|
PR PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL
|
Professional
|
Both
|
$1,243.00
|
|
|
Service Code
|
HCPCS 92937
|
| Min. Negotiated Rate |
$146.34 |
| Max. Negotiated Rate |
$837.60 |
| Rate for Payer: Aetna Commercial |
$655.81
|
| Rate for Payer: Aetna Medicare |
$621.50
|
| Rate for Payer: BCBS Complete |
$384.68
|
| Rate for Payer: BCBS Trust/PPO |
$146.34
|
| Rate for Payer: BCN Commercial |
$837.60
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Meridian Medicaid |
$384.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$366.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$809.36
|
| Rate for Payer: Priority Health Narrow Network |
$809.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$819.86
|
| Rate for Payer: UHC Exchange |
$819.86
|
| Rate for Payer: UHCCP Medicaid |
$366.36
|
|
|
PR PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 92934
|
| Min. Negotiated Rate |
$82.41 |
| Max. Negotiated Rate |
$809.25 |
| Rate for Payer: Aetna Commercial |
$273.84
|
| Rate for Payer: Aetna Medicare |
$622.50
|
| Rate for Payer: BCBS Complete |
$498.00
|
| Rate for Payer: BCBS Trust/PPO |
$82.41
|
| Rate for Payer: BCN Commercial |
$253.73
|
| Rate for Payer: Cash Price |
$996.00
|
| Rate for Payer: Cash Price |
$996.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$809.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$310.00
|
| Rate for Payer: Priority Health Narrow Network |
$310.00
|
|
|
PR PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH
|
Professional
|
Both
|
$1,213.00
|
|
|
Service Code
|
HCPCS 92929
|
| Min. Negotiated Rate |
$226.41 |
| Max. Negotiated Rate |
$788.45 |
| Rate for Payer: Aetna Commercial |
$352.65
|
| Rate for Payer: Aetna Medicare |
$606.50
|
| Rate for Payer: BCBS Complete |
$485.20
|
| Rate for Payer: BCBS Trust/PPO |
$250.41
|
| Rate for Payer: BCN Commercial |
$226.41
|
| Rate for Payer: Cash Price |
$970.40
|
| Rate for Payer: Cash Price |
$970.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$275.00
|
| Rate for Payer: Priority Health Narrow Network |
$275.00
|
|
|
PR PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
HCPCS 92928
|
| Min. Negotiated Rate |
$334.41 |
| Max. Negotiated Rate |
$838.57 |
| Rate for Payer: Aetna Commercial |
$656.55
|
| Rate for Payer: Aetna Medicare |
$622.00
|
| Rate for Payer: BCBS Complete |
$384.90
|
| Rate for Payer: BCBS Trust/PPO |
$334.41
|
| Rate for Payer: BCN Commercial |
$838.57
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Meridian Medicaid |
$384.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$366.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$808.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$809.36
|
| Rate for Payer: Priority Health Narrow Network |
$809.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$820.78
|
| Rate for Payer: UHC Exchange |
$820.78
|
| Rate for Payer: UHCCP Medicaid |
$366.57
|
|
|
PR PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL
|
Professional
|
Both
|
$1,392.00
|
|
|
Service Code
|
HCPCS 92943
|
| Min. Negotiated Rate |
$411.94 |
| Max. Negotiated Rate |
$1,794.11 |
| Rate for Payer: Aetna Commercial |
$738.29
|
| Rate for Payer: Aetna Medicare |
$696.00
|
| Rate for Payer: BCBS Complete |
$432.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,794.11
|
| Rate for Payer: BCN Commercial |
$941.68
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Meridian Medicaid |
$432.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$411.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$904.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$908.72
|
| Rate for Payer: Priority Health Narrow Network |
$908.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$919.70
|
| Rate for Payer: UHC Exchange |
$919.70
|
| Rate for Payer: UHCCP Medicaid |
$411.94
|
|
|
PR PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH
|
Professional
|
Both
|
$1,437.00
|
|
|
Service Code
|
HCPCS 92933
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$939.73 |
| Rate for Payer: Aetna Commercial |
$737.15
|
| Rate for Payer: Aetna Medicare |
$718.50
|
| Rate for Payer: BCBS Complete |
$432.10
|
