|
PR TENOTOMY ADDUCTOR HIP OPEN
|
Professional
|
Both
|
$1,058.00
|
|
|
Service Code
|
HCPCS 27001
|
| Min. Negotiated Rate |
$352.94 |
| Max. Negotiated Rate |
$838.10 |
| Rate for Payer: Aetna Commercial |
$723.30
|
| Rate for Payer: Aetna Medicare |
$529.00
|
| Rate for Payer: BCBS Complete |
$370.59
|
| Rate for Payer: BCBS Trust/PPO |
$781.36
|
| Rate for Payer: BCN Commercial |
$798.99
|
| Rate for Payer: Cash Price |
$846.40
|
| Rate for Payer: Cash Price |
$846.40
|
| Rate for Payer: Meridian Medicaid |
$370.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$352.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$687.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$838.10
|
| Rate for Payer: Priority Health Narrow Network |
$838.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$612.59
|
| Rate for Payer: UHC Exchange |
$612.59
|
| Rate for Payer: UHCCP Medicaid |
$352.94
|
|
|
PR TENOTOMY ADDUCTOR HIP PERCUTANEOUS SPX
|
Professional
|
Both
|
$835.00
|
|
|
Service Code
|
HCPCS 27000
|
| Min. Negotiated Rate |
$253.90 |
| Max. Negotiated Rate |
$635.54 |
| Rate for Payer: Aetna Commercial |
$541.57
|
| Rate for Payer: Aetna Medicare |
$417.50
|
| Rate for Payer: BCBS Complete |
$266.60
|
| Rate for Payer: BCBS Trust/PPO |
$635.54
|
| Rate for Payer: BCN Commercial |
$578.11
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Meridian Medicaid |
$266.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$253.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$604.01
|
| Rate for Payer: Priority Health Narrow Network |
$604.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$500.41
|
| Rate for Payer: UHC Exchange |
$500.41
|
| Rate for Payer: UHCCP Medicaid |
$253.90
|
|
|
PR TENOTOMY ELBOW LATERAL/MEDIAL PERCUTANEOUS
|
Professional
|
Both
|
$1,273.00
|
|
|
Service Code
|
HCPCS 24357
|
| Min. Negotiated Rate |
$271.36 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Aetna Commercial |
$554.57
|
| Rate for Payer: Aetna Medicare |
$636.50
|
| Rate for Payer: BCBS Complete |
$284.93
|
| Rate for Payer: BCBS Trust/PPO |
$296.90
|
| Rate for Payer: BCN Commercial |
$617.20
|
| Rate for Payer: Cash Price |
$1,018.40
|
| Rate for Payer: Cash Price |
$1,018.40
|
| Rate for Payer: Meridian Medicaid |
$284.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$271.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$827.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$647.28
|
| Rate for Payer: Priority Health Narrow Network |
$647.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$499.32
|
| Rate for Payer: UHC Exchange |
$499.32
|
| Rate for Payer: UHCCP Medicaid |
$271.36
|
|
|
PR TENOTOMY EXTENSOR HAND/FINGER OPEN EACH TENDON
|
Professional
|
Both
|
$991.00
|
|
|
Service Code
|
HCPCS 26460
|
| Min. Negotiated Rate |
$292.45 |
| Max. Negotiated Rate |
$1,932.52 |
| Rate for Payer: Aetna Commercial |
$582.66
|
| Rate for Payer: Aetna Medicare |
$495.50
|
| Rate for Payer: BCBS Complete |
$307.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,932.52
|
| Rate for Payer: BCN Commercial |
$670.47
|
| Rate for Payer: Cash Price |
$792.80
|
| Rate for Payer: Cash Price |
$792.80
|
| Rate for Payer: Meridian Medicaid |
$307.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$292.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$701.71
|
| Rate for Payer: Priority Health Narrow Network |
$701.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.48
|
| Rate for Payer: UHC Exchange |
$426.48
|
| Rate for Payer: UHCCP Medicaid |
$292.45
|
|
|
PR TENOTOMY FLEXOR FINGER OPEN EACH TENDON
|
Professional
|
Both
|
$991.00
|
|
|
Service Code
|
HCPCS 26455
|
| Min. Negotiated Rate |
$298.84 |
| Max. Negotiated Rate |
$1,822.64 |
| Rate for Payer: Aetna Commercial |
$593.34
|
| Rate for Payer: Aetna Medicare |
$495.50
|
| Rate for Payer: BCBS Complete |
$313.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,822.64
|
| Rate for Payer: BCN Commercial |
$690.01
|
