|
PR SCROTAL EXPLORATION
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 55110
|
| Min. Negotiated Rate |
$251.55 |
| Max. Negotiated Rate |
$2,153.88 |
| Rate for Payer: Aetna Commercial |
$496.07
|
| Rate for Payer: Aetna Medicare |
$351.00
|
| Rate for Payer: BCBS Complete |
$264.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,153.88
|
| Rate for Payer: BCN Commercial |
$562.96
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Meridian Medicaid |
$264.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$251.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$622.61
|
| Rate for Payer: Priority Health Narrow Network |
$622.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.48
|
| Rate for Payer: UHC Exchange |
$461.48
|
| Rate for Payer: UHCCP Medicaid |
$251.55
|
|
|
PR SCROTOPLASTY COMPLICATED
|
Professional
|
Both
|
$1,414.00
|
|
|
Service Code
|
HCPCS 55180
|
| Min. Negotiated Rate |
$442.40 |
| Max. Negotiated Rate |
$1,956.82 |
| Rate for Payer: Aetna Commercial |
$887.31
|
| Rate for Payer: Aetna Medicare |
$707.00
|
| Rate for Payer: BCBS Complete |
$464.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,956.82
|
| Rate for Payer: BCN Commercial |
$996.41
|
| Rate for Payer: Cash Price |
$1,131.20
|
| Rate for Payer: Cash Price |
$1,131.20
|
| Rate for Payer: Meridian Medicaid |
$464.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$442.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,099.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$825.02
|
| Rate for Payer: UHC Exchange |
$825.02
|
| Rate for Payer: UHCCP Medicaid |
$442.40
|
|
|
PR SCROTOPLASTY SIMPLE
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
HCPCS 55175
|
| Min. Negotiated Rate |
$236.22 |
| Max. Negotiated Rate |
$1,287.47 |
| Rate for Payer: Aetna Commercial |
$466.37
|
| Rate for Payer: Aetna Medicare |
$342.00
|
| Rate for Payer: BCBS Complete |
$248.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,287.47
|
| Rate for Payer: BCN Commercial |
$530.22
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Meridian Medicaid |
$248.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$236.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$585.86
|
| Rate for Payer: Priority Health Narrow Network |
$585.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$433.52
|
| Rate for Payer: UHC Exchange |
$433.52
|
| Rate for Payer: UHCCP Medicaid |
$236.22
|
|
|
PR SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN
|
Professional
|
Both
|
$2,346.00
|
|
|
Service Code
|
HCPCS 49900
|
| Min. Negotiated Rate |
$533.78 |
| Max. Negotiated Rate |
$4,854.55 |
| Rate for Payer: Aetna Commercial |
$1,096.92
|
| Rate for Payer: Aetna Medicare |
$1,173.00
|
| Rate for Payer: BCBS Complete |
$560.47
|
| Rate for Payer: BCBS Trust/PPO |
$4,854.55
|
| Rate for Payer: BCN Commercial |
$1,200.68
|
| Rate for Payer: Cash Price |
$1,876.80
|
| Rate for Payer: Cash Price |
$1,876.80
|
| Rate for Payer: Meridian Medicaid |
$560.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$533.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,524.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,482.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,482.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$970.84
|
| Rate for Payer: UHC Exchange |
$970.84
|
| Rate for Payer: UHCCP Medicaid |
$533.78
|
|
|
PR SECONDARY CLOSURE SURG WOUND/DEHSN XTNSV/COMP
|
Professional
|
Both
|
$1,792.00
|
|
|
Service Code
|
HCPCS 13160
|
| Min. Negotiated Rate |
$349.63 |
| Max. Negotiated Rate |
$1,164.80 |
| Rate for Payer: Aetna Commercial |
$864.74
|
| Rate for Payer: Aetna Medicare |
$896.00
|
| Rate for Payer: BCBS Complete |
$539.45
|
| Rate for Payer: BCBS Trust/PPO |
$349.63
|
| Rate for Payer: BCN Commercial |
$1,160.61
|
| Rate for Payer: Cash Price |
$1,433.60
|
| Rate for Payer: Cash Price |
$1,433.60
|
| Rate for Payer: Meridian Medicaid |