| Rate for Payer: BCBS Trust/PPO |
$128.38
|
| Rate for Payer: BCN Commercial |
$939.73
|
| Rate for Payer: Cash Price |
$1,149.60
|
| Rate for Payer: Cash Price |
$1,149.60
|
| Rate for Payer: Meridian Medicaid |
$432.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$411.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$934.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$907.77
|
| Rate for Payer: Priority Health Narrow Network |
$907.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$917.83
|
| Rate for Payer: UHC Exchange |
$917.83
|
| Rate for Payer: UHCCP Medicaid |
$411.52
|
|
|
PR PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL
|
Professional
|
Both
|
$1,398.00
|
|
|
Service Code
|
HCPCS 92941
|
| Min. Negotiated Rate |
$180.15 |
| Max. Negotiated Rate |
$940.71 |
| Rate for Payer: Aetna Commercial |
$737.52
|
| Rate for Payer: Aetna Medicare |
$699.00
|
| Rate for Payer: BCBS Complete |
$432.54
|
| Rate for Payer: BCBS Trust/PPO |
$180.15
|
| Rate for Payer: BCN Commercial |
$940.71
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Meridian Medicaid |
$432.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$411.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$908.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$908.72
|
| Rate for Payer: Priority Health Narrow Network |
$908.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$919.70
|
| Rate for Payer: UHC Exchange |
$919.70
|
| Rate for Payer: UHCCP Medicaid |
$411.94
|
|
|
PR PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX
|
Professional
|
Both
|
$542.00
|
|
|
Service Code
|
HCPCS 37188
|
| Min. Negotiated Rate |
$176.36 |
| Max. Negotiated Rate |
$2,165.33 |
| Rate for Payer: Aetna Commercial |
$371.46
|
| Rate for Payer: Aetna Medicare |
$271.00
|
| Rate for Payer: BCBS Complete |
$185.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,237.28
|
| Rate for Payer: BCN Commercial |
$2,165.33
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Meridian Medicaid |
$185.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.56
|
| Rate for Payer: Priority Health Narrow Network |
$435.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.73
|
| Rate for Payer: UHC Exchange |
$393.73
|
| Rate for Payer: UHCCP Medicaid |
$176.36
|
|
|
PR PRTL ESOPHAGECTOMY CERVICAL W/FREE INTSTINAL GRF
|
Professional
|
Both
|
$9,458.00
|
|
|
Service Code
|
HCPCS 43116
|
| Min. Negotiated Rate |
$216.60 |
| Max. Negotiated Rate |
$8,719.22 |
| Rate for Payer: Aetna Commercial |
$6,701.66
|
| Rate for Payer: Aetna Medicare |
$4,729.00
|
| Rate for Payer: BCBS Complete |
$3,274.24
|
| Rate for Payer: BCBS Trust/PPO |
$216.60
|
| Rate for Payer: BCN Commercial |
$7,124.91
|
| Rate for Payer: Cash Price |
$7,566.40
|
| Rate for Payer: Cash Price |
$7,566.40
|
| Rate for Payer: Meridian Medicaid |
$3,274.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,118.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,147.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,719.22
|
| Rate for Payer: Priority Health Narrow Network |
$8,719.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,261.04
|
| Rate for Payer: UHC Exchange |
$6,261.04
|
| Rate for Payer: UHCCP Medicaid |
$3,118.32
|
|
|
PR PRTL ESOPHAGEC W/WO PROX GASTREC/PYLOROPLASTY
|
Professional
|
Both
|
$6,010.00
|
|
|
Service Code
|
HCPCS 43121
|
| Min. Negotiated Rate |
$86.60 |
| Max. Negotiated Rate |
$5,034.65 |
| Rate for Payer: Aetna Commercial |
$3,841.89
|
| Rate for Payer: Aetna Medicare |
$3,005.00
|
| Rate for Payer: BCBS Complete |
$1,892.08
|
| Rate for Payer: BCBS Trust/PPO |
$86.60
|
| Rate for Payer: BCN Commercial |
$4,105.38
|
| Rate for Payer: Cash Price |
$4,808.00
|
| Rate for Payer: Cash Price |
$4,808.00
|
| Rate for Payer: Meridian Medicaid |
$1,892.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,801.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,906.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,034.65
|
| Rate for Payer: Priority Health Narrow Network |
$5,034.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,633.35
|
| Rate for Payer: UHC Exchange |
$3,633.35
|
| Rate for Payer: UHCCP Medicaid |
