|
PR PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 11105
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: Aetna Commercial |
$27.89
|
| Rate for Payer: Aetna Medicare |
$91.00
|
| Rate for Payer: BCBS Complete |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$23.50
|
| Rate for Payer: BCN Commercial |
$69.89
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Meridian Medicaid |
$17.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.32
|
| Rate for Payer: Priority Health Narrow Network |
$34.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.43
|
| Rate for Payer: UHC Exchange |
$31.43
|
| Rate for Payer: UHCCP Medicaid |
$16.19
|
|
|
PR PUNCH BIOPSY SKIN SINGLE LESION
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 11104
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$158.60 |
| Rate for Payer: Aetna Commercial |
$51.32
|
| Rate for Payer: Aetna Medicare |
$122.00
|
| Rate for Payer: BCBS Complete |
$31.31
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$148.43
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Meridian Medicaid |
$31.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.76
|
| Rate for Payer: Priority Health Narrow Network |
$62.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.62
|
| Rate for Payer: UHC Exchange |
$57.62
|
| Rate for Payer: UHCCP Medicaid |
$29.82
|
|
|
PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
10160
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$193.50
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$208.55
|
| Rate for Payer: ASR Commercial |
$208.55
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$176.06
|
| Rate for Payer: BCN Commercial |
$166.69
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$202.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$215.00
|
| Rate for Payer: Healthscope Whirlpool |
$208.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$193.50
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: Nomi Health Commercial |
$176.30
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.09
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$180.07
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
10160
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$153.14 |
| Rate for Payer: Aetna Commercial |
$101.52
|
| Rate for Payer: Aetna Medicare |
$107.50
|
| Rate for Payer: BCBS Complete |
$65.53
|
| Rate for Payer: BCBS Trust/PPO |
$11.15
|
| Rate for Payer: BCN Commercial |
$153.14
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Meridian Medicaid |
$65.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.40
|
| Rate for Payer: Priority Health Narrow Network |
$131.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.29
|
| Rate for Payer: UHC Exchange |
$99.29
|
| Rate for Payer: UHCCP Medicaid |
$62.41
|
|
|
PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
10160
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna Commercial |
$193.50
|
| Rate for Payer: ASR ASR |
$208.55
|
| Rate for Payer: ASR Commercial |
$208.55
|
| Rate for Payer: BCBS Trust/PPO |
$175.20
|
| Rate for Payer: BCN Commercial |
$166.69
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$202.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
| Rate for Payer: Healthscope Commercial |
$215.00
|
| Rate for Payer: Healthscope Whirlpool |
$208.55
|
| Rate for Payer: Mclaren Commercial |
$193.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: Nomi Health Commercial |
$176.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.20
|
|
|
PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 10160
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$153.14 |
| Rate for Payer: Aetna Commercial |
$101.52
|
| Rate for Payer: Aetna Medicare |
$107.50
|
| Rate for Payer: BCBS Complete |
$65.53
|
| Rate for Payer: BCBS Trust/PPO |
$11.15
|
| Rate for Payer: BCN Commercial |
$153.14
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Meridian Medicaid |
$65.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.40
|
| Rate for Payer: Priority Health Narrow Network |
$131.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.29
|
| Rate for Payer: UHC Exchange |
$99.29
|
| Rate for Payer: UHCCP Medicaid |
$62.41
|
|
|
PR PUNCTURE ASPIRATION CYST BREAST EACH ADDL CYST
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 19001
