|
PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL
|
Professional
|
Both
|
$2,733.00
|
|
|
Service Code
|
HCPCS 37229
|
| Min. Negotiated Rate |
$430.05 |
| Max. Negotiated Rate |
$13,126.37 |
| Rate for Payer: Aetna Commercial |
$937.57
|
| Rate for Payer: Aetna Medicare |
$1,366.50
|
| Rate for Payer: BCBS Complete |
$451.55
|
| Rate for Payer: BCBS Trust/PPO |
$476.53
|
| Rate for Payer: BCN Commercial |
$13,126.37
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Meridian Medicaid |
$451.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,776.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,071.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,071.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,030.45
|
| Rate for Payer: UHC Exchange |
$1,030.45
|
| Rate for Payer: UHCCP Medicaid |
$430.05
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL
|
Professional
|
Both
|
$1,141.00
|
|
|
Service Code
|
HCPCS 37233
|
| Min. Negotiated Rate |
$200.01 |
| Max. Negotiated Rate |
$1,531.51 |
| Rate for Payer: Aetna Commercial |
$437.50
|
| Rate for Payer: Aetna Medicare |
$570.50
|
| Rate for Payer: BCBS Complete |
$210.01
|
| Rate for Payer: BCBS Trust/PPO |
$495.55
|
| Rate for Payer: BCN Commercial |
$1,531.51
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Meridian Medicaid |
$210.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$741.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$497.79
|
| Rate for Payer: Priority Health Narrow Network |
$497.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$474.39
|
| Rate for Payer: UHC Exchange |
$474.39
|
| Rate for Payer: UHCCP Medicaid |
$200.01
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL
|
Professional
|
Both
|
$2,739.00
|
|
|
Service Code
|
HCPCS 37230
|
| Min. Negotiated Rate |
$431.75 |
| Max. Negotiated Rate |
$13,145.42 |
| Rate for Payer: Aetna Commercial |
$935.98
|
| Rate for Payer: Aetna Medicare |
$1,369.50
|
| Rate for Payer: BCBS Complete |
$453.34
|
| Rate for Payer: BCBS Trust/PPO |
$709.51
|
| Rate for Payer: BCN Commercial |
$13,145.42
|
| Rate for Payer: Cash Price |
$2,191.20
|
| Rate for Payer: Cash Price |
$2,191.20
|
| Rate for Payer: Meridian Medicaid |
$453.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,780.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,072.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,072.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$992.91
|
| Rate for Payer: UHC Exchange |
$992.91
|
| Rate for Payer: UHCCP Medicaid |
$431.75
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 37234
|
| Min. Negotiated Rate |
$174.87 |
| Max. Negotiated Rate |
$5,352.48 |
| Rate for Payer: Aetna Commercial |
$383.02
|
| Rate for Payer: Aetna Medicare |
$260.00
|
| Rate for Payer: BCBS Complete |
$183.61
|
| Rate for Payer: BCBS Trust/PPO |
$790.87
|
| Rate for Payer: BCN Commercial |
$5,352.48
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Meridian Medicaid |
$183.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.03
|
| Rate for Payer: Priority Health Narrow Network |
$435.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$395.26
|
| Rate for Payer: UHC Exchange |
$395.26
|
| Rate for Payer: UHCCP Medicaid |
$174.87
|
|
|
PR RHINOPLASTY EXTERNAL
|
Professional
|
Both
|
$3,162.00
|
|
|
Service Code
|
HCPCS 00536
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,264.80 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Medicare |
$1,581.00
|
| Rate for Payer: BCBS Complete |
$1,264.80
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,055.30
|
|
|
PR RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR
|
Professional
|
Both
|
$2,464.00
|
|
|
Service Code
|
HCPCS 30420
|
| Min. Negotiated Rate |
$782.41 |
| Max. Negotiated Rate |
$2,150.18 |
| Rate for Payer: Aetna Commercial |
$1,845.15
|
| Rate for Payer: Aetna Medicare |
$1,232.00
|
| Rate for Payer: BCBS Complete |
$967.51
|
| Rate for Payer: BCBS Trust/PPO |
$782.41
|
| Rate for Payer: BCN Commercial |
$2,150.18
|
| Rate for Payer: Cash Price |
$1,971.20
|
| Rate for Payer: Cash Price |
$1,971.20
|
| Rate for Payer: Meridian Medicaid |
$967.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$921.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,601.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,029.98
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,501.53
|
| Rate for Payer: UHC Exchange |
$1,501.53
|
| Rate for Payer: UHCCP Medicaid |
$921.44
|
|
|
PR RHINOPLASTY SECONDARY INTERMEDIATE REVISION
|
Professional
|
Both
|
$2,030.00
|
|
|
Service Code
|
HCPCS 30435
|
| Min. Negotiated Rate |
$855.41 |
| Max. Negotiated Rate |