$1,801.98
|
|
|
PR PRTL ESOPHECT DSTL W/WO PROX GASTRECT/PYLORPLSTY
|
Professional
|
Both
|
$6,334.00
|
|
|
Service Code
|
HCPCS 43117
|
| Min. Negotiated Rate |
$147.40 |
| Max. Negotiated Rate |
$5,746.98 |
| Rate for Payer: Aetna Commercial |
$4,374.05
|
| Rate for Payer: Aetna Medicare |
$3,167.00
|
| Rate for Payer: BCBS Complete |
$2,161.58
|
| Rate for Payer: BCBS Trust/PPO |
$147.40
|
| Rate for Payer: BCN Commercial |
$4,684.46
|
| Rate for Payer: Cash Price |
$5,067.20
|
| Rate for Payer: Cash Price |
$5,067.20
|
| Rate for Payer: Meridian Medicaid |
$2,161.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,058.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,117.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,746.98
|
| Rate for Payer: Priority Health Narrow Network |
$5,746.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,137.30
|
| Rate for Payer: UHC Exchange |
$3,137.30
|
| Rate for Payer: UHCCP Medicaid |
$2,058.65
|
|
|
PR PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 28122
|
| Min. Negotiated Rate |
$285.63 |
| Max. Negotiated Rate |
$1,020.15 |
| Rate for Payer: Aetna Commercial |
$578.62
|
| Rate for Payer: Aetna Medicare |
$622.50
|
| Rate for Payer: BCBS Complete |
$299.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,020.15
|
| Rate for Payer: BCN Commercial |
$859.58
|
| Rate for Payer: Cash Price |
$996.00
|
| Rate for Payer: Cash Price |
$996.00
|
| Rate for Payer: Meridian Medicaid |
$299.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$285.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$809.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$676.78
|
| Rate for Payer: Priority Health Narrow Network |
$676.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$584.45
|
| Rate for Payer: UHC Exchange |
$584.45
|
| Rate for Payer: UHCCP Medicaid |
$285.63
|
|
|
PR PRTL EXC BONE FEMUR PROX TIBIA&/FIBULA
|
Professional
|
Both
|
$3,303.00
|
|
|
Service Code
|
HCPCS 27360
|
| Min. Negotiated Rate |
$585.11 |
| Max. Negotiated Rate |
$2,146.95 |
| Rate for Payer: Aetna Commercial |
$1,194.20
|
| Rate for Payer: Aetna Medicare |
$1,651.50
|
| Rate for Payer: BCBS Complete |
$614.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,958.41
|
| Rate for Payer: BCN Commercial |
$1,331.65
|
| Rate for Payer: Cash Price |
$2,642.40
|
| Rate for Payer: Cash Price |
$2,642.40
|
| Rate for Payer: Meridian Medicaid |
$614.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$585.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,146.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,393.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,393.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$969.72
|
| Rate for Payer: UHC Exchange |
$969.72
|
| Rate for Payer: UHCCP Medicaid |
$585.11
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM CRV
|
Professional
|
Both
|
$1,770.00
|
|
|
Service Code
|
HCPCS 22100
|
| Min. Negotiated Rate |
$621.96 |
| Max. Negotiated Rate |
$22,818.32 |
| Rate for Payer: Aetna Commercial |
$1,149.22
|
| Rate for Payer: Aetna Medicare |
$885.00
|
| Rate for Payer: BCBS Complete |
$653.06
|
| Rate for Payer: BCBS Trust/PPO |
$22,818.32
|
| Rate for Payer: BCN Commercial |
$1,270.07
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Meridian Medicaid |
$653.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$621.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,150.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,474.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,474.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$989.69
|
| Rate for Payer: UHC Exchange |
$989.69
|
| Rate for Payer: UHCCP Medicaid |
$621.96
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM EA
|
Professional
|
Both
|
$656.00
|
|
|
Service Code
|
HCPCS 22103
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$18,089.98 |
| Rate for Payer: Aetna Commercial |
$190.38
|
| Rate for Payer: Aetna Medicare |
$328.00
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCBS Trust/PPO |
$18,089.98
|
| Rate for Payer: BCN Commercial |
$196.45
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.05
|
