|
PR PRGRMG DEV EVAL 1 LEAD PM/LDLS PM 1 CAR CHMBR IP
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 93279
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$530.41 |
| Rate for Payer: Aetna Commercial |
$85.64
|
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: BCBS Complete |
$20.58
|
| Rate for Payer: BCBS Trust/PPO |
$530.41
|
| Rate for Payer: BCN Commercial |
$99.20
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Meridian Medicaid |
$20.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.84
|
| Rate for Payer: Priority Health Narrow Network |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.22
|
| Rate for Payer: UHC Exchange |
$56.22
|
| Rate for Payer: UHCCP Medicaid |
$19.60
|
|
|
PR PRGRMG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 93285
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$1,404.75 |
| Rate for Payer: Aetna Commercial |
$76.52
|
| Rate for Payer: Aetna Commercial |
$76.52
|
| Rate for Payer: Aetna Medicare |
$43.50
|
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,404.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,404.75
|
| Rate for Payer: BCN Commercial |
$88.94
|
| Rate for Payer: BCN Commercial |
$88.94
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.84
|
| Rate for Payer: Priority Health Narrow Network |
$34.84
|
| Rate for Payer: Priority Health Narrow Network |
$34.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.42
|
| Rate for Payer: UHC Exchange |
$47.42
|
| Rate for Payer: UHC Exchange |
$47.42
|
| Rate for Payer: UHCCP Medicaid |
$15.76
|
| Rate for Payer: UHCCP Medicaid |
$15.76
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 93284
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$1,468.15 |
| Rate for Payer: Aetna Commercial |
$137.14
|
| Rate for Payer: Aetna Medicare |
$85.00
|
| Rate for Payer: BCBS Complete |
$39.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,468.15
|
| Rate for Payer: BCN Commercial |
$155.40
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Meridian Medicaid |
$39.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.34
|
| Rate for Payer: Priority Health Narrow Network |
$83.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.47
|
| Rate for Payer: UHC Exchange |
$101.47
|
| Rate for Payer: UHCCP Medicaid |
$37.91
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 93283
|
| Min. Negotiated Rate |
$34.93 |
| Max. Negotiated Rate |
$214.49 |
| Rate for Payer: Aetna Commercial |
$126.86
|
| Rate for Payer: Aetna Medicare |
$79.00
|
| Rate for Payer: BCBS Complete |
$36.68
|
| Rate for Payer: BCBS Trust/PPO |
$214.49
|
| Rate for Payer: BCN Commercial |
$144.16
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Meridian Medicaid |
$36.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.75
|
| Rate for Payer: Priority Health Narrow Network |
$76.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.90
|
| Rate for Payer: UHC Exchange |
$90.90
|
| Rate for Payer: UHCCP Medicaid |
$34.93
|
|
|
PR PRGRMNG DEV EVAL IMPLANTABLE IN PERSN 1 LD DFB
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 93282
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$1,583.32 |
| Rate for Payer: Aetna Commercial |
$103.28
|
| Rate for Payer: Aetna Medicare |
$62.00
|
| Rate for Payer: BCBS Complete |
$27.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,583.32
|
| Rate for Payer: BCN Commercial |
$118.26
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Meridian Medicaid |
$27.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.51
|
| Rate for Payer: Priority Health Narrow Network |
$56.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.04
|
| Rate for Payer: UHC Exchange |
$71.04
|
| Rate for Payer: UHCCP Medicaid |
$25.77
|
|
|
PR PRICARDIECTOMY STOT/COMPL W/CARDPULM BYPASS
|
Professional
|
Both
|
$5,726.00
|
|
|
Service Code
|
HCPCS 33031
|
| Min. Negotiated Rate |
$1,051.32 |
| Max. Negotiated Rate |
$3,869.03 |
| Rate for Payer: Aetna Commercial |
$3,326.92
|
| Rate for Payer: Aetna Medicare |
$2,863.00
|
| Rate for Payer: BCBS Complete |
$1,632.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,051.32
|