$1,983.05 |
| Rate for Payer: Aetna Commercial |
$1,717.52
|
| Rate for Payer: Aetna Medicare |
$1,015.00
|
| Rate for Payer: BCBS Complete |
$898.18
|
| Rate for Payer: BCBS Trust/PPO |
$987.39
|
| Rate for Payer: BCN Commercial |
$1,983.05
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Meridian Medicaid |
$898.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$855.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,319.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,869.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,869.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,267.17
|
| Rate for Payer: UHC Exchange |
$1,267.17
|
| Rate for Payer: UHCCP Medicaid |
$855.41
|
|
|
PR RHINOPLASTY SECONDARY MAJOR REVISION
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 30450
|
| Min. Negotiated Rate |
$858.49 |
| Max. Negotiated Rate |
$2,584.13 |
| Rate for Payer: Aetna Commercial |
$2,252.58
|
| Rate for Payer: Aetna Medicare |
$1,750.00
|
| Rate for Payer: BCBS Complete |
$1,175.29
|
| Rate for Payer: BCBS Trust/PPO |
$858.49
|
| Rate for Payer: BCN Commercial |
$2,584.13
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Meridian Medicaid |
$1,175.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,119.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,275.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,438.76
|
| Rate for Payer: Priority Health Narrow Network |
$2,438.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,695.71
|
| Rate for Payer: UHC Exchange |
$1,695.71
|
| Rate for Payer: UHCCP Medicaid |
$1,119.32
|
|
|
PR RHINP DFRM W/COLUM LNGTH TIP ONLY
|
Professional
|
Both
|
$1,370.00
|
|
|
Service Code
|
HCPCS 30460
|
| Min. Negotiated Rate |
$532.71 |
| Max. Negotiated Rate |
$1,222.67 |
| Rate for Payer: Aetna Commercial |
$1,069.66
|
| Rate for Payer: Aetna Medicare |
$685.00
|
| Rate for Payer: BCBS Complete |
$559.35
|
| Rate for Payer: BCBS Trust/PPO |
$557.88
|
| Rate for Payer: BCN Commercial |
$1,222.67
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Meridian Medicaid |
$559.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$532.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,156.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,156.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$862.51
|
| Rate for Payer: UHC Exchange |
$862.51
|
| Rate for Payer: UHCCP Medicaid |
$532.71
|
|
|
PR RHINP PRIM COMPLETE XTRNL PARTS
|
Professional
|
Both
|
$3,060.00
|
|
|
Service Code
|
HCPCS 30410
|
| Min. Negotiated Rate |
$562.64 |
| Max. Negotiated Rate |
$2,093.01 |
| Rate for Payer: Aetna Commercial |
$1,815.03
|
| Rate for Payer: Aetna Commercial |
$1,815.03
|
| Rate for Payer: Aetna Medicare |
$1,530.00
|
| Rate for Payer: Aetna Medicare |
$1,542.00
|
| Rate for Payer: BCBS Complete |
$948.95
|
| Rate for Payer: BCBS Complete |
$948.95
|
| Rate for Payer: BCBS Trust/PPO |
$562.64
|
| Rate for Payer: BCBS Trust/PPO |
$562.64
|
| Rate for Payer: BCN Commercial |
$2,093.01
|
| Rate for Payer: BCN Commercial |
$2,093.01
|
| Rate for Payer: Cash Price |
$2,467.20
|
| Rate for Payer: Cash Price |
$2,467.20
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Meridian Medicaid |
$948.95
|
| Rate for Payer: Meridian Medicaid |
$948.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$903.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$903.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,989.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,004.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,974.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,974.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,974.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,974.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,313.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,313.89
|
| Rate for Payer: UHC Exchange |
$1,313.89
|
| Rate for Payer: UHC Exchange |
$1,313.89
|
| Rate for Payer: UHCCP Medicaid |
$903.76
|
| Rate for Payer: UHCCP Medicaid |
$903.76
|
|
|
PR RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 30400
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$1,845.35 |
| Rate for Payer: Aetna Commercial |
$1,572.55
|
| Rate for Payer: Aetna Medicare |
$765.00
|
| Rate for Payer: BCBS Complete |
$823.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,845.35
|
| Rate for Payer: BCN Commercial |
$1,821.79
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Meridian Medicaid |
$823.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$784.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,716.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,716.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,109.04
