|
PR RIV3 VACCINE PRESERVATIVE FREE FOR IM USE
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 90673
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$100.19 |
| Rate for Payer: Aetna Commercial |
$36.34
|
| Rate for Payer: Aetna Medicare |
$55.50
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS Trust/PPO |
$30.00
|
| Rate for Payer: BCN Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.45
|
| Rate for Payer: Priority Health Narrow Network |
$42.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.19
|
| Rate for Payer: UHC Exchange |
$100.19
|
|
|
PR RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 90682
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$88.08 |
| Rate for Payer: Aetna Commercial |
$73.40
|
| Rate for Payer: Aetna Medicare |
$46.50
|
| Rate for Payer: BCBS Complete |
$37.20
|
| Rate for Payer: BCBS Trust/PPO |
$73.62
|
| Rate for Payer: BCN Commercial |
$73.62
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.08
|
| Rate for Payer: UHC Exchange |
$88.08
|
|
|
PR R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I
|
Professional
|
Both
|
$2,919.00
|
|
|
Service Code
|
HCPCS 93461
|
| Min. Negotiated Rate |
$256.67 |
| Max. Negotiated Rate |
$2,006.02 |
| Rate for Payer: Aetna Commercial |
$1,897.18
|
| Rate for Payer: Aetna Commercial |
$1,897.18
|
| Rate for Payer: Aetna Medicare |
$1,459.50
|
| Rate for Payer: Aetna Medicare |
$1,402.00
|
| Rate for Payer: BCBS Complete |
$269.50
|
| Rate for Payer: BCBS Complete |
$269.50
|
| Rate for Payer: BCBS Trust/PPO |
$716.90
|
| Rate for Payer: BCBS Trust/PPO |
$716.90
|
| Rate for Payer: BCN Commercial |
$2,006.02
|
| Rate for Payer: BCN Commercial |
$2,006.02
|
| Rate for Payer: Cash Price |
$2,243.20
|
| Rate for Payer: Cash Price |
$2,335.20
|
| Rate for Payer: Cash Price |
$2,335.20
|
| Rate for Payer: Cash Price |
$2,243.20
|
| Rate for Payer: Meridian Medicaid |
$269.50
|
| Rate for Payer: Meridian Medicaid |
$269.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$256.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$256.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,822.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$566.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$566.42
|
| Rate for Payer: Priority Health Narrow Network |
$566.42
|
| Rate for Payer: Priority Health Narrow Network |
$566.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,888.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,888.83
|
| Rate for Payer: UHC Exchange |
$1,888.83
|
| Rate for Payer: UHC Exchange |
$1,888.83
|
| Rate for Payer: UHCCP Medicaid |
$256.67
|
| Rate for Payer: UHCCP Medicaid |
$256.67
|
|
|
PR R & L HRT CATH WINJX HRT ART& L VENTR IMG
|
Professional
|
Both
|
$1,229.00
|
|
|
Service Code
|
HCPCS 93460
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$1,818.86 |
| Rate for Payer: Aetna Commercial |
$1,711.27
|
| Rate for Payer: Aetna Medicare |
$614.50
|
| Rate for Payer: BCBS Complete |
$244.00
|
| Rate for Payer: BCBS Trust/PPO |
$728.00
|
| Rate for Payer: BCN Commercial |
$1,818.86
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Meridian Medicaid |
$244.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$798.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$512.27
|
| Rate for Payer: Priority Health Narrow Network |
$512.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,649.23
|
| Rate for Payer: UHC Exchange |
$1,649.23
|
| Rate for Payer: UHCCP Medicaid |
$232.38
|
|
|
PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
|
Professional
|
Both
|
$672.00
|
|
|
Service Code
|
HCPCS 93453
|
| Min. Negotiated Rate |
$196.17 |
| Max. Negotiated Rate |
$1,678.12 |
| Rate for Payer: Aetna Commercial |
$1,569.84
|
| Rate for Payer: Aetna Medicare |
$336.00
|
| Rate for Payer: BCBS Complete |
$205.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,507.77
|
| Rate for Payer: BCN Commercial |
$1,678.12
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Meridian Medicaid |
$205.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$433.18
|