| Rate for Payer: BCN Commercial |
$3,542.92
|
| Rate for Payer: Cash Price |
$4,580.80
|
| Rate for Payer: Cash Price |
$4,580.80
|
| Rate for Payer: Meridian Medicaid |
$1,632.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,554.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,721.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,869.03
|
| Rate for Payer: Priority Health Narrow Network |
$3,869.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,861.26
|
| Rate for Payer: UHC Exchange |
$1,861.26
|
| Rate for Payer: UHCCP Medicaid |
$1,554.47
|
|
|
PR PRICARDIECTOMY STOT/COMPL W/O CARDPULM BYPASS
|
Professional
|
Both
|
$3,419.00
|
|
|
Service Code
|
HCPCS 33030
|
| Min. Negotiated Rate |
$1,062.94 |
| Max. Negotiated Rate |
$3,133.51 |
| Rate for Payer: Aetna Commercial |
$2,685.08
|
| Rate for Payer: Aetna Medicare |
$1,709.50
|
| Rate for Payer: BCBS Complete |
$1,322.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,062.94
|
| Rate for Payer: BCN Commercial |
$2,865.11
|
| Rate for Payer: Cash Price |
$2,735.20
|
| Rate for Payer: Cash Price |
$2,735.20
|
| Rate for Payer: Meridian Medicaid |
$1,322.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,259.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,222.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,133.51
|
| Rate for Payer: Priority Health Narrow Network |
$3,133.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,664.79
|
| Rate for Payer: UHC Exchange |
$1,664.79
|
| Rate for Payer: UHCCP Medicaid |
$1,259.90
|
|
|
PR PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST
|
Professional
|
Both
|
$4,133.00
|
|
|
Service Code
|
HCPCS 37184
|
| Min. Negotiated Rate |
$268.81 |
| Max. Negotiated Rate |
$2,686.45 |
| Rate for Payer: Aetna Commercial |
$578.15
|
| Rate for Payer: Aetna Medicare |
$2,066.50
|
| Rate for Payer: BCBS Complete |
$282.25
|
| Rate for Payer: BCBS Trust/PPO |
$939.85
|
| Rate for Payer: BCN Commercial |
$2,516.69
|
| Rate for Payer: Cash Price |
$3,306.40
|
| Rate for Payer: Cash Price |
$3,306.40
|
| Rate for Payer: Meridian Medicaid |
$282.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,686.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$667.44
|
| Rate for Payer: Priority Health Narrow Network |
$667.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$605.31
|
| Rate for Payer: UHC Exchange |
$605.31
|
| Rate for Payer: UHCCP Medicaid |
$268.81
|
|
|
PR PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA SBSQ
|
Professional
|
Both
|
$3,440.00
|
|
|
Service Code
|
HCPCS 37185
|
| Min. Negotiated Rate |
$101.39 |
| Max. Negotiated Rate |
$2,236.00 |
| Rate for Payer: Aetna Commercial |
$219.24
|
| Rate for Payer: Aetna Medicare |
$1,720.00
|
| Rate for Payer: BCBS Complete |
$106.46
|
| Rate for Payer: BCBS Trust/PPO |
$728.00
|
| Rate for Payer: BCN Commercial |
$693.44
|
| Rate for Payer: Cash Price |
$2,752.00
|
| Rate for Payer: Cash Price |
$2,752.00
|
| Rate for Payer: Meridian Medicaid |
$106.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,236.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.08
|
| Rate for Payer: Priority Health Narrow Network |
$252.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.08
|
| Rate for Payer: UHC Exchange |
$225.08
|
| Rate for Payer: UHCCP Medicaid |
$101.39
|
|
|
PR PRINCIPAL CARE MGMT SVC 1ST 30 PHYS/QHP CAL MO
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 99424
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$1,314.94 |
| Rate for Payer: Aetna Commercial |
$74.16
|
| Rate for Payer: Aetna Medicare |
$83.00
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,314.94
|
| Rate for Payer: BCN Commercial |
$117.28
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Meridian Medicaid |
$49.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.66
|
| Rate for Payer: Priority Health Narrow Network |
$82.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.79
|
| Rate for Payer: UHC Exchange |
$87.79
|
| Rate for Payer: UHCCP Medicaid |
$47.50
|
|
|
PR PRINCIPAL CARE MGMT SVC 1ST 30 STAFF CAL MO
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 99426