|
| Rate for Payer: UHC Exchange |
$1,109.04
|
| Rate for Payer: UHCCP Medicaid |
$784.27
|
|
|
PR RHO(D) IMMUNE GLOBULIN HUMAN FULL-DOSE IM
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 90384
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Commercial |
$78.10
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$91.88
|
| Rate for Payer: BCN Commercial |
$91.88
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.40
|
| Rate for Payer: UHC Exchange |
$99.40
|
|
|
PR RHO D IMMUNE GLOBULIN INJ
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS J2790
|
| Min. Negotiated Rate |
$60.97 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$64.41
|
| Rate for Payer: BCN Commercial |
$60.97
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.32
|
| Rate for Payer: UHC Exchange |
$77.32
|
|
|
PR RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 93042
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$2,070.41 |
| Rate for Payer: Aetna Commercial |
$9.24
|
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: BCBS Complete |
$4.47
|
| Rate for Payer: BCBS Trust/PPO |
$2,070.41
|
| Rate for Payer: BCN Commercial |
$7.85
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Meridian Medicaid |
$4.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.42
|
| Rate for Payer: Priority Health Narrow Network |
$9.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.09
|
| Rate for Payer: UHC Exchange |
$10.09
|
| Rate for Payer: UHCCP Medicaid |
$4.26
|
|
|
PR RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 93041
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$1,926.71 |
| Rate for Payer: Aetna Commercial |
$7.33
|
| Rate for Payer: Aetna Medicare |
$8.00
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,926.71
|
| Rate for Payer: BCN Commercial |
$8.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.94
|
| Rate for Payer: Priority Health Narrow Network |
$8.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.71
|
| Rate for Payer: UHC Exchange |
$6.71
|
|
|
PR RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 93040
|
| Min. Negotiated Rate |
$16.57 |
| Max. Negotiated Rate |
$2,312.90 |
| Rate for Payer: Aetna Commercial |
$16.57
|
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,312.90
|
| Rate for Payer: BCN Commercial |
$18.57
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.36
|
| Rate for Payer: Priority Health Narrow Network |
$18.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.80
|
| Rate for Payer: UHC Exchange |
$16.80
|
|
|
PR RHYTIDECTOMY 3 HOURS
|
Professional
|
Both
|
$4,896.00
|
|
|
Service Code
|
HCPCS 00539
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,958.40 |
| Max. Negotiated Rate |
$3,182.40 |
| Rate for Payer: Aetna Medicare |
$2,448.00
|
| Rate for Payer: BCBS Complete |
$1,958.40
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
|
|
PR RHYTIDECTOMY SMAS FLAP
|
Professional
|
Both
|
$4,896.00
|
|
|
Service Code
|
HCPCS 15829
|
| Min. Negotiated Rate |
$129.77 |
| Max. Negotiated Rate |
$3,616.65 |
| Rate for Payer: Aetna Commercial |
$2,885.67
|
| Rate for Payer: Aetna Medicare |
$2,448.00
|
| Rate for Payer: BCBS Complete |
$1,958.40
|
| Rate for Payer: BCBS Trust/PPO |
$129.77
|
| Rate for Payer: BCN Commercial |
$3,009.06
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,616.65
|
| Rate for Payer: Priority Health Narrow Network |
$3,616.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,733.49
|
| Rate for Payer: UHC Exchange |
$2,733.49
|
|
|
PR RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
HCPCS 93451
|
| Min. Negotiated Rate |
$81.58 |
| Max. Negotiated Rate |
$1,711.69 |
| Rate for Payer: Aetna Commercial |
$1,160.68
|
| Rate for Payer: Aetna Medicare |
$223.00
|
| Rate for Payer: BCBS Complete |
$85.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,711.69
|
| Rate for Payer: BCN Commercial |
$1,270.56
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Meridian Medicaid |
$85.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.40
|
| Rate for Payer: Priority Health Narrow Network |
$179.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,004.54
|
| Rate for Payer: UHC Exchange |
$1,004.54
|
| Rate for Payer: UHCCP Medicaid |
$81.58
|
|
|
PR RIMPLTJ VISC ART INFRARNL AORTIC PROSTH EA ART
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 35697
|
| Min. Negotiated Rate |
$91.16 |
| Max. Negotiated Rate |
$1,973.73 |
| Rate for Payer: Aetna Commercial |
$199.90
|
| Rate for Payer: Aetna Medicare |
$164.00
|
| Rate for Payer: BCBS Complete |
$95.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,973.73