| Rate for Payer: Priority Health Narrow Network |
$433.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,466.49
|
| Rate for Payer: UHC Exchange |
$1,466.49
|
| Rate for Payer: UHCCP Medicaid |
$196.17
|
|
|
PR RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ
|
Professional
|
Both
|
$1,796.00
|
|
|
Service Code
|
HCPCS 33244
|
| Min. Negotiated Rate |
$542.72 |
| Max. Negotiated Rate |
$1,352.96 |
| Rate for Payer: Aetna Commercial |
$1,162.22
|
| Rate for Payer: Aetna Medicare |
$898.00
|
| Rate for Payer: BCBS Complete |
$569.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,160.68
|
| Rate for Payer: BCN Commercial |
$1,250.53
|
| Rate for Payer: Cash Price |
$1,436.80
|
| Rate for Payer: Cash Price |
$1,436.80
|
| Rate for Payer: Meridian Medicaid |
$569.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$542.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,352.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,352.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,147.93
|
| Rate for Payer: UHC Exchange |
$1,147.93
|
| Rate for Payer: UHCCP Medicaid |
$542.72
|
|
|
PR RMVL ASCENDING-AORTA BALO DEV W/RPR ASCEND-AORTA
|
Professional
|
Both
|
$2,480.00
|
|
|
Service Code
|
HCPCS 33974
|
| Min. Negotiated Rate |
$564.02 |
| Max. Negotiated Rate |
$2,513.12 |
| Rate for Payer: Aetna Commercial |
$1,191.43
|
| Rate for Payer: Aetna Medicare |
$1,240.00
|
| Rate for Payer: BCBS Complete |
$592.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,513.12
|
| Rate for Payer: BCN Commercial |
$1,280.82
|
| Rate for Payer: Cash Price |
$1,984.00
|
| Rate for Payer: Cash Price |
$1,984.00
|
| Rate for Payer: Meridian Medicaid |
$592.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$564.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,612.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,399.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,399.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,190.18
|
| Rate for Payer: UHC Exchange |
$1,190.18
|
| Rate for Payer: UHCCP Medicaid |
$564.02
|
|
|
PR RMVL BONE FLAP/PROSTHETIC PLATE SKULL
|
Professional
|
Both
|
$3,371.00
|
|
|
Service Code
|
HCPCS 62142
|
| Min. Negotiated Rate |
$586.82 |
| Max. Negotiated Rate |
$2,191.15 |
| Rate for Payer: Aetna Commercial |
$1,142.27
|
| Rate for Payer: Aetna Medicare |
$1,685.50
|
| Rate for Payer: BCBS Complete |
$616.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,320.75
|
| Rate for Payer: BCN Commercial |
$1,831.09
|
| Rate for Payer: Cash Price |
$2,696.80
|
| Rate for Payer: Cash Price |
$2,696.80
|
| Rate for Payer: Meridian Medicaid |
$616.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$586.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,191.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,553.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,553.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,012.42
|
| Rate for Payer: UHC Exchange |
$1,012.42
|
| Rate for Payer: UHCCP Medicaid |
$586.82
|
|
|
PR RMVL COMPL CSF SHUNT SYSTEM W/O RPLCMT SHUNT
|
Professional
|
Both
|
$2,207.00
|
|
|
Service Code
|
HCPCS 62256
|
| Min. Negotiated Rate |
$87.02 |
| Max. Negotiated Rate |
$1,434.55 |
| Rate for Payer: Aetna Commercial |
$781.13
|
| Rate for Payer: Aetna Medicare |
$1,103.50
|
| Rate for Payer: BCBS Complete |
$422.03
|
| Rate for Payer: BCBS Trust/PPO |
$87.02
|
| Rate for Payer: BCN Commercial |
$1,256.21
|
| Rate for Payer: Cash Price |
$1,765.60
|
| Rate for Payer: Cash Price |
$1,765.60
|
| Rate for Payer: Meridian Medicaid |
$422.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$401.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,434.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,070.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,070.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$671.03
|
| Rate for Payer: UHC Exchange |
$671.03
|
| Rate for Payer: UHCCP Medicaid |
$401.93
|
|
|
PR RMVL COMPLETE CSF SHUNT SYSTEM W/RPLCMT SHUNT
|
Professional
|
Both
|
$5,127.00
|
|
|
Service Code
|
HCPCS 62258
|
| Min. Negotiated Rate |
$586.41 |