$539.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$513.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,164.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,078.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,078.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$856.15
|
| Rate for Payer: UHC Exchange |
$856.15
|
| Rate for Payer: UHCCP Medicaid |
$513.76
|
|
|
PR SECONDARY REVISION ORBITOCRANIOFACIAL RCNSTJ
|
Professional
|
Both
|
$4,570.00
|
|
|
Service Code
|
HCPCS 21275
|
| Min. Negotiated Rate |
$544.43 |
| Max. Negotiated Rate |
$3,205.12 |
| Rate for Payer: Aetna Commercial |
$1,121.53
|
| Rate for Payer: Aetna Medicare |
$2,285.00
|
| Rate for Payer: BCBS Complete |
$571.65
|
| Rate for Payer: BCBS Trust/PPO |
$3,205.12
|
| Rate for Payer: BCN Commercial |
$1,235.37
|
| Rate for Payer: Cash Price |
$3,656.00
|
| Rate for Payer: Cash Price |
$3,656.00
|
| Rate for Payer: Meridian Medicaid |
$571.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$544.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,970.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,290.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,290.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$953.35
|
| Rate for Payer: UHC Exchange |
$953.35
|
| Rate for Payer: UHCCP Medicaid |
$544.43
|
|
|
PR SECONDARY RPR DURA CSF LEAK FREE TISSUE GRAFT
|
Professional
|
Both
|
$6,290.00
|
|
|
Service Code
|
HCPCS 61618
|
| Min. Negotiated Rate |
$44.38 |
| Max. Negotiated Rate |
$4,088.50 |
| Rate for Payer: Aetna Commercial |
$1,666.10
|
| Rate for Payer: Aetna Medicare |
$3,145.00
|
| Rate for Payer: BCBS Complete |
$882.30
|
| Rate for Payer: BCBS Trust/PPO |
$44.38
|
| Rate for Payer: BCN Commercial |
$2,635.81
|
| Rate for Payer: Cash Price |
$5,032.00
|
| Rate for Payer: Cash Price |
$5,032.00
|
| Rate for Payer: Meridian Medicaid |
$882.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,088.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,221.97
|
| Rate for Payer: Priority Health Narrow Network |
$2,221.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,504.30
|
| Rate for Payer: UHC Exchange |
$1,504.30
|
| Rate for Payer: UHCCP Medicaid |
$840.29
|
|
|
PR SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL
|
Professional
|
Both
|
$2,567.00
|
|
|
Service Code
|
HCPCS 37186
|
| Min. Negotiated Rate |
$152.51 |
| Max. Negotiated Rate |
$1,745.07 |
| Rate for Payer: Aetna Commercial |
$328.32
|
| Rate for Payer: Aetna Medicare |
$1,283.50
|
| Rate for Payer: BCBS Complete |
$160.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.73
|
| Rate for Payer: BCN Commercial |
$1,745.07
|
| Rate for Payer: Cash Price |
$2,053.60
|
| Rate for Payer: Cash Price |
$2,053.60
|
| Rate for Payer: Meridian Medicaid |
$160.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,668.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$377.59
|
| Rate for Payer: Priority Health Narrow Network |
$377.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$344.19
|
| Rate for Payer: UHC Exchange |
$344.19
|
| Rate for Payer: UHCCP Medicaid |
$152.51
|
|
|
PR SEC RPR DURA CSF LEAK LOCAL/REGIONALIZED FLAP
|
Professional
|
Both
|
$9,939.00
|
|
|
Service Code
|
HCPCS 61619
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$6,460.35 |
| Rate for Payer: Aetna Commercial |
$1,797.22
|
| Rate for Payer: Aetna Medicare |
$4,969.50
|
| Rate for Payer: BCBS Complete |
$968.18
|
| Rate for Payer: BCBS Trust/PPO |
$18.49
|
| Rate for Payer: BCN Commercial |
$2,915.79
|
| Rate for Payer: Cash Price |
$7,951.20
|
| Rate for Payer: Cash Price |
$7,951.20
|
| Rate for Payer: Meridian Medicaid |
$968.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$922.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,460.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,464.81
|
| Rate for Payer: Priority Health Narrow Network |