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$1,519.92 |
| Rate for Payer: Aetna Commercial |
$49.79
|
| Rate for Payer: Aetna Medicare |
$63.00
|
| Rate for Payer: BCBS Complete |
$32.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,519.92
|
| Rate for Payer: BCN Commercial |
$88.45
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Meridian Medicaid |
$32.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.98
|
| Rate for Payer: Priority Health Narrow Network |
$54.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.91
|
| Rate for Payer: UHC Exchange |
$58.91
|
| Rate for Payer: UHCCP Medicaid |
$31.31
|
|
|
PR PRINCIPAL CARE MGMT SVC EA ADDL 30 STAFF CAL MO
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 99427
|
| Min. Negotiated Rate |
$22.58 |
| Max. Negotiated Rate |
$971.54 |
| Rate for Payer: Aetna Commercial |
$35.13
|
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: BCBS Complete |
$23.71
|
| Rate for Payer: BCBS Trust/PPO |
$971.54
|
| Rate for Payer: BCN Commercial |
$68.41
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Meridian Medicaid |
$23.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.52
|
| Rate for Payer: Priority Health Narrow Network |
$38.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.53
|
| Rate for Payer: UHC Exchange |
$41.53
|
| Rate for Payer: UHCCP Medicaid |
$22.58
|
|
|
PR PRINCIPAL CARE MGMT SVC EA ADL 30 PHY/QHP CAL MO
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 99425
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$1,104.48 |
| Rate for Payer: Aetna Commercial |
$51.70
|
| Rate for Payer: Aetna Medicare |
$60.00
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,104.48
|
| Rate for Payer: BCN Commercial |
$84.05
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Meridian Medicaid |
$34.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.85
|
| Rate for Payer: Priority Health Narrow Network |
$56.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.25
|
| Rate for Payer: UHC Exchange |
$61.25
|
| Rate for Payer: UHCCP Medicaid |
$32.38
|
|
|
PR PROBE NASOLACRIMAL DUCT W/WO IRRIGATION
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
HCPCS 68810
|
| Min. Negotiated Rate |
$81.58 |
| Max. Negotiated Rate |
$4,968.66 |
| Rate for Payer: Aetna Commercial |
$165.22
|
| Rate for Payer: Aetna Medicare |
$142.00
|
| Rate for Payer: BCBS Complete |
$85.66
|
| Rate for Payer: BCBS Trust/PPO |
$4,968.66
|
| Rate for Payer: BCN Commercial |
$188.09
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Meridian Medicaid |
$85.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.86
|
| Rate for Payer: Priority Health Narrow Network |
$222.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.94
|
| Rate for Payer: UHC Exchange |
$199.94
|
| Rate for Payer: UHCCP Medicaid |
$81.58
|
|
|
PR PROCHLORPERAZINE INJECTION
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J0780
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.73
|
| Rate for Payer: BCN Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.05
|
| Rate for Payer: UHC Exchange |
$4.05
|
|
|
PR PROCTOPEXY ABDOMINAL APPROACH
|
Professional
|
Both
|
$3,082.00
|
|
|
Service Code
|
HCPCS 45540
|
| Min. Negotiated Rate |
$670.74 |
| Max. Negotiated Rate |
$2,003.30 |
| Rate for Payer: Aetna Commercial |
$1,412.95
|
| Rate for Payer: Aetna Medicare |
$1,541.00
|
| Rate for Payer: BCBS Complete |
$704.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,895.01
|
| Rate for Payer: BCN Commercial |
$1,528.09
|
| Rate for Payer: Cash Price |
$2,465.60
|
| Rate for Payer: Cash Price |
$2,465.60
|
| Rate for Payer: Meridian Medicaid |
$704.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$670.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,003.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,869.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,869.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,276.71
|
| Rate for Payer: UHC Exchange |
$1,276.71
|
| Rate for Payer: UHCCP Medicaid |
$670.74
|
|
|
PR PROCTOPEXY PERINEAL APPROACH
|
Professional
|
Both
|
$1,658.00
|
|
|
Service Code
|
HCPCS 45541
|