| Max. Negotiated Rate |
$3,332.55 |
| Rate for Payer: Aetna Commercial |
$1,443.38
|
| Rate for Payer: Aetna Medicare |
$2,563.50
|
| Rate for Payer: BCBS Complete |
$761.30
|
| Rate for Payer: BCBS Trust/PPO |
$586.41
|
| Rate for Payer: BCN Commercial |
$2,282.59
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Meridian Medicaid |
$761.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$725.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,332.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,935.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,935.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,295.27
|
| Rate for Payer: UHC Exchange |
$1,295.27
|
| Rate for Payer: UHCCP Medicaid |
$725.05
|
|
|
PR RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 97602
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$917.66 |
| Rate for Payer: Aetna Commercial |
$89.75
|
| Rate for Payer: Aetna Medicare |
$75.00
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS Trust/PPO |
$917.66
|
| Rate for Payer: BCN Commercial |
$167.04
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.57
|
| Rate for Payer: Priority Health Narrow Network |
$109.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.74
|
| Rate for Payer: UHC Exchange |
$35.74
|
|
|
PR RMVL EMBEDDED FB VESTIBULE MOUTH COMP
|
Professional
|
Both
|
$705.00
|
|
|
Service Code
|
HCPCS 40805
|
| Min. Negotiated Rate |
$129.29 |
| Max. Negotiated Rate |
$526.19 |
| Rate for Payer: Aetna Commercial |
$263.54
|
| Rate for Payer: Aetna Medicare |
$352.50
|
| Rate for Payer: BCBS Complete |
$135.75
|
| Rate for Payer: BCBS Trust/PPO |
$526.19
|
| Rate for Payer: BCN Commercial |
$416.35
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Meridian Medicaid |
$135.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$354.38
|
| Rate for Payer: Priority Health Narrow Network |
$354.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$269.28
|
| Rate for Payer: UHC Exchange |
$269.28
|
| Rate for Payer: UHCCP Medicaid |
$129.29
|
|
|
PR RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 40804
|
| Min. Negotiated Rate |
$76.47 |
| Max. Negotiated Rate |
$1,065.05 |
| Rate for Payer: Aetna Commercial |
$149.26
|
| Rate for Payer: Aetna Medicare |
$170.00
|
| Rate for Payer: BCBS Complete |
$80.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,065.05
|
| Rate for Payer: BCN Commercial |
$275.12
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Meridian Medicaid |
$80.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.23
|
| Rate for Payer: Priority Health Narrow Network |
$205.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.38
|
| Rate for Payer: UHC Exchange |
$152.38
|
| Rate for Payer: UHCCP Medicaid |
$76.47
|
|
|
PR RMVL ENTIRE LUMBOSARACH SHUNT SYS W/O RPLCMT
|
Professional
|
Both
|
$1,658.00
|
|
|
Service Code
|
HCPCS 63746
|
| Min. Negotiated Rate |
$214.49 |
| Max. Negotiated Rate |
$1,077.70 |
| Rate for Payer: Aetna Commercial |
$781.78
|
| Rate for Payer: Aetna Medicare |
$829.00
|
| Rate for Payer: BCBS Complete |
$423.37
|
| Rate for Payer: BCBS Trust/PPO |
$214.49
|
| Rate for Payer: BCN Commercial |
$999.20
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Meridian Medicaid |
$423.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$403.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,069.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,069.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$660.30
|
| Rate for Payer: UHC Exchange |
$660.30
|
| Rate for Payer: UHCCP Medicaid |
$403.21
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL ANES
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 69205
|
| Min. Negotiated Rate |
$61.13 |
| Max. Negotiated Rate |
$1,749.20 |
| Rate for Payer: Aetna Commercial |
$106.72
|
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: BCBS Complete |
$64.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,749.20
|
| Rate for Payer: BCN Commercial |
$140.74
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Meridian Medicaid |