| Rate for Payer: Priority Health Narrow Network |
$204.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.61
|
| Rate for Payer: UHC Exchange |
$171.61
|
| Rate for Payer: UHCCP Medicaid |
$84.99
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM LMBR
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 22102
|
| Min. Negotiated Rate |
$494.16 |
| Max. Negotiated Rate |
$18,089.98 |
| Rate for Payer: Aetna Commercial |
$1,102.33
|
| Rate for Payer: Aetna Medicare |
$1,100.00
|
| Rate for Payer: BCBS Complete |
$518.87
|
| Rate for Payer: BCBS Trust/PPO |
$18,089.98
|
| Rate for Payer: BCN Commercial |
$1,141.55
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Meridian Medicaid |
$518.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$494.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,188.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,188.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$940.03
|
| Rate for Payer: UHC Exchange |
$940.03
|
| Rate for Payer: UHCCP Medicaid |
$494.16
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM THRC
|
Professional
|
Both
|
$2,270.00
|
|
|
Service Code
|
HCPCS 22101
|
| Min. Negotiated Rate |
$116.11 |
| Max. Negotiated Rate |
$1,475.50 |
| Rate for Payer: Aetna Commercial |
$1,154.53
|
| Rate for Payer: Aetna Medicare |
$1,135.00
|
| Rate for Payer: BCBS Complete |
$611.46
|
| Rate for Payer: BCBS Trust/PPO |
$116.11
|
| Rate for Payer: BCN Commercial |
$1,279.36
|
| Rate for Payer: Cash Price |
$1,816.00
|
| Rate for Payer: Cash Price |
$1,816.00
|
| Rate for Payer: Meridian Medicaid |
$611.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$582.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,475.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,359.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,359.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,003.49
|
| Rate for Payer: UHC Exchange |
$1,003.49
|
| Rate for Payer: UHCCP Medicaid |
$582.34
|
|
|
PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM CRV
|
Professional
|
Both
|
$3,264.00
|
|
|
Service Code
|
HCPCS 22110
|
| Min. Negotiated Rate |
$689.48 |
| Max. Negotiated Rate |
$18,089.98 |
| Rate for Payer: Aetna Commercial |
$1,399.72
|
| Rate for Payer: Aetna Medicare |
$1,632.00
|
| Rate for Payer: BCBS Complete |
$723.95
|
| Rate for Payer: BCBS Trust/PPO |
$18,089.98
|
| Rate for Payer: BCN Commercial |
$1,721.83
|
| Rate for Payer: Cash Price |
$2,611.20
|
| Rate for Payer: Cash Price |
$2,611.20
|
| Rate for Payer: Meridian Medicaid |
$723.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$689.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,121.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,642.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,642.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,221.58
|
| Rate for Payer: UHC Exchange |
$1,221.58
|
| Rate for Payer: UHCCP Medicaid |
$689.48
|
|
|
PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM EA
|
Professional
|
Both
|
$803.00
|
|
|
Service Code
|
HCPCS 22116
|
| Min. Negotiated Rate |
$91.16 |
| Max. Negotiated Rate |
$4,702.18 |
| Rate for Payer: Aetna Commercial |
$190.52
|
| Rate for Payer: Aetna Medicare |
$401.50
|
| Rate for Payer: BCBS Complete |
$95.72
|
| Rate for Payer: BCBS Trust/PPO |
$4,702.18
|
| Rate for Payer: BCN Commercial |
$205.25
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Meridian Medicaid |
$95.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.23
|
| Rate for Payer: Priority Health Narrow Network |
$214.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$168.01
|
| Rate for Payer: UHC Exchange |
$168.01
|
| Rate for Payer: UHCCP Medicaid |
$91.16
|
|
|
PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM LMBR
|
Professional
|
Both
|
$2,432.00
|
|
|
Service Code
|
HCPCS 22114
|
| Min. Negotiated Rate |
$746.35 |
| Max. Negotiated Rate |
$1,771.35 |
| Rate for Payer: Aetna Commercial |
$1,505.09
|
| Rate for Payer: Aetna Medicare |
$1,216.00
|
| Rate for Payer: BCBS Complete |
$783.67
|
| Rate for Payer: BCN Commercial |
$1,679.59
|
| Rate for Payer: Cash Price |
$1,945.60
|
| Rate for Payer: Cash Price |