|
| Min. Negotiated Rate |
$12.99 |
| Max. Negotiated Rate |
$456.13 |
| Rate for Payer: Aetna Commercial |
$23.24
|
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: BCBS Complete |
$13.64
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: BCN Commercial |
$38.12
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Meridian Medicaid |
$13.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.00
|
| Rate for Payer: Priority Health Narrow Network |
$28.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.64
|
| Rate for Payer: UHC Exchange |
$24.64
|
| Rate for Payer: UHCCP Medicaid |
$12.99
|
|
|
PR PUNCTURE ASPIRATION CYST OF BREAST
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
HCPCS 19000
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$6,614.63 |
| Rate for Payer: Aetna Commercial |
$47.21
|
| Rate for Payer: Aetna Medicare |
$95.50
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: BCBS Trust/PPO |
$6,614.63
|
| Rate for Payer: BCN Commercial |
$149.54
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Meridian Medicaid |
$28.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.44
|
| Rate for Payer: Priority Health Narrow Network |
$56.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.29
|
| Rate for Payer: UHC Exchange |
$49.29
|
| Rate for Payer: UHCCP Medicaid |
$27.05
|
|
|
PR PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX
|
Professional
|
Both
|
$401.00
|
|
|
Service Code
|
HCPCS 61070
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$355.02 |
| Rate for Payer: Aetna Commercial |
$71.83
|
| Rate for Payer: Aetna Medicare |
$200.50
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: BCBS Trust/PPO |
$355.02
|
| Rate for Payer: BCN Commercial |
$113.90
|
| Rate for Payer: Cash Price |
$320.80
|
| Rate for Payer: Cash Price |
$320.80
|
| Rate for Payer: Meridian Medicaid |
$37.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.54
|
| Rate for Payer: Priority Health Narrow Network |
$95.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.25
|
| Rate for Payer: UHC Exchange |
$94.25
|
| Rate for Payer: UHCCP Medicaid |
$36.00
|
|
|
PR PURE TONE AUDIOMETRY AIR & BONE
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 92553
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$1,526.79 |
| Rate for Payer: Aetna Commercial |
$40.97
|
| Rate for Payer: Aetna Medicare |
$32.50
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,526.79
|
| Rate for Payer: BCN Commercial |
$63.53
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.42
|
| Rate for Payer: Priority Health Narrow Network |
$62.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.73
|
| Rate for Payer: UHC Exchange |
$28.73
|
|
|
PR PURE TONE AUDIOMETRY AIR ONLY
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 92552
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$1,476.07 |
| Rate for Payer: Aetna Commercial |
$33.49
|
| Rate for Payer: Aetna Medicare |
$27.00
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,476.07
|
| Rate for Payer: BCN Commercial |
$51.80
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.57
|
| Rate for Payer: Priority Health Narrow Network |
$51.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.40
|
| Rate for Payer: UHC Exchange |
$22.40
|
|
|
PR PVB THORACIC CONT CATHETER INFUSION W/IMG GID
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 64463
|
| Min. Negotiated Rate |
$51.55 |
| Max. Negotiated Rate |
$788.75 |
| Rate for Payer: Aetna Commercial |
$107.31
|
| Rate for Payer: Aetna Medicare |
$158.50
|
| Rate for Payer: BCBS Complete |
$54.13
|
| Rate for Payer: BCBS Trust/PPO |
$788.75
|
| Rate for Payer: BCN Commercial |
$340.61
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Meridian Medicaid |
$54.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.06
|
| Rate for Payer: Priority Health Narrow Network |
$137.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.38
|
| Rate for Payer: UHC Exchange |
$106.38
|
| Rate for Payer: UHCCP Medicaid |
$51.55
|
|
|
PR PYELOPLASTY COMPLICATED
|
Professional
|
Both
|
$2,668.00
|
|
|
Service Code
|
HCPCS 50405
|
| Min. Negotiated Rate |
$888.00 |
| Max. Negotiated Rate |
$2,206.56 |
| Rate for Payer: Aetna Commercial |
$1,790.90
|
| Rate for Payer: Aetna Medicare |
$1,334.00
|
| Rate for Payer: BCBS Complete |
