|
PR SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC
|
Professional
|
Both
|
$398.00
|
|
|
Service Code
|
HCPCS 36227
|
| Min. Negotiated Rate |
$76.89 |
| Max. Negotiated Rate |
$1,296.45 |
| Rate for Payer: Aetna Commercial |
$158.05
|
| Rate for Payer: Aetna Medicare |
$199.00
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,296.45
|
| Rate for Payer: BCN Commercial |
$351.85
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.39
|
| Rate for Payer: Priority Health Narrow Network |
$190.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.28
|
| Rate for Payer: UHC Exchange |
$148.28
|
| Rate for Payer: UHCCP Medicaid |
$76.89
|
|
|
PR SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 95806
|
| Min. Negotiated Rate |
$27.48 |
| Max. Negotiated Rate |
$410.49 |
| Rate for Payer: Aetna Commercial |
$106.13
|
| Rate for Payer: Aetna Commercial |
$106.13
|
| Rate for Payer: Aetna Medicare |
$74.50
|
| Rate for Payer: Aetna Medicare |
$283.50
|
| Rate for Payer: BCBS Complete |
$28.85
|
| Rate for Payer: BCBS Complete |
$28.85
|
| Rate for Payer: BCBS Trust/PPO |
$410.49
|
| Rate for Payer: BCBS Trust/PPO |
$410.49
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Meridian Medicaid |
$28.85
|
| Rate for Payer: Meridian Medicaid |
$28.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.35
|
| Rate for Payer: Priority Health Narrow Network |
$58.35
|
| Rate for Payer: Priority Health Narrow Network |
$58.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.36
|
| Rate for Payer: UHC Exchange |
$208.36
|
| Rate for Payer: UHC Exchange |
$208.36
|
| Rate for Payer: UHCCP Medicaid |
$27.48
|
| Rate for Payer: UHCCP Medicaid |
$27.48
|
|
|
PR SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 95807
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$485.70 |
| Rate for Payer: Aetna Commercial |
$412.45
|
| Rate for Payer: Aetna Commercial |
$412.45
|
| Rate for Payer: Aetna Medicare |
$744.50
|
| Rate for Payer: Aetna Medicare |
$74.00
|
| Rate for Payer: BCBS Complete |
$38.69
|
| Rate for Payer: BCBS Complete |
$38.69
|
| Rate for Payer: BCBS Trust/PPO |
$78.19
|
| Rate for Payer: BCBS Trust/PPO |
$78.19
|
| Rate for Payer: BCN Commercial |
$453.53
|
| Rate for Payer: BCN Commercial |
$453.53
|
| Rate for Payer: Cash Price |
$1,191.20
|
| Rate for Payer: Cash Price |
$1,191.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Meridian Medicaid |
$38.69
|
| Rate for Payer: Meridian Medicaid |
$38.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$967.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.70
|
| Rate for Payer: Priority Health Narrow Network |
$78.70
|
| Rate for Payer: Priority Health Narrow Network |
$78.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$485.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$485.70
|
| Rate for Payer: UHC Exchange |
$485.70
|
| Rate for Payer: UHC Exchange |
$485.70
|
| Rate for Payer: UHCCP Medicaid |
$36.85
|
| Rate for Payer: UHCCP Medicaid |
$36.85
|
|
|
PR SLING OPERATION STRESS INCONTINENCE
|
Professional
|
Both
|
$2,280.00
|
|
|
Service Code
|
HCPCS 57288
|
| Min. Negotiated Rate |
$477.97 |
| Max. Negotiated Rate |
$2,553.80 |
| Rate for Payer: Aetna Commercial |
$881.31
|
| Rate for Payer: Aetna Medicare |
$1,140.00
|
| Rate for Payer: BCBS Complete |
$501.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,553.80
|
| Rate for Payer: BCN Commercial |
$1,508.40
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Meridian Medicaid |
$501.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$477.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,482.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,112.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,112.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$829.56
|
| Rate for Payer: UHC Exchange |
$829.56
|
| Rate for Payer: UHCCP Medicaid |
$477.97
|
|
|
PR SLING OPRATION CORRJ MALE URINARY INCONTINENCE
|
Professional
|
Both
|
$1,677.00
|
|
|
Service Code
|
HCPCS 53440
|
| Min. Negotiated Rate |
$482.23 |
| Max. Negotiated Rate |
$2,746.63 |
| Rate for Payer: Aetna Commercial |
$966.60
|
| Rate for Payer: Aetna Medicare |
$838.50
|
| Rate for Payer: BCBS Complete |
$506.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,746.63
|
| Rate for Payer: BCN Commercial |
$1,085.84
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Meridian Medicaid |
$506.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$482.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,198.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,198.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,060.79
|
| Rate for Payer: UHC Exchange |
$1,060.79
|
| Rate for Payer: UHCCP Medicaid |
$482.23
|
|
|
PR SLINGS