$64.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.08
|
| Rate for Payer: Priority Health Narrow Network |
$140.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.08
|
| Rate for Payer: UHC Exchange |
$111.08
|
| Rate for Payer: UHCCP Medicaid |
$61.13
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 69200
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$1,294.34 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Aetna Medicare |
$121.50
|
| Rate for Payer: BCBS Complete |
$32.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,294.34
|
| Rate for Payer: BCN Commercial |
$117.77
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Meridian Medicaid |
$32.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.07
|
| Rate for Payer: Priority Health Narrow Network |
$69.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.97
|
| Rate for Payer: UHC Exchange |
$61.97
|
| Rate for Payer: UHCCP Medicaid |
$30.67
|
|
|
PR RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 65220
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$303.77 |
| Rate for Payer: Aetna Commercial |
$55.19
|
| Rate for Payer: Aetna Medicare |
$82.50
|
| Rate for Payer: BCBS Complete |
$27.29
|
| Rate for Payer: BCBS Trust/PPO |
$303.77
|
| Rate for Payer: BCN Commercial |
$87.96
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$27.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.94
|
| Rate for Payer: Priority Health Narrow Network |
$71.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.84
|
| Rate for Payer: UHC Exchange |
$46.84
|
| Rate for Payer: UHCCP Medicaid |
$25.99
|
|
|
PR RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 65222
|
| Min. Negotiated Rate |
$31.52 |
| Max. Negotiated Rate |
$260.45 |
| Rate for Payer: Aetna Commercial |
$66.76
|
| Rate for Payer: Aetna Medicare |
$91.50
|
| Rate for Payer: BCBS Complete |
$33.10
|
| Rate for Payer: BCBS Trust/PPO |
$260.45
|
| Rate for Payer: BCN Commercial |
$97.74
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Meridian Medicaid |
$33.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.15
|
| Rate for Payer: Priority Health Narrow Network |
$87.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.61
|
| Rate for Payer: UHC Exchange |
$63.61
|
| Rate for Payer: UHCCP Medicaid |
$31.52
|
|
|
PR RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 65210
|
| Min. Negotiated Rate |
$22.79 |
| Max. Negotiated Rate |
$264.15 |
| Rate for Payer: Aetna Commercial |
$48.17
|
| Rate for Payer: Aetna Medicare |
$97.50
|
| Rate for Payer: BCBS Complete |
$23.93
|
| Rate for Payer: BCBS Trust/PPO |
$264.15
|
| Rate for Payer: BCN Commercial |
$44.76
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Meridian Medicaid |
$23.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.99
|
| Rate for Payer: Priority Health Narrow Network |
$61.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.11
|
| Rate for Payer: UHC Exchange |
$58.11
|
| Rate for Payer: UHCCP Medicaid |
$22.79
|
|
|
PR RMVL FECAL IMPACTION/FB SPX UNDER ANES
|
Professional
|
Both
|
$613.00
|
|
|
Service Code
|
HCPCS 45915
|
| Min. Negotiated Rate |
$148.46 |
| Max. Negotiated Rate |
$1,239.39 |
| Rate for Payer: Aetna Commercial |
$308.27
|
| Rate for Payer: Aetna Medicare |
$306.50
|
| Rate for Payer: BCBS Complete |
$155.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,239.39
|
| Rate for Payer: BCN Commercial |
$518.49
|
| Rate for Payer: Cash Price |
$490.40
|
| Rate for Payer: Cash Price |
$490.40
|
| Rate for Payer: Meridian Medicaid |
$155.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$411.05
|
| Rate for Payer: Priority Health Narrow Network |
$411.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.21
|
| Rate for Payer: UHC Exchange |
$262.21
|
| Rate for Payer: UHCCP Medicaid |
$148.46
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
20525
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$499.20 |
| Max. Negotiated Rate |
$4,346.48 |
| Rate for Payer: Aetna Commercial |
$691.20
|
| Rate for Payer: Aetna Medicare |
$2,804.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: ASR ASR |
