|
PR STEREOTACTIC RADIOSURGERY 1 COMPLEX CRANIAL LES
|
Professional
|
Both
|
$8,316.00
|
|
|
Service Code
|
HCPCS 61798
|
| Min. Negotiated Rate |
$900.78 |
| Max. Negotiated Rate |
$5,405.40 |
| Rate for Payer: Aetna Commercial |
$1,782.51
|
| Rate for Payer: Aetna Medicare |
$4,158.00
|
| Rate for Payer: BCBS Complete |
$945.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,623.47
|
| Rate for Payer: BCN Commercial |
$2,036.80
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Meridian Medicaid |
$945.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$900.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,405.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,394.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,394.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,458.06
|
| Rate for Payer: UHC Exchange |
$1,458.06
|
| Rate for Payer: UHCCP Medicaid |
$900.78
|
|
|
PR STEREOTACTIC RADIOSURGERY 1 SIMPLE CRANIAL LES
|
Professional
|
Both
|
$8,316.00
|
|
|
Service Code
|
HCPCS 61796
|
| Min. Negotiated Rate |
$667.97 |
| Max. Negotiated Rate |
$5,405.40 |
| Rate for Payer: Aetna Commercial |
$1,312.22
|
| Rate for Payer: Aetna Medicare |
$4,158.00
|
| Rate for Payer: BCBS Complete |
$701.37
|
| Rate for Payer: BCBS Trust/PPO |
$828.90
|
| Rate for Payer: BCN Commercial |
$1,506.59
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Meridian Medicaid |
$701.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$667.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,405.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,771.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,771.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,098.12
|
| Rate for Payer: UHC Exchange |
$1,098.12
|
| Rate for Payer: UHCCP Medicaid |
$667.97
|
|
|
PR STEREOTACTIC RADIOSURGERY 1 SPINAL LESION
|
Professional
|
Both
|
$2,336.00
|
|
|
Service Code
|
HCPCS 63620
|
| Min. Negotiated Rate |
$737.41 |
| Max. Negotiated Rate |
$1,957.53 |
| Rate for Payer: Aetna Commercial |
$1,450.25
|
| Rate for Payer: Aetna Medicare |
$1,168.00
|
| Rate for Payer: BCBS Complete |
$774.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,093.05
|
| Rate for Payer: BCN Commercial |
$1,665.42
|
| Rate for Payer: Cash Price |
$1,868.80
|
| Rate for Payer: Cash Price |
$1,868.80
|
| Rate for Payer: Meridian Medicaid |
$774.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$737.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,518.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,957.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,957.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,199.75
|
| Rate for Payer: UHC Exchange |
$1,199.75
|
| Rate for Payer: UHCCP Medicaid |
$737.41
|
|
|
PR STERILE SALINE OR WATER
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS A4218
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCN Commercial |
$1.04
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
|
|
PR STERNAL DEBRIDEMENT
|
Professional
|
Both
|
$4,148.00
|
|
|
Service Code
|
HCPCS 21627
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$2,696.20 |
| Rate for Payer: Aetna Commercial |
$720.59
|
| Rate for Payer: Aetna Medicare |
$2,074.00
|
| Rate for Payer: BCBS Complete |
$372.82
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$798.50
|
| Rate for Payer: Cash Price |
$3,318.40
|
| Rate for Payer: Cash Price |
$3,318.40
|
| Rate for Payer: Meridian Medicaid |
$372.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$355.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,696.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$841.66
|
| Rate for Payer: Priority Health Narrow Network |
$841.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$638.52
|
| Rate for Payer: UHC Exchange |
$638.52
|
| Rate for Payer: UHCCP Medicaid |
$355.07
|
|
|
PR STOT/TOT HYSTERECTOMY AFTER CESAREAN DELIVERY
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
HCPCS 59525
|
| Min. Negotiated Rate |
$106.19 |
| Max. Negotiated Rate |
$742.30 |
| Rate for Payer: Aetna Commercial |
$530.07
|
| Rate for Payer: Aetna Medicare |
$571.00
|
| Rate for Payer: BCBS Complete |
$322.28
|
| Rate for Payer: BCBS Trust/PPO |
$106.19
|
| Rate for Payer: BCN Commercial |
$702.23
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Meridian Medicaid |
$322.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$306.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$742.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$672.56
|
| Rate for Payer: Priority Health Narrow Network |
$672.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$562.61
|
| Rate for Payer: UHC Exchange |
$562.61
|
| Rate for Payer: UHCCP Medicaid |