$2,464.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,731.49
|
| Rate for Payer: UHC Exchange |
$1,731.49
|
| Rate for Payer: UHCCP Medicaid |
$922.08
|
|
|
PR SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 97535
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$88.75 |
| Rate for Payer: Aetna Commercial |
$24.21
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Trust/PPO |
$88.75
|
| Rate for Payer: BCN Commercial |
$31.97
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Narrow Network |
$77.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.83
|
| Rate for Payer: UHC Exchange |
$30.83
|
|
|
PR SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 92060
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$970.49 |
| Rate for Payer: Aetna Commercial |
$66.75
|
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: BCBS Complete |
$24.38
|
| Rate for Payer: BCBS Trust/PPO |
$970.49
|
| Rate for Payer: BCN Commercial |
$91.87
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Meridian Medicaid |
$24.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.26
|
| Rate for Payer: Priority Health Narrow Network |
$45.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.69
|
| Rate for Payer: UHC Exchange |
$61.69
|
| Rate for Payer: UHCCP Medicaid |
$23.22
|
|
|
PR SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF
|
Professional
|
Both
|
$1,820.00
|
|
|
Service Code
|
HCPCS 30520
|
| Min. Negotiated Rate |
$430.47 |
| Max. Negotiated Rate |
$1,206.64 |
| Rate for Payer: Aetna Commercial |
$848.68
|
| Rate for Payer: Aetna Commercial |
$848.68
|
| Rate for Payer: Aetna Medicare |
$1,581.00
|
| Rate for Payer: Aetna Medicare |
$910.00
|
| Rate for Payer: BCBS Complete |
$451.99
|
| Rate for Payer: BCBS Complete |
$451.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,206.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,206.64
|
| Rate for Payer: BCN Commercial |
$999.83
|
| Rate for Payer: BCN Commercial |
$999.83
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Cash Price |
$1,456.00
|
| Rate for Payer: Cash Price |
$1,456.00
|
| Rate for Payer: Meridian Medicaid |
$451.99
|
| Rate for Payer: Meridian Medicaid |
$451.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,183.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,055.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$946.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$946.86
|
| Rate for Payer: Priority Health Narrow Network |
$946.86
|
| Rate for Payer: Priority Health Narrow Network |
$946.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$662.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$662.06
|
| Rate for Payer: UHC Exchange |
$662.06
|
| Rate for Payer: UHC Exchange |
$662.06
|
| Rate for Payer: UHCCP Medicaid |
$430.47
|
| Rate for Payer: UHCCP Medicaid |
$430.47
|
|
|
PR SEQUESTRECTOMY FOREARM &/WRIST
|
Professional
|
Both
|
$2,257.00
|
|
|
Service Code
|
HCPCS 25145
|
| Min. Negotiated Rate |
$334.94 |
| Max. Negotiated Rate |
$1,467.05 |
| Rate for Payer: Aetna Commercial |
$694.20
|
| Rate for Payer: Aetna Medicare |
$1,128.50
|
| Rate for Payer: BCBS Complete |
$360.97
|
| Rate for Payer: BCBS Trust/PPO |
$334.94
|
| Rate for Payer: BCN Commercial |
$772.60
|
| Rate for Payer: Cash Price |
$1,805.60
|
| Rate for Payer: Cash Price |
$1,805.60
|
| Rate for Payer: Meridian Medicaid |
$360.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,467.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.67
|
| Rate for Payer: Priority Health Narrow Network |
$813.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$628.98
|
| Rate for Payer: UHC Exchange |
$628.98
|
| Rate for Payer: UHCCP Medicaid |
$343.78
|
|
|
PR SEQUESTRECTOMY SHAFT/DISTAL HUMERUS
|
Professional
|
Both
|
$2,220.00
|
|
|
Service Code
|
HCPCS 24134
|
| Min. Negotiated Rate |
$175.92 |
| Max. Negotiated Rate |
$1,443.00 |