$932.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,085.73
|
| Rate for Payer: BCN Commercial |
$2,003.58
|
| Rate for Payer: Cash Price |
$2,134.40
|
| Rate for Payer: Cash Price |
$2,134.40
|
| Rate for Payer: Meridian Medicaid |
$932.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$888.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,734.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,206.56
|
| Rate for Payer: Priority Health Narrow Network |
$2,206.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,686.49
|
| Rate for Payer: UHC Exchange |
$1,686.49
|
| Rate for Payer: UHCCP Medicaid |
$888.00
|
|
|
PR PYELOPLASTY SIMPLE
|
Professional
|
Both
|
$1,795.00
|
|
|
Service Code
|
HCPCS 50400
|
| Min. Negotiated Rate |
$736.13 |
| Max. Negotiated Rate |
$2,368.90 |
| Rate for Payer: Aetna Commercial |
$1,482.71
|
| Rate for Payer: Aetna Medicare |
$897.50
|
| Rate for Payer: BCBS Complete |
$772.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,368.90
|
| Rate for Payer: BCN Commercial |
$1,659.55
|
| Rate for Payer: Cash Price |
$1,436.00
|
| Rate for Payer: Cash Price |
$1,436.00
|
| Rate for Payer: Meridian Medicaid |
$772.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$736.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,166.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,829.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,829.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,394.86
|
| Rate for Payer: UHC Exchange |
$1,394.86
|
| Rate for Payer: UHCCP Medicaid |
$736.13
|
|
|
PR PYLOROMYOTOMY CUTTING PYLORIC MUSC
|
Professional
|
Both
|
$2,256.00
|
|
|
Service Code
|
HCPCS 43520
|
| Min. Negotiated Rate |
$460.72 |
| Max. Negotiated Rate |
$1,466.40 |
| Rate for Payer: Aetna Commercial |
$925.56
|
| Rate for Payer: Aetna Medicare |
$1,128.00
|
| Rate for Payer: BCBS Complete |
$483.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,015.39
|
| Rate for Payer: BCN Commercial |
$1,007.65
|
| Rate for Payer: Cash Price |
$1,804.80
|
| Rate for Payer: Cash Price |
$1,804.80
|
| Rate for Payer: Meridian Medicaid |
$483.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,466.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,240.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,240.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.88
|
| Rate for Payer: UHC Exchange |
$849.88
|
| Rate for Payer: UHCCP Medicaid |
$460.72
|
|
|
PR PYLOROPLASTY
|
Professional
|
Both
|
$2,557.00
|
|
|
Service Code
|
HCPCS 43800
|
| Min. Negotiated Rate |
$598.32 |
| Max. Negotiated Rate |
$1,667.49 |
| Rate for Payer: Aetna Commercial |
$1,258.80
|
| Rate for Payer: Aetna Medicare |
$1,278.50
|
| Rate for Payer: BCBS Complete |
$628.24
|
| Rate for Payer: BCBS Trust/PPO |
$665.13
|
| Rate for Payer: BCN Commercial |
$1,357.06
|
| Rate for Payer: Cash Price |
$2,045.60
|
| Rate for Payer: Cash Price |
$2,045.60
|
| Rate for Payer: Meridian Medicaid |
$628.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$598.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,662.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,667.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,667.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,123.80
|
| Rate for Payer: UHC Exchange |
$1,123.80
|
| Rate for Payer: UHCCP Medicaid |
$598.32
|
|
|
PR QUADRICEPSPLASTY
|
Professional
|
Both
|
$2,049.00
|
|
|
Service Code
|
HCPCS 27430
|
| Min. Negotiated Rate |
$484.36 |
| Max. Negotiated Rate |
$1,331.85 |
| Rate for Payer: Aetna Commercial |
$990.95
|
| Rate for Payer: Aetna Medicare |
$1,024.50
|
| Rate for Payer: BCBS Complete |
$508.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,015.92
|
| Rate for Payer: BCN Commercial |
$1,093.66
|
| Rate for Payer: Cash Price |
$1,639.20
|
| Rate for Payer: Cash Price |
$1,639.20
|
| Rate for Payer: Meridian Medicaid |
$508.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,331.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,149.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,149.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$845.15
|
| Rate for Payer: UHC Exchange |
$845.15
|
| Rate for Payer: UHCCP Medicaid |
$484.36
|
|
|
PR QUAL NONMD EST PT 11-20M
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G2062