$306.93
|
|
|
PR STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC
|
Professional
|
Both
|
$1,445.00
|
|
|
Service Code
|
HCPCS 67311
|
| Min. Negotiated Rate |
$289.25 |
| Max. Negotiated Rate |
$939.25 |
| Rate for Payer: Aetna Commercial |
$775.15
|
| Rate for Payer: Aetna Medicare |
$722.50
|
| Rate for Payer: BCBS Complete |
$303.71
|
| Rate for Payer: BCBS Trust/PPO |
$310.11
|
| Rate for Payer: BCN Commercial |
$654.34
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Meridian Medicaid |
$303.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$289.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$792.55
|
| Rate for Payer: Priority Health Narrow Network |
$792.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$633.01
|
| Rate for Payer: UHC Exchange |
$633.01
|
| Rate for Payer: UHCCP Medicaid |
$289.25
|
|
|
PR STRAIGHT TIP URINE CATHETER
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS A4351
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$1.69
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCN Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.14
|
| Rate for Payer: UHC Exchange |
$1.14
|
|
|
PR STRAPPING ANKLE &/FOOT
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 29540
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$984.22 |
| Rate for Payer: Aetna Commercial |
$24.08
|
| Rate for Payer: Aetna Medicare |
$35.00
|
| Rate for Payer: BCBS Complete |
$11.63
|
| Rate for Payer: BCBS Trust/PPO |
$984.22
|
| Rate for Payer: BCN Commercial |
$32.99
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Meridian Medicaid |
$11.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.96
|
| Rate for Payer: Priority Health Narrow Network |
$25.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.20
|
| Rate for Payer: UHC Exchange |
$37.20
|
| Rate for Payer: UHCCP Medicaid |
$11.08
|
|
|
PR STRAPPING ELBOW/WRIST
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 29260
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$1,354.56 |
| Rate for Payer: Aetna Commercial |
$26.22
|
| Rate for Payer: Aetna Medicare |
$29.50
|
| Rate for Payer: BCBS Complete |
$12.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,354.56
|
| Rate for Payer: BCN Commercial |
$43.00
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Meridian Medicaid |
$12.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.49
|
| Rate for Payer: Priority Health Narrow Network |
$28.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.43
|
| Rate for Payer: UHC Exchange |
$42.43
|
| Rate for Payer: UHCCP Medicaid |
$11.93
|
|
|
PR STRAPPING HAND/FINGER
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 29280
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$66.95 |
| Rate for Payer: Aetna Commercial |
$26.22
|
| Rate for Payer: Aetna Medicare |
$51.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCN Commercial |
$43.49
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Meridian Medicaid |
$13.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.53
|
| Rate for Payer: Priority Health Narrow Network |
$30.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.18
|
| Rate for Payer: UHC Exchange |
$40.18
|
| Rate for Payer: UHCCP Medicaid |
$12.57
|
|
|
PR STRAPPING TOES
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 29550
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$958.34 |
| Rate for Payer: Aetna Commercial |
$15.27
|
| Rate for Payer: Aetna Medicare |
$29.50
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS Trust/PPO |
$958.34
|
| Rate for Payer: BCN Commercial |
$22.39
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Meridian Medicaid |
$7.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.78
|
| Rate for Payer: Priority Health Narrow Network |
$16.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.00
|
| Rate for Payer: UHC Exchange |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$7.03
|
|
|
PR STRAPPING UNNA BOOT
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 29580
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$1,192.37 |
| Rate for Payer: Aetna Commercial |
$35.54
|
| Rate for Payer: Aetna Medicare |
$47.50
|
| Rate for Payer: BCBS Complete |
$17.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,192.37
|
| Rate for Payer: BCN Commercial |
$74.21
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Meridian Medicaid |
$17.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.68
|
| Rate for Payer: Priority Health Narrow Network |
$39.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.63
|
| Rate for Payer: UHC Exchange |
$41.63
|
| Rate for Payer: UHCCP Medicaid |
$16.61
|
|
|
PR STRTCTC BX ASPIR/EXC BURR ICRA LESION W/CT&I/MR