| Rate for Payer: Aetna Commercial |
$998.19
|
| Rate for Payer: Aetna Medicare |
$1,110.00
|
| Rate for Payer: BCBS Complete |
$513.72
|
| Rate for Payer: BCBS Trust/PPO |
$175.92
|
| Rate for Payer: BCN Commercial |
$1,101.97
|
| Rate for Payer: Cash Price |
$1,776.00
|
| Rate for Payer: Cash Price |
$1,776.00
|
| Rate for Payer: Meridian Medicaid |
$513.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$489.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,443.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,157.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,157.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$855.95
|
| Rate for Payer: UHC Exchange |
$855.95
|
| Rate for Payer: UHCCP Medicaid |
$489.26
|
|
|
PR SERVICES PROVIDED OFFICE OTH/THN REG SCHED HOURS
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 99050
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$608.60 |
| Rate for Payer: Aetna Commercial |
$23.50
|
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Trust/PPO |
$608.60
|
| Rate for Payer: BCN Commercial |
$20.16
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.43
|
| Rate for Payer: Priority Health Narrow Network |
$24.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.62
|
| Rate for Payer: UHC Exchange |
$21.62
|
|
|
PR SESAMOIDECTOMY FIRST TOE SPX
|
Professional
|
Both
|
$889.00
|
|
|
Service Code
|
HCPCS 28315
|
| Min. Negotiated Rate |
$212.57 |
| Max. Negotiated Rate |
$1,893.96 |
| Rate for Payer: Aetna Commercial |
$432.42
|
| Rate for Payer: Aetna Medicare |
$444.50
|
| Rate for Payer: BCBS Complete |
$223.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,893.96
|
| Rate for Payer: BCN Commercial |
$697.34
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Meridian Medicaid |
$223.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$212.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$502.25
|
| Rate for Payer: Priority Health Narrow Network |
$502.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$379.38
|
| Rate for Payer: UHC Exchange |
$379.38
|
| Rate for Payer: UHCCP Medicaid |
$212.57
|
|
|
PR SESAMOIDECTOMY THUMB/FINGER SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,680.00
|
|
|
Service Code
|
HCPCS 26185
|
| Min. Negotiated Rate |
$369.13 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Aetna Commercial |
$737.45
|
| Rate for Payer: Aetna Medicare |
$840.00
|
| Rate for Payer: BCBS Complete |
$387.59
|
| Rate for Payer: BCBS Trust/PPO |
$580.95
|
| Rate for Payer: BCN Commercial |
$825.87
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Meridian Medicaid |
$387.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,092.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$871.67
|
| Rate for Payer: Priority Health Narrow Network |
$871.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$603.41
|
| Rate for Payer: UHC Exchange |
$603.41
|
| Rate for Payer: UHCCP Medicaid |
$369.13
|
|
|
PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 45335
|
| Hospital Charge Code |
45335
|
| Min. Negotiated Rate |
$43.03 |
| Max. Negotiated Rate |
$430.03 |
| Rate for Payer: Aetna Commercial |
$88.06
|
| Rate for Payer: Aetna Medicare |
$325.00
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: BCBS Trust/PPO |
$306.41
|
| Rate for Payer: BCN Commercial |
$430.03
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Meridian Medicaid |
$45.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.72
|
| Rate for Payer: Priority Health Narrow Network |
$118.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.35
|
| Rate for Payer: UHC Exchange |
$114.35
|
| Rate for Payer: UHCCP Medicaid |
$43.03
|
|
|
PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
45335
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$585.00
|
| Rate for Payer: ASR ASR |
$630.50
|
| Rate for Payer: ASR Commercial |
$630.50
|
| Rate for Payer: BCBS Trust/PPO |
$529.68