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.64
|
| Rate for Payer: Priority Health Narrow Network |
$24.64
|
|
|
PR QUAL NONMD EST PT 21>MIN
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G2063
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$38.19 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.19
|
| Rate for Payer: Priority Health Narrow Network |
$38.19
|
|
|
PR QUAL NONMD EST PT 5-10M
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G2061
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.96
|
| Rate for Payer: Priority Health Narrow Network |
$13.96
|
|
|
PR RABIES IMMUNE GLOBULIN RIG HUMAN IM/SUBQ
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 90375
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$346.06 |
| Rate for Payer: Aetna Commercial |
$289.98
|
| Rate for Payer: Aetna Medicare |
$110.00
|
| Rate for Payer: BCBS Complete |
$88.00
|
| Rate for Payer: BCBS Trust/PPO |
$298.09
|
| Rate for Payer: BCN Commercial |
$345.60
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$346.06
|
| Rate for Payer: UHC Exchange |
$346.06
|
|
|
PR RABIES VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 90675
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$406.19 |
| Rate for Payer: Aetna Commercial |
$324.74
|
| Rate for Payer: Aetna Medicare |
$104.00
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCBS Trust/PPO |
$345.74
|
| Rate for Payer: BCN Commercial |
$364.50
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$406.19
|
| Rate for Payer: UHC Exchange |
$406.19
|
|
|
PR RAD ABDL HYSTERECTOMY W/BI PELVIC LMPHADENECTOMY
|
Professional
|
Both
|
$6,028.00
|
|
|
Service Code
|
HCPCS 58210
|
| Min. Negotiated Rate |
$166.94 |
| Max. Negotiated Rate |
$3,918.20 |
| Rate for Payer: Aetna Commercial |
$2,168.52
|
| Rate for Payer: Aetna Medicare |
$3,014.00
|
| Rate for Payer: BCBS Complete |
$1,227.39
|
| Rate for Payer: BCBS Trust/PPO |
$166.94
|
| Rate for Payer: BCN Commercial |
$2,658.89
|
| Rate for Payer: Cash Price |
$4,822.40
|
| Rate for Payer: Cash Price |
$4,822.40
|
| Rate for Payer: Meridian Medicaid |
$1,227.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,168.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,918.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,719.82
|
| Rate for Payer: Priority Health Narrow Network |
$2,719.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,003.23
|
| Rate for Payer: UHC Exchange |
$2,003.23
|
| Rate for Payer: UHCCP Medicaid |
$1,168.94
|
|
|
PR RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS
|
Professional
|
Both
|
$2,719.00
|
|
|
Service Code
|
HCPCS 25115
|
| Min. Negotiated Rate |
$306.41 |
| Max. Negotiated Rate |
$1,767.35 |
| Rate for Payer: Aetna Commercial |
$1,005.89
|
| Rate for Payer: Aetna Medicare |
$1,359.50
|
| Rate for Payer: BCBS Complete |
$522.00
|
| Rate for Payer: BCBS Trust/PPO |
$306.41
|
| Rate for Payer: BCN Commercial |
$1,116.14
|
| Rate for Payer: Cash Price |
$2,175.20
|
| Rate for Payer: Cash Price |
$2,175.20
|
| Rate for Payer: Meridian Medicaid |
$522.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$497.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,767.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,173.43
|
| Rate for Payer: Priority Health Narrow Network |
$1,173.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$902.59
|
| Rate for Payer: UHC Exchange |
$902.59
|
| Rate for Payer: UHCCP Medicaid |
$497.14
|
|
|
PR RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS
|
Professional
|
Both
|
$2,330.00
|
|
|
Service Code
|
HCPCS 25116
|
| Min. Negotiated Rate |
$70.26 |
| Max. Negotiated Rate |
$1,514.50 |
| Rate for Payer: Aetna Commercial |
$800.80
|
| Rate for Payer: Aetna Medicare |
$1,165.00
|
| Rate for Payer: BCBS Complete |
$418.45
|
| Rate for Payer: BCBS Trust/PPO |
$70.26
|
| Rate for Payer: BCN Commercial |
$893.30
|
| Rate for Payer: Cash Price |
$1,864.00
|
| Rate for Payer: Cash Price |
$1,864.00
|
| Rate for Payer: Meridian Medicaid |
$418.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,514.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$941.90
|
| Rate for Payer: Priority Health Narrow Network |
$941.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$720.72
|
| Rate for Payer: UHC Exchange |
$720.72
|
| Rate for Payer: UHCCP Medicaid |
$398.52
|
|