| Min. Negotiated Rate |
$603.43 |
| Max. Negotiated Rate |
$2,270.63 |
| Rate for Payer: Aetna Commercial |
$1,266.92
|
| Rate for Payer: Aetna Medicare |
$829.00
|
| Rate for Payer: BCBS Complete |
$633.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,270.63
|
| Rate for Payer: BCN Commercial |
$1,368.30
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Meridian Medicaid |
$633.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$603.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,677.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,677.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,099.88
|
| Rate for Payer: UHC Exchange |
$1,099.88
|
| Rate for Payer: UHCCP Medicaid |
$603.43
|
|
|
PR PROCTOPEXY W/SIGMOID RESCJ ABDL APPR
|
Professional
|
Both
|
$3,690.00
|
|
|
Service Code
|
HCPCS 45550
|
| Min. Negotiated Rate |
$927.62 |
| Max. Negotiated Rate |
$2,582.05 |
| Rate for Payer: Aetna Commercial |
$1,961.26
|
| Rate for Payer: Aetna Medicare |
$1,845.00
|
| Rate for Payer: BCBS Complete |
$974.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,697.43
|
| Rate for Payer: BCN Commercial |
$2,116.46
|
| Rate for Payer: Cash Price |
$2,952.00
|
| Rate for Payer: Cash Price |
$2,952.00
|
| Rate for Payer: Meridian Medicaid |
$974.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,398.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,582.05
|
| Rate for Payer: Priority Health Narrow Network |
$2,582.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,762.65
|
| Rate for Payer: UHC Exchange |
$1,762.65
|
| Rate for Payer: UHCCP Medicaid |
$927.62
|
|
|
PR PROCTOPLASTY PROLAPSE MUCOUS MEMBRANE
|
Professional
|
Both
|
$1,687.00
|
|
|
Service Code
|
HCPCS 45505
|
| Min. Negotiated Rate |
$389.15 |
| Max. Negotiated Rate |
$2,064.60 |
| Rate for Payer: Aetna Commercial |
$801.01
|
| Rate for Payer: Aetna Medicare |
$843.50
|
| Rate for Payer: BCBS Complete |
$408.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,064.60
|
| Rate for Payer: BCN Commercial |
$882.55
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Meridian Medicaid |
$408.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,096.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,082.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,082.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$676.61
|
| Rate for Payer: UHC Exchange |
$676.61
|
| Rate for Payer: UHCCP Medicaid |
$389.15
|
|
|
PR PROCTOPLASTY STENOSIS
|
Professional
|
Both
|
$1,140.00
|
|
|
Service Code
|
HCPCS 45500
|
| Min. Negotiated Rate |
$370.19 |
| Max. Negotiated Rate |
$2,757.73 |
| Rate for Payer: Aetna Commercial |
$764.12
|
| Rate for Payer: Aetna Medicare |
$570.00
|
| Rate for Payer: BCBS Complete |
$388.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,757.73
|
| Rate for Payer: BCN Commercial |
$836.62
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Meridian Medicaid |
$388.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$370.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$741.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,027.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,027.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$607.78
|
| Rate for Payer: UHC Exchange |
$607.78
|
| Rate for Payer: UHCCP Medicaid |
$370.19
|
|
|
PR PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 45300
|
| Hospital Charge Code |
45300
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$502.41 |
| Rate for Payer: Aetna Commercial |
$64.28
|
| Rate for Payer: Aetna Medicare |
$98.50
|
| Rate for Payer: BCBS Complete |
$32.66
|
| Rate for Payer: BCBS Trust/PPO |
$502.41
|
| Rate for Payer: BCN Commercial |
$151.96
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Meridian Medicaid |
$32.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.90
|
| Rate for Payer: Priority Health Narrow Network |
$85.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.20
|
| Rate for Payer: UHC Exchange |
$62.20
|
| Rate for Payer: UHCCP Medicaid |
$31.10
|
|
|
PR PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
45300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$128.05 |