$744.96
|
| Rate for Payer: ASR Commercial |
$744.96
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$628.92
|
| Rate for Payer: BCN Commercial |
$595.43
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$721.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$614.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Healthscope Commercial |
$768.00
|
| Rate for Payer: Healthscope Whirlpool |
$744.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,804.18
|
| Rate for Payer: Mclaren Commercial |
$691.20
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$652.80
|
| Rate for Payer: Nomi Health Commercial |
$629.76
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Commercial |
$3,084.60
|
| Rate for Payer: PHP Medicaid |
$1,503.04
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,614.65
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$2,891.72
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$675.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Exchange |
$4,346.48
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP DNSP |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,503.04
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 20525
|
| Min. Negotiated Rate |
$161.03 |
| Max. Negotiated Rate |
$684.64 |
| Rate for Payer: Aetna Commercial |
$328.41
|
| Rate for Payer: Aetna Medicare |
$384.00
|
| Rate for Payer: BCBS Complete |
$169.08
|
| Rate for Payer: BCBS Trust/PPO |
$195.38
|
| Rate for Payer: BCN Commercial |
$684.64
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Meridian Medicaid |
$169.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$379.10
|
| Rate for Payer: Priority Health Narrow Network |
$379.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$284.29
|
| Rate for Payer: UHC Exchange |
$284.29
|
| Rate for Payer: UHCCP Medicaid |
$161.03
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
20525
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$499.20 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$691.20
|
| Rate for Payer: ASR ASR |
$744.96
|
| Rate for Payer: ASR Commercial |
$744.96
|
| Rate for Payer: BCBS Trust/PPO |
$625.84
|
| Rate for Payer: BCN Commercial |
$595.43
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$721.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$614.40
|
| Rate for Payer: Healthscope Commercial |
$768.00
|
| Rate for Payer: Healthscope Whirlpool |
$744.96
|
| Rate for Payer: Mclaren Commercial |
$691.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$652.80
|
| Rate for Payer: Nomi Health Commercial |
$629.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$675.84
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
20525
|
| Min. Negotiated Rate |
$161.03 |
| Max. Negotiated Rate |
$684.64 |
| Rate for Payer: Aetna Commercial |
$328.41
|
| Rate for Payer: Aetna Medicare |
$384.00
|
| Rate for Payer: BCBS Complete |
$169.08
|
| Rate for Payer: BCBS Trust/PPO |
$195.38
|
| Rate for Payer: BCN Commercial |
$684.64
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Meridian Medicaid |
$169.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$379.10
|
| Rate for Payer: Priority Health Narrow Network |
$379.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$284.29
|
| Rate for Payer: UHC Exchange |
$284.29
|
| Rate for Payer: UHCCP Medicaid |
$161.03
|
|
|
PR RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 27086
|
| Min. Negotiated Rate |
$110.55 |
| Max. Negotiated Rate |
$459.36 |
| Rate for Payer: Aetna Commercial |
$222.58
|
| Rate for Payer: Aetna Medicare |
$203.00
|
| Rate for Payer: BCBS Complete |
$116.08
|
| Rate for Payer: BCBS Trust/PPO |
$227.17
|
| Rate for Payer: BCN Commercial |
$459.36
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Meridian Medicaid |
$116.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$262.06
|
| Rate for Payer: Priority Health Narrow Network |
$262.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.06
|
| Rate for Payer: UHC Exchange |
$167.06
|
| Rate for Payer: UHCCP Medicaid |
$110.55
|
|