|
| Rate for Payer: BCN Commercial |
$503.94
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$611.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.00
|
| Rate for Payer: Healthscope Commercial |
$650.00
|
| Rate for Payer: Healthscope Whirlpool |
$630.50
|
| Rate for Payer: Mclaren Commercial |
$585.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.50
|
| Rate for Payer: Nomi Health Commercial |
$533.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$572.00
|
|
|
PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 45335
|
| Min. Negotiated Rate |
$43.03 |
| Max. Negotiated Rate |
$430.03 |
| Rate for Payer: Aetna Commercial |
$88.06
|
| Rate for Payer: Aetna Medicare |
$325.00
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: BCBS Trust/PPO |
$306.41
|
| Rate for Payer: BCN Commercial |
$430.03
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Meridian Medicaid |
$45.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.72
|
| Rate for Payer: Priority Health Narrow Network |
$118.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.35
|
| Rate for Payer: UHC Exchange |
$114.35
|
| Rate for Payer: UHCCP Medicaid |
$43.03
|
|
|
PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
45335
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$1,384.58 |
| Rate for Payer: Aetna Commercial |
$585.00
|
| Rate for Payer: Aetna Medicare |
$893.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,116.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,116.60
|
| Rate for Payer: ASR ASR |
$630.50
|
| Rate for Payer: ASR Commercial |
$630.50
|
| Rate for Payer: BCBS Complete |
$502.74
|
| Rate for Payer: BCBS MAPPO |
$893.28
|
| Rate for Payer: BCBS Trust/PPO |
$532.28
|
| Rate for Payer: BCN Commercial |
$503.94
|
| Rate for Payer: BCN Medicare Advantage |
$893.28
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$611.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$893.28
|
| Rate for Payer: Healthscope Commercial |
$650.00
|
| Rate for Payer: Healthscope Whirlpool |
$630.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$893.28
|
| Rate for Payer: Mclaren Commercial |
$585.00
|
| Rate for Payer: Mclaren Medicaid |
$478.80
|
| Rate for Payer: Mclaren Medicare |
$893.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$937.94
|
| Rate for Payer: Meridian Medicaid |
$502.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,027.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.50
|
| Rate for Payer: Nomi Health Commercial |
$533.00
|
| Rate for Payer: PACE Medicare |
$848.62
|
| Rate for Payer: PACE SWMI |
$893.28
|
| Rate for Payer: PHP Commercial |
$982.61
|
| Rate for Payer: PHP Medicaid |
$478.80
|
| Rate for Payer: PHP Medicare Advantage |
$893.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$478.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$569.53
|
| Rate for Payer: Priority Health Medicare |
$893.28
|
| Rate for Payer: Priority Health Narrow Network |
$455.65
|
| Rate for Payer: Railroad Medicare Medicare |
$893.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$572.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$893.28
|
| Rate for Payer: UHC Exchange |
$1,384.58
|
| Rate for Payer: UHC Medicare Advantage |
$893.28
|
| Rate for Payer: UHCCP DNSP |
$893.28
|
| Rate for Payer: UHCCP Medicaid |
$478.80
|
| Rate for Payer: VA VA |
$893.28
|
|
|
PR SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
HCPCS 45338
|
| Min. Negotiated Rate |
$76.08 |
| Max. Negotiated Rate |
$488.15 |
| Rate for Payer: Aetna Commercial |
$159.59
|
| Rate for Payer: Aetna Medicare |
$375.50
|
| Rate for Payer: BCBS Complete |
$80.06
|
| Rate for Payer: BCBS Trust/PPO |
$76.08
|
| Rate for Payer: BCN Commercial |
$439.81
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Meridian Medicaid |
$80.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.38
|
| Rate for Payer: Priority Health Narrow Network |