| Max. Negotiated Rate |
$1,384.58 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Medicare |
$893.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,116.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,116.60
|
| Rate for Payer: ASR ASR |
$191.09
|
| Rate for Payer: ASR Commercial |
$191.09
|
| Rate for Payer: BCBS Complete |
$502.74
|
| Rate for Payer: BCBS MAPPO |
$893.28
|
| Rate for Payer: BCBS Trust/PPO |
$161.32
|
| Rate for Payer: BCN Commercial |
$152.73
|
| Rate for Payer: BCN Medicare Advantage |
$893.28
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$185.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$893.28
|
| Rate for Payer: Healthscope Commercial |
$197.00
|
| Rate for Payer: Healthscope Whirlpool |
$191.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$893.28
|
| Rate for Payer: Mclaren Commercial |
$177.30
|
| Rate for Payer: Mclaren Medicaid |
$478.80
|
| Rate for Payer: Mclaren Medicare |
$893.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$937.94
|
| Rate for Payer: Meridian Medicaid |
$502.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,027.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.45
|
| Rate for Payer: Nomi Health Commercial |
$161.54
|
| Rate for Payer: PACE Medicare |
$848.62
|
| Rate for Payer: PACE SWMI |
$893.28
|
| Rate for Payer: PHP Commercial |
$982.61
|
| Rate for Payer: PHP Medicaid |
$478.80
|
| Rate for Payer: PHP Medicare Advantage |
$893.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$478.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$172.61
|
| Rate for Payer: Priority Health Medicare |
$893.28
|
| Rate for Payer: Priority Health Narrow Network |
$138.10
|
| Rate for Payer: Railroad Medicare Medicare |
$893.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$893.28
|
| Rate for Payer: UHC Exchange |
$1,384.58
|
| Rate for Payer: UHC Medicare Advantage |
$893.28
|
| Rate for Payer: UHCCP DNSP |
$893.28
|
| Rate for Payer: UHCCP Medicaid |
$478.80
|
| Rate for Payer: VA VA |
$893.28
|
|
|
PR PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
45300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$128.05 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: ASR ASR |
$191.09
|
| Rate for Payer: ASR Commercial |
$191.09
|
| Rate for Payer: BCBS Trust/PPO |
$160.54
|
| Rate for Payer: BCN Commercial |
$152.73
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$185.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.60
|
| Rate for Payer: Healthscope Commercial |
$197.00
|
| Rate for Payer: Healthscope Whirlpool |
$191.09
|
| Rate for Payer: Mclaren Commercial |
$177.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.45
|
| Rate for Payer: Nomi Health Commercial |
$161.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.36
|
|
|
PR PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 45300
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$502.41 |
| Rate for Payer: Aetna Commercial |
$64.28
|
| Rate for Payer: Aetna Medicare |
$98.50
|
| Rate for Payer: BCBS Complete |
$32.66
|
| Rate for Payer: BCBS Trust/PPO |
$502.41
|
| Rate for Payer: BCN Commercial |
$151.96
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Meridian Medicaid |
$32.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.90
|
| Rate for Payer: Priority Health Narrow Network |
$85.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.20
|
| Rate for Payer: UHC Exchange |
$62.20
|
| Rate for Payer: UHCCP Medicaid |
$31.10
|
|
|
PR PROCTOSGMDSC RIGID ABLATION LESION
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
HCPCS 45320
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$330.35 |
| Rate for Payer: Aetna Commercial |
$140.99
|
| Rate for Payer: Aetna Medicare |
$241.00
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCBS Trust/PPO |
$223.95
|
| Rate for Payer: BCN Commercial |
$330.35
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.33
|
| Rate for Payer: Priority Health Narrow Network |
$187.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.54
|
| Rate for Payer: UHC Exchange |
$132.54
|
| Rate for Payer: UHCCP Medicaid |
$67.95
|
|
