payer: Aetna Medicare |
$224.50
|
| Rate for Payer: BCBS Complete |
$174.07
|
| Rate for Payer: BCBS Trust/PPO |
$23.25
|
| Rate for Payer: BCN Commercial |
$309.12
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Meridian Medicaid |
$174.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.05
|
| Rate for Payer: Priority Health Narrow Network |
$251.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.34
|
| Rate for Payer: UHC Exchange |
$144.34
|
| Rate for Payer: UHCCP Medicaid |
$165.78
|
|
|
PR POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
HCPCS 64566
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$861.13 |
| Rate for Payer: Aetna Commercial |
$39.89
|
| Rate for Payer: Aetna Medicare |
$115.50
|
| Rate for Payer: BCBS Complete |
$19.91
|
| Rate for Payer: BCBS Trust/PPO |
$861.13
|
| Rate for Payer: BCN Commercial |
$171.52
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Meridian Medicaid |
$19.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.74
|
| Rate for Payer: UHC Exchange |
$38.74
|
| Rate for Payer: UHCCP Medicaid |
$18.96
|
|
|
PR POTASSIUM HYDROXIDE PREPS
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS Q0112
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$334.41 |
| Rate for Payer: Aetna Commercial |
$5.54
|
| Rate for Payer: Aetna Medicare |
$11.00
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS Trust/PPO |
$334.41
|
| Rate for Payer: BCN Commercial |
$4.37
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.11
|
| Rate for Payer: UHC Exchange |
$6.11
|
|
|
PR PPPS, INITIAL VISIT
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS G0438
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$387.24 |
| Rate for Payer: Aetna Commercial |
$164.23
|
| Rate for Payer: Aetna Medicare |
$129.50
|
| Rate for Payer: BCBS Complete |
$103.60
|
| Rate for Payer: BCBS Trust/PPO |
$387.24
|
| Rate for Payer: BCN Commercial |
$239.95
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.97
|
| Rate for Payer: Priority Health Narrow Network |
$217.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.29
|
| Rate for Payer: UHC Exchange |
$189.29
|
|