$1,945.60
|
| Rate for Payer: Meridian Medicaid |
$783.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$746.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,580.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,771.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,771.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,141.30
|
| Rate for Payer: UHC Exchange |
$1,141.30
|
| Rate for Payer: UHCCP Medicaid |
$746.35
|
|
|
PR PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY
|
Professional
|
Both
|
$3,968.00
|
|
|
Service Code
|
HCPCS 60210
|
| Min. Negotiated Rate |
$259.40 |
| Max. Negotiated Rate |
$2,579.20 |
| Rate for Payer: Aetna Commercial |
$910.33
|
| Rate for Payer: Aetna Medicare |
$1,984.00
|
| Rate for Payer: BCBS Complete |
$480.18
|
| Rate for Payer: BCBS Trust/PPO |
$259.40
|
| Rate for Payer: BCN Commercial |
$1,036.48
|
| Rate for Payer: Cash Price |
$3,174.40
|
| Rate for Payer: Cash Price |
$3,174.40
|
| Rate for Payer: Meridian Medicaid |
$480.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$457.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,579.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,148.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,148.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$786.67
|
| Rate for Payer: UHC Exchange |
$786.67
|
| Rate for Payer: UHCCP Medicaid |
$457.31
|
|
|
PR PRTL THYROID LOBEC UNI W/CONTRATLAT STOT LOBEC
|
Professional
|
Both
|
$1,831.00
|
|
|
Service Code
|
HCPCS 60212
|
| Min. Negotiated Rate |
$368.75 |
| Max. Negotiated Rate |
$1,662.35 |
| Rate for Payer: Aetna Commercial |
$1,335.39
|
| Rate for Payer: Aetna Medicare |
$915.50
|
| Rate for Payer: BCBS Complete |
$693.99
|
| Rate for Payer: BCBS Trust/PPO |
$368.75
|
| Rate for Payer: BCN Commercial |
$1,501.71
|
| Rate for Payer: Cash Price |
$1,464.80
|
| Rate for Payer: Cash Price |
$1,464.80
|
| Rate for Payer: Meridian Medicaid |
$693.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$660.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,662.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,662.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,127.99
|
| Rate for Payer: UHC Exchange |
$1,127.99
|
| Rate for Payer: UHCCP Medicaid |
$660.94
|
|
|
PR PSA SCREENING
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS G0103
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$1,566.94 |
| Rate for Payer: Aetna Commercial |
$18.34
|
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,566.94
|
| Rate for Payer: BCN Commercial |
$14.48
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.31
|
| Rate for Payer: Priority Health Narrow Network |
$19.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.80
|
| Rate for Payer: UHC Exchange |
$15.80
|
|
|
PR PSYCHIATRIC DIAGNOSTIC EVALUATION
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 90791
|
| Min. Negotiated Rate |
$94.15 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna Medicare |
$132.50
|
| Rate for Payer: BCBS Complete |
$98.86
|
| Rate for Payer: BCBS Trust/PPO |
$203.40
|
| Rate for Payer: BCN Commercial |
$202.61
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Meridian Medicaid |
$98.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.98
|
| Rate for Payer: Priority Health Narrow Network |
$159.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.76
|
| Rate for Payer: UHC Exchange |
$132.76
|
| Rate for Payer: UHCCP Medicaid |
$94.15
|
|
|
PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 90792
|
| Min. Negotiated Rate |
$107.78 |
| Max. Negotiated Rate |
$227.74 |
| Rate for Payer: Aetna Commercial |
$163.88
|
| Rate for Payer: Aetna Medicare |
$132.00
|
| Rate for Payer: BCBS Complete |
$113.17
|
| Rate for Payer: BCBS Trust/PPO |
$140.00
|
| Rate for Payer: BCN Commercial |
$227.74
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Meridian Medicaid |
$113.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.10
|
| Rate for Payer: Priority Health Narrow Network |
$165.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.09
|
| Rate for Payer: UHC Exchange |
$137.09
|
| Rate for Payer: UHCCP Medicaid |
$107.78
|
|