|
Professional
|
Both
|
$7,034.00
|
|
|
Service Code
|
HCPCS 61751
|
| Min. Negotiated Rate |
$741.20 |
| Max. Negotiated Rate |
$4,572.10 |
| Rate for Payer: Aetna Commercial |
$1,786.62
|
| Rate for Payer: Aetna Medicare |
$3,517.00
|
| Rate for Payer: BCBS Complete |
$953.87
|
| Rate for Payer: BCBS Trust/PPO |
$741.20
|
| Rate for Payer: BCN Commercial |
$2,847.32
|
| Rate for Payer: Cash Price |
$5,627.20
|
| Rate for Payer: Cash Price |
$5,627.20
|
| Rate for Payer: Meridian Medicaid |
$953.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$908.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,572.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,413.63
|
| Rate for Payer: Priority Health Narrow Network |
$2,413.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,578.82
|
| Rate for Payer: UHC Exchange |
$1,578.82
|
| Rate for Payer: UHCCP Medicaid |
$908.45
|
|
|
PR STRTCTC CPTR ASSTD PX CRANIAL INTRADURAL
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 61781
|
| Min. Negotiated Rate |
$151.44 |
| Max. Negotiated Rate |
$698.41 |
| Rate for Payer: Aetna Commercial |
$305.80
|
| Rate for Payer: Aetna Medicare |
$371.50
|
| Rate for Payer: BCBS Complete |
$159.01
|
| Rate for Payer: BCBS Trust/PPO |
$698.41
|
| Rate for Payer: BCN Commercial |
$345.01
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Meridian Medicaid |
$159.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$151.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$402.66
|
| Rate for Payer: Priority Health Narrow Network |
$402.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.49
|
| Rate for Payer: UHC Exchange |
$316.49
|
| Rate for Payer: UHCCP Medicaid |
$151.44
|
|
|
PR STRTCTC CPTR ASSTD PX EXTRADURAL CRANIAL
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 61782
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$892.30 |
| Rate for Payer: Aetna Commercial |
$222.50
|
| Rate for Payer: Aetna Medicare |
$371.50
|
| Rate for Payer: BCBS Complete |
$115.63
|
| Rate for Payer: BCBS Trust/PPO |
$892.30
|
| Rate for Payer: BCN Commercial |
$251.18
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Meridian Medicaid |
$115.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$291.74
|
| Rate for Payer: Priority Health Narrow Network |
$291.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.02
|
| Rate for Payer: UHC Exchange |
$259.02
|
| Rate for Payer: UHCCP Medicaid |
$110.12
|
|
|
PR STRTCTC RADIOSURGERY EA ADDL CRANIAL LES COMPLEX
|
Professional
|
Both
|
$8,316.00
|
|
|
Service Code
|
HCPCS 61799
|
| Min. Negotiated Rate |
$194.26 |
| Max. Negotiated Rate |
$5,405.40 |
| Rate for Payer: Aetna Commercial |
$391.39
|
| Rate for Payer: Aetna Medicare |
$4,158.00
|
| Rate for Payer: BCBS Complete |
$203.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,112.60
|
| Rate for Payer: BCN Commercial |
$442.25
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Meridian Medicaid |
$203.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,405.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$518.66
|
| Rate for Payer: Priority Health Narrow Network |
$518.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$351.90
|
| Rate for Payer: UHC Exchange |
$351.90
|
| Rate for Payer: UHCCP Medicaid |
$194.26
|
|
|
PR STRTCTC RADIOSURGERY EA ADDL CRANIAL LES SIMPLE
|
Professional
|
Both
|
$8,316.00
|
|
|
Service Code
|
HCPCS 61797
|
| Min. Negotiated Rate |
$140.79 |
| Max. Negotiated Rate |
$5,405.40 |
| Rate for Payer: Aetna Commercial |
$284.57
|
| Rate for Payer: Aetna Medicare |
$4,158.00
|
| Rate for Payer: BCBS Complete |
$147.83
|
| Rate for Payer: BCBS Trust/PPO |
$828.37
|
| Rate for Payer: BCN Commercial |
$319.60
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Meridian Medicaid |
$147.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,405.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.36
|
| Rate for Payer: Priority Health Narrow Network |
$375.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$254.74
|
| Rate for Payer: UHC Exchange |
$254.74
|
| Rate for Payer: UHCCP Medicaid |
$140.79
|
|
|
PR SUBCUTANEOUS HORMONE PELLET IMPLANTATION
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 11980
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$137.81 |
| Rate for Payer: Aetna Commercial |
$61.12
|
| Rate for Payer: Aetna Medicare |
$91.00
|
| Rate for Payer: BCBS Complete |
$36.91
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$137.81
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Meridian Medicaid |
$36.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.49
|
| Rate for Payer: Priority Health Narrow Network |
$74.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.57