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS A4565
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCN Commercial |
$7.97
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.65
|
| Rate for Payer: UHC Exchange |
$4.65
|
|
|
PR SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 54001
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$1,072.45 |
| Rate for Payer: Aetna Commercial |
$178.45
|
| Rate for Payer: Aetna Medicare |
$167.50
|
| Rate for Payer: BCBS Complete |
$95.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,072.45
|
| Rate for Payer: BCN Commercial |
$289.29
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Meridian Medicaid |
$95.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.30
|
| Rate for Payer: Priority Health Narrow Network |
$225.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.21
|
| Rate for Payer: UHC Exchange |
$165.21
|
| Rate for Payer: UHCCP Medicaid |
$90.95
|
|
|
PR SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 95800
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$545.73 |
| Rate for Payer: Aetna Commercial |
$173.67
|
| Rate for Payer: Aetna Commercial |
$173.67
|
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: Aetna Medicare |
$45.50
|
| Rate for Payer: BCBS Complete |
$25.72
|
| Rate for Payer: BCBS Complete |
$25.72
|
| Rate for Payer: BCBS Trust/PPO |
$545.73
|
| Rate for Payer: BCBS Trust/PPO |
$545.73
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Meridian Medicaid |
$25.72
|
| Rate for Payer: Meridian Medicaid |
$25.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.46
|
| Rate for Payer: Priority Health Narrow Network |
$52.46
|
| Rate for Payer: Priority Health Narrow Network |
$52.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.12
|
| Rate for Payer: UHC Exchange |
$227.12
|
| Rate for Payer: UHC Exchange |
$227.12
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
|
|
PR SMOKE/TOBACCO COUNSELNG 3-10
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS G0375
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
|
|
PR SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 12002
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$517.72 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS Trust/PPO |
$517.72
|
| Rate for Payer: BCN Commercial |
$167.13
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.47
|
| Rate for Payer: Priority Health Narrow Network |
$79.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.48
|
| Rate for Payer: UHC Exchange |
$123.48
|
| Rate for Payer: UHCCP Medicaid |
$37.49
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
HCPCS 12005
|
| Min. Negotiated Rate |
$60.07 |
| Max. Negotiated Rate |
$561.29 |
| Rate for Payer: Aetna Commercial |
$105.98
|
| Rate for Payer: Aetna Medicare |
$286.50
|
| Rate for Payer: BCBS Complete |
$63.07
|
| Rate for Payer: BCBS Trust/PPO |
$561.29
|
| Rate for Payer: BCN Commercial |
$259.49
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Meridian Medicaid |
$63.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.77
|
| Rate for Payer: Priority Health Narrow Network |
$127.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.88
|
| Rate for Payer: UHC Exchange |
$179.88
|
| Rate for Payer: UHCCP Medicaid |
$60.07
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM
|
Professional
|
Both
|
$731.00
|
|
|
Service Code
|
HCPCS 12006
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$525.42 |
| Rate for Payer: Aetna Commercial |
$129.27
|
| Rate for Payer: Aetna Medicare |
$365.50
|
| Rate for Payer: BCBS Complete |
$78.06
|
| Rate for Payer: BCBS Trust/PPO |
$525.42
|
| Rate for Payer: BCN Commercial |
$301.51
|
| Rate for Payer: Cash Price |
$584.80
|
| Rate for Payer: Cash Price |
$584.80
|
| Rate for Payer: Meridian Medicaid |
$78.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.22
|
| Rate for Payer: Priority Health Narrow Network |
$156.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.32
|
| Rate for Payer: UHC Exchange |
$227.32
|
| Rate for Payer: UHCCP Medicaid |
$74.34
|
|
|
PR SO 8 ABD RESTRAINT PRE OTS
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS L3650
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$62.27 |
| Rate for Payer: Aetna Commercial |
$39.50
|
| Rate for Payer: Aetna Medicare |
$34.50
|
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCN Commercial |
$62.27
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.63
|
| Rate for Payer: UHC Exchange |
$35.63
|
|
|
PR SPECIAL CASTING MATERIAL
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS A4590
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCN Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.69
|
| Rate for Payer: UHC Exchange |
$14.69