|
| Rate for Payer: BCN Commercial |
$208.66
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Meridian Medicaid |
$95.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.09
|
| Rate for Payer: Priority Health Narrow Network |
$227.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$202.75
|
| Rate for Payer: UHC Exchange |
$202.75
|
| Rate for Payer: UHCCP Medicaid |
$91.16
|
|
|
PR RINGERS LACTATE INFUSION
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J7120
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$2.67
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.74
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.45
|
| Rate for Payer: UHC Exchange |
$2.45
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,632.00
|
|
|
Service Code
|
HCPCS 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$117.28 |
| Max. Negotiated Rate |
$1,710.80 |
| Rate for Payer: Aetna Commercial |
$1,036.16
|
| Rate for Payer: Aetna Medicare |
$1,316.00
|
| Rate for Payer: BCBS Complete |
$530.27
|
| Rate for Payer: BCBS Trust/PPO |
$117.28
|
| Rate for Payer: BCN Commercial |
$1,140.08
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Meridian Medicaid |
$530.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$505.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,196.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,196.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$892.62
|
| Rate for Payer: UHC Exchange |
$892.62
|
| Rate for Payer: UHCCP Medicaid |
$505.02
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,632.00
|
|
|
Service Code
|
HCPCS 24342
|
| Min. Negotiated Rate |
$117.28 |
| Max. Negotiated Rate |
$1,710.80 |
| Rate for Payer: Aetna Commercial |
$1,036.16
|
| Rate for Payer: Aetna Medicare |
$1,316.00
|
| Rate for Payer: BCBS Complete |
$530.27
|
| Rate for Payer: BCBS Trust/PPO |
$117.28
|
| Rate for Payer: BCN Commercial |
$1,140.08
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Meridian Medicaid |
$530.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$505.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,196.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,196.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$892.62
|
| Rate for Payer: UHC Exchange |
$892.62
|
| Rate for Payer: UHCCP Medicaid |
$505.02
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Facility
|
OP
|
$2,632.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$1,710.80 |
| Max. Negotiated Rate |
$10,848.88 |
| Rate for Payer: Aetna Commercial |
$2,368.80
|
| Rate for Payer: Aetna Medicare |
$6,999.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: ASR ASR |
$2,553.04
|
| Rate for Payer: ASR Commercial |
$2,553.04
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,155.34
|
| Rate for Payer: BCN Commercial |
$2,040.59
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cofinity Commercial |
$2,474.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,105.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Healthscope Commercial |
$2,632.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,553.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,999.28
|
| Rate for Payer: Mclaren Commercial |
$2,368.80
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,237.20
|
| Rate for Payer: Nomi Health Commercial |
$2,158.24
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Commercial |
$7,699.21
|
| Rate for Payer: PHP Medicaid |
$3,751.61
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,306.16
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,845.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,316.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$10,848.88
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP DNSP |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Facility
|
IP
|
$2,632.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$1,710.80 |
| Max. Negotiated Rate |
$2,632.00 |
| Rate for Payer: Aetna Commercial |
$2,368.80
|
| Rate for Payer: ASR ASR |
$2,553.04
|
| Rate for Payer: ASR Commercial |
$2,553.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,144.82
|
| Rate for Payer: BCN Commercial |
$2,040.59
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cofinity Commercial |
$2,474.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,105.60
|
| Rate for Payer: Healthscope Commercial |
$2,632.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,553.04
|
| Rate for Payer: Mclaren Commercial |
$2,368.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,237.20
|
| Rate for Payer: Nomi Health Commercial |
$2,158.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,316.16
|
|