|
| Rate for Payer: UHC Exchange |
$88.57
|
| Rate for Payer: UHCCP Medicaid |
$35.15
|
|
|
PR SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI INIT
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 61000
|
| Min. Negotiated Rate |
$73.91 |
| Max. Negotiated Rate |
$461.73 |
| Rate for Payer: Aetna Commercial |
$145.81
|
| Rate for Payer: Aetna Medicare |
$233.00
|
| Rate for Payer: BCBS Complete |
$77.61
|
| Rate for Payer: BCBS Trust/PPO |
$461.73
|
| Rate for Payer: BCN Commercial |
$231.18
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Meridian Medicaid |
$77.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.20
|
| Rate for Payer: Priority Health Narrow Network |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$125.35
|
| Rate for Payer: UHC Exchange |
$125.35
|
| Rate for Payer: UHCCP Medicaid |
$73.91
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D >= 100SCM 1ST 100SQ CM
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 15277
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$505.29 |
| Rate for Payer: Aetna Commercial |
$245.92
|
| Rate for Payer: Aetna Medicare |
$245.50
|
| Rate for Payer: BCBS Complete |
$149.17
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$505.29
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Meridian Medicaid |
$149.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$142.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.45
|
| Rate for Payer: Priority Health Narrow Network |
$298.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.83
|
| Rate for Payer: UHC Exchange |
$256.83
|
| Rate for Payer: UHCCP Medicaid |
$142.07
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D >= 100SCM ADL 100SQ CM
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 15278
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$139.76 |
| Rate for Payer: Aetna Commercial |
$61.98
|
| Rate for Payer: Aetna Medicare |
$64.50
|
| Rate for Payer: BCBS Complete |
$37.35
|
| Rate for Payer: BCBS Trust/PPO |
$13.97
|
| Rate for Payer: BCN Commercial |
$139.76
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Meridian Medicaid |
$37.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.49
|
| Rate for Payer: Priority Health Narrow Network |
$74.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.00
|
| Rate for Payer: UHC Exchange |
$65.00
|
| Rate for Payer: UHCCP Medicaid |
$35.57
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D <100SQ CM 1ST 25 SQ CM
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
HCPCS 15275
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$231.63 |
| Rate for Payer: Aetna Commercial |
$102.56
|
| Rate for Payer: Aetna Medicare |
$141.50
|
| Rate for Payer: BCBS Complete |
$62.62
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$231.63
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Meridian Medicaid |
$62.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.08
|
| Rate for Payer: Priority Health Narrow Network |
$125.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.01
|
| Rate for Payer: UHC Exchange |
$121.01
|
| Rate for Payer: UHCCP Medicaid |
$59.64
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D<100SQ CM EA ADDL25SQ CM
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 15276
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$590.36 |
| Rate for Payer: Aetna Commercial |
$27.39
|
| Rate for Payer: Aetna Medicare |
$33.00
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS Trust/PPO |
$590.36
|
| Rate for Payer: BCN Commercial |
$47.41
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.41
|
| Rate for Payer: Priority Health Narrow Network |
$33.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.55
|
| Rate for Payer: UHC Exchange |
$29.55
|
| Rate for Payer: UHCCP Medicaid |
$15.76
|
|
|
PR SUBMUCOSAL ABLTJ TONGUE RF 1/> SITES PR SESSION
|
Professional
|
Both
|
$734.00
|
|
|
Service Code
|
HCPCS 41530
|
| Min. Negotiated Rate |
$241.97 |
| Max. Negotiated Rate |
$1,358.04 |
| Rate for Payer: Aetna Commercial |
$504.96
|
| Rate for Payer: Aetna Medicare |
$367.00
|
| Rate for Payer: BCBS Complete |
$254.07
|
| Rate for Payer: BCBS Trust/PPO |
$901.28
|
| Rate for Payer: BCN Commercial |
$1,358.04
|
| Rate for Payer: Cash Price |
$587.20
|
| Rate for Payer: Cash Price |
$587.20
|
| Rate for Payer: Meridian Medicaid |
$254.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$241.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$676.54
|
| Rate for Payer: Priority Health Narrow Network |
$676.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$476.96
|
| Rate for Payer: UHC Exchange |
$476.96
|
| Rate for Payer: UHCCP Medicaid |
$241.97
|
|