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 92555
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$1,605.50 |
| Rate for Payer: Aetna Commercial |
$25.66
|
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,605.50
|
| Rate for Payer: BCN Commercial |
$40.07
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.35
|
| Rate for Payer: Priority Health Narrow Network |
$39.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.07
|
| Rate for Payer: UHC Exchange |
$16.07
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 92556
|
| Min. Negotiated Rate |
$24.63 |
| Max. Negotiated Rate |
$1,742.33 |
| Rate for Payer: Aetna Commercial |
$40.61
|
| Rate for Payer: Aetna Medicare |
$33.00
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,742.33
|
| Rate for Payer: BCN Commercial |
$62.06
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.06
|
| Rate for Payer: Priority Health Narrow Network |
$61.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.63
|
| Rate for Payer: UHC Exchange |
$24.63
|
|
|
PR SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 46080
|
| Min. Negotiated Rate |
$102.24 |
| Max. Negotiated Rate |
$1,543.16 |
| Rate for Payer: Aetna Commercial |
$211.65
|
| Rate for Payer: Aetna Medicare |
$450.00
|
| Rate for Payer: BCBS Complete |
$107.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.16
|
| Rate for Payer: BCN Commercial |
$425.15
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Meridian Medicaid |
$107.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.39
|
| Rate for Payer: Priority Health Narrow Network |
$283.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.55
|
| Rate for Payer: UHC Exchange |
$189.55
|
| Rate for Payer: UHCCP Medicaid |
$102.24
|
|
|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT
|
Professional
|
Both
|
$1,510.00
|
|
|
Service Code
|
HCPCS 46750
|
| Min. Negotiated Rate |
$480.32 |
| Max. Negotiated Rate |
$1,341.75 |
| Rate for Payer: Aetna Commercial |
$1,008.35
|
| Rate for Payer: Aetna Medicare |
$755.00
|
| Rate for Payer: BCBS Complete |
$504.34
|
| Rate for Payer: BCBS Trust/PPO |
$714.79
|
| Rate for Payer: BCN Commercial |
$1,093.66
|
| Rate for Payer: Cash Price |
$1,208.00
|
| Rate for Payer: Cash Price |
$1,208.00
|
| Rate for Payer: Meridian Medicaid |
$504.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$480.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$981.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,341.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,341.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$908.63
|
| Rate for Payer: UHC Exchange |
$908.63
|
| Rate for Payer: UHCCP Medicaid |
$480.32
|
|
|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE CHLD
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 46751
|
| Min. Negotiated Rate |
$434.73 |
| Max. Negotiated Rate |
$1,205.72 |
| Rate for Payer: Aetna Commercial |
$898.95
|
| Rate for Payer: Aetna Medicare |
$650.50
|
| Rate for Payer: BCBS Complete |
$456.47
|
| Rate for Payer: BCBS Trust/PPO |
$477.58
|
| Rate for Payer: BCN Commercial |
$983.71
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Meridian Medicaid |
$456.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$434.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,205.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,205.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$738.79
|
| Rate for Payer: UHC Exchange |
$738.79
|
| Rate for Payer: UHCCP Medicaid |
$434.73
|
|
|
PR SPHNCTROP ANAL LEVATOR MUSC IMBRCJ
|
Professional
|
Both
|
$1,888.00
|
|
|
Service Code
|
HCPCS 46761
|
| Min. Negotiated Rate |
$584.47 |
| Max. Negotiated Rate |
$1,632.88 |
| Rate for Payer: Aetna Commercial |
$1,233.15
|
| Rate for Payer: Aetna Medicare |
$944.00
|
| Rate for Payer: BCBS Complete |
$613.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,041.81
|
| Rate for Payer: BCN Commercial |
$1,335.07
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Meridian Medicaid |
$613.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,632.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,632.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,111.06
|
| Rate for Payer: UHC Exchange |
$1,111.06
|
| Rate for Payer: UHCCP Medicaid |
$584.47
|
|
|
PR SPLENC TOT EN BLOC EXTNSV DS CONJUNCT W/OTH PX
|
Professional
|
Both
|
$2,697.00
|
|
|
Service Code
|
HCPCS 38102
|
| Min. Negotiated Rate |
$166.57 |
| Max. Negotiated Rate |
$1,753.05 |
| Rate for Payer: Aetna Commercial |
$326.41
|
| Rate for Payer: Aetna Medicare |
$1,348.50
|
| Rate for Payer: BCBS Complete |
$174.90
|
| Rate for Payer: BCBS Trust/PPO |
$538.34
|
| Rate for Payer: BCN Commercial |
$379.70
|
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Meridian Medicaid |