$212.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.70
|
| Rate for Payer: UHC Exchange |
$176.70
|
| Rate for Payer: UHCCP Medicaid |
$76.25
|
|
|
PR SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 45338
|
| Hospital Charge Code |
45338
|
| Min. Negotiated Rate |
$488.15 |
| Max. Negotiated Rate |
$751.00 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: ASR ASR |
$728.47
|
| Rate for Payer: ASR Commercial |
$728.47
|
| Rate for Payer: BCBS Trust/PPO |
$611.99
|
| Rate for Payer: BCN Commercial |
$582.25
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cofinity Commercial |
$705.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.80
|
| Rate for Payer: Healthscope Commercial |
$751.00
|
| Rate for Payer: Healthscope Whirlpool |
$728.47
|
| Rate for Payer: Mclaren Commercial |
$675.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.35
|
| Rate for Payer: Nomi Health Commercial |
$615.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$660.88
|
|
|
PR SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
HCPCS 45338
|
| Hospital Charge Code |
45338
|
| Min. Negotiated Rate |
$76.08 |
| Max. Negotiated Rate |
$488.15 |
| Rate for Payer: Aetna Commercial |
$159.59
|
| Rate for Payer: Aetna Medicare |
$375.50
|
| Rate for Payer: BCBS Complete |
$80.06
|
| Rate for Payer: BCBS Trust/PPO |
$76.08
|
| Rate for Payer: BCN Commercial |
$439.81
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Meridian Medicaid |
$80.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.38
|
| Rate for Payer: Priority Health Narrow Network |
$212.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.70
|
| Rate for Payer: UHC Exchange |
$176.70
|
| Rate for Payer: UHCCP Medicaid |
$76.25
|
|
|
PR SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 45338
|
| Hospital Charge Code |
45338
|
| Min. Negotiated Rate |
$488.15 |
| Max. Negotiated Rate |
$1,790.62 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Aetna Medicare |
$1,155.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,444.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,444.05
|
| Rate for Payer: ASR ASR |
$728.47
|
| Rate for Payer: ASR Commercial |
$728.47
|
| Rate for Payer: BCBS Complete |
$650.17
|
| Rate for Payer: BCBS MAPPO |
$1,155.24
|
| Rate for Payer: BCBS Trust/PPO |
$614.99
|
| Rate for Payer: BCN Commercial |
$582.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.24
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cofinity Commercial |
$705.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.24
|
| Rate for Payer: Healthscope Commercial |
$751.00
|
| Rate for Payer: Healthscope Whirlpool |
$728.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,155.24
|
| Rate for Payer: Mclaren Commercial |
$675.90
|
| Rate for Payer: Mclaren Medicaid |
$619.21
|
| Rate for Payer: Mclaren Medicare |
$1,155.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,213.00
|
| Rate for Payer: Meridian Medicaid |
$650.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,328.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.35
|
| Rate for Payer: Nomi Health Commercial |
$615.82
|
| Rate for Payer: PACE Medicare |
$1,097.48
|
| Rate for Payer: PACE SWMI |
$1,155.24
|
| Rate for Payer: PHP Commercial |
$1,270.76
|
| Rate for Payer: PHP Medicaid |
$619.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$658.03
|
| Rate for Payer: Priority Health Medicare |
$1,155.24
|
| Rate for Payer: Priority Health Narrow Network |
$526.45
|
| Rate for Payer: Railroad Medicare Medicare |
$1,155.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$660.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,155.24
|
| Rate for Payer: UHC Exchange |
$1,790.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,155.24
|
| Rate for Payer: UHCCP DNSP |
$1,155.24
|
| Rate for Payer: UHCCP Medicaid |
$619.21
|
| Rate for Payer: VA VA |
$1,155.24
|
|