$174.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$518.62
|
| Rate for Payer: Priority Health Narrow Network |
$518.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.64
|
| Rate for Payer: UHC Exchange |
$298.64
|
| Rate for Payer: UHCCP Medicaid |
$166.57
|
|
|
PR SPLENECTOMY PARTIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,997.00
|
|
|
Service Code
|
HCPCS 38101
|
| Min. Negotiated Rate |
$566.87 |
| Max. Negotiated Rate |
$2,322.80 |
| Rate for Payer: Aetna Commercial |
$1,458.52
|
| Rate for Payer: Aetna Medicare |
$1,498.50
|
| Rate for Payer: BCBS Complete |
$785.23
|
| Rate for Payer: BCBS Trust/PPO |
$566.87
|
| Rate for Payer: BCN Commercial |
$1,697.66
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Meridian Medicaid |
$785.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$747.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,948.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,322.80
|
| Rate for Payer: Priority Health Narrow Network |
$2,322.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,284.03
|
| Rate for Payer: UHC Exchange |
$1,284.03
|
| Rate for Payer: UHCCP Medicaid |
$747.84
|
|
|
PR SPLENECTOMY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$4,732.00
|
|
|
Service Code
|
HCPCS 38100
|
| Min. Negotiated Rate |
$482.87 |
| Max. Negotiated Rate |
$3,075.80 |
| Rate for Payer: Aetna Commercial |
$1,440.33
|
| Rate for Payer: Aetna Medicare |
$2,366.00
|
| Rate for Payer: BCBS Complete |
$774.72
|
| Rate for Payer: BCBS Trust/PPO |
$482.87
|
| Rate for Payer: BCN Commercial |
$1,677.15
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Meridian Medicaid |
$774.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$737.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,293.50
|
| Rate for Payer: Priority Health Narrow Network |
$2,293.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,277.20
|
| Rate for Payer: UHC Exchange |
$1,277.20
|
| Rate for Payer: UHCCP Medicaid |
$737.83
|
|
|
PR SPLINT
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS A4570
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$8.90
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| 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 |
$6.60
|
| Rate for Payer: UHC Exchange |
$6.60
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Facility
|
OP
|
$1,602.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
15120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,041.30 |
| Max. Negotiated Rate |
$5,559.77 |
| Rate for Payer: Aetna Commercial |
$1,441.80
|
| Rate for Payer: Aetna Medicare |
$3,586.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,483.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,483.69
|
| Rate for Payer: ASR ASR |
$1,553.94
|
| Rate for Payer: ASR Commercial |
$1,553.94
|
| Rate for Payer: BCBS Complete |
$2,018.74
|
| Rate for Payer: BCBS MAPPO |
$3,586.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,311.88
|
| Rate for Payer: BCN Commercial |
$1,242.03
|
| Rate for Payer: BCN Medicare Advantage |
$3,586.95
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$1,505.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,281.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,586.95
|
| Rate for Payer: Healthscope Commercial |
$1,602.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,553.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,586.95
|
| Rate for Payer: Mclaren Commercial |
$1,441.80
|
| Rate for Payer: Mclaren Medicaid |
$1,922.61
|
| Rate for Payer: Mclaren Medicare |
$3,586.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,766.30
|
| Rate for Payer: Meridian Medicaid |
$2,018.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,124.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,361.70
|
| Rate for Payer: Nomi Health Commercial |
$1,313.64
|
| Rate for Payer: PACE Medicare |
$3,407.60
|
| Rate for Payer: PACE SWMI |
$3,586.95
|
| Rate for Payer: PHP Commercial |
$3,945.64
|
| Rate for Payer: PHP Medicaid |
$1,922.61
|
| Rate for Payer: PHP Medicare Advantage |
$3,586.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,922.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,403.67
|
| Rate for Payer: Priority Health Medicare |
$3,586.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,123.00
|
| Rate for Payer: Railroad Medicare Medicare |
$3,586.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,409.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,586.95
|
| Rate for Payer: UHC Exchange |
$5,559.77
|
| Rate for Payer: UHC Medicare Advantage |
$3,586.95
|
| Rate for Payer: UHCCP DNSP |
$3,586.95
|
| Rate for Payer: UHCCP Medicaid |
$1,922.61
|
| Rate for Payer: VA VA |
$3,586.95
|
|