| Rate for Payer: Cash Price |
$792.80
|
| Rate for Payer: Cash Price |
$792.80
|
| Rate for Payer: Meridian Medicaid |
$313.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$716.48
|
| Rate for Payer: Priority Health Narrow Network |
$716.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$439.82
|
| Rate for Payer: UHC Exchange |
$439.82
|
| Rate for Payer: UHCCP Medicaid |
$298.84
|
|
|
PR TENOTOMY FLEXOR PALM OPEN EACH TENDON
|
Professional
|
Both
|
$1,127.00
|
|
|
Service Code
|
HCPCS 26450
|
| Min. Negotiated Rate |
$300.97 |
| Max. Negotiated Rate |
$1,515.16 |
| Rate for Payer: Aetna Commercial |
$597.83
|
| Rate for Payer: Aetna Medicare |
$563.50
|
| Rate for Payer: BCBS Complete |
$316.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,515.16
|
| Rate for Payer: BCN Commercial |
$693.93
|
| Rate for Payer: Cash Price |
$901.60
|
| Rate for Payer: Cash Price |
$901.60
|
| Rate for Payer: Meridian Medicaid |
$316.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$300.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$732.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$721.05
|
| Rate for Payer: Priority Health Narrow Network |
$721.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$442.37
|
| Rate for Payer: UHC Exchange |
$442.37
|
| Rate for Payer: UHCCP Medicaid |
$300.97
|
|
|
PR TENOTOMY HIP FLEXOR OPEN SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,411.00
|
|
|
Service Code
|
HCPCS 27005
|
| Min. Negotiated Rate |
$471.58 |
| Max. Negotiated Rate |
$1,113.39 |
| Rate for Payer: Aetna Commercial |
$959.38
|
| Rate for Payer: Aetna Medicare |
$705.50
|
| Rate for Payer: BCBS Complete |
$495.16
|
| Rate for Payer: BCBS Trust/PPO |
$801.96
|
| Rate for Payer: BCN Commercial |
$1,053.58
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Meridian Medicaid |
$495.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$471.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$917.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,113.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,113.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$831.32
|
| Rate for Payer: UHC Exchange |
$831.32
|
| Rate for Payer: UHCCP Medicaid |
$471.58
|
|
|
PR TENOTOMY OPEN ELBOW TO SHOULDER EACH TENDON
|
Professional
|
Both
|
$906.00
|
|
|
Service Code
|
HCPCS 24310
|
| Min. Negotiated Rate |
$182.79 |
| Max. Negotiated Rate |
$739.38 |
| Rate for Payer: Aetna Commercial |
$632.34
|
| Rate for Payer: Aetna Medicare |
$453.00
|
| Rate for Payer: BCBS Complete |
$325.18
|
| Rate for Payer: BCBS Trust/PPO |
$182.79
|
| Rate for Payer: BCN Commercial |
$704.67
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Meridian Medicaid |
$325.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$309.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$588.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$739.38
|
| Rate for Payer: Priority Health Narrow Network |
$739.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$537.66
|
| Rate for Payer: UHC Exchange |
$537.66
|
| Rate for Payer: UHCCP Medicaid |
$309.70
|
|
|
PR TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON
|
Professional
|
Both
|
$664.00
|
|
|
Service Code
|
HCPCS 28234
|
| Min. Negotiated Rate |
$176.79 |
| Max. Negotiated Rate |
$2,375.77 |
| Rate for Payer: Aetna Commercial |
$349.37
|
| Rate for Payer: Aetna Medicare |
$332.00
|
| Rate for Payer: BCBS Complete |
$185.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,375.77
|
| Rate for Payer: BCN Commercial |
$594.72
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Meridian Medicaid |
$185.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$417.27
|
| Rate for Payer: Priority Health Narrow Network |
$417.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$306.16
|
| Rate for Payer: UHC Exchange |
$306.16
|
| Rate for Payer: UHCCP Medicaid |
$176.79
|
|
|
PR TENOTOMY OPN HAMSTRING KNEE HIP MULTIPLE 1 LEG
|
Professional
|
Both
|
$1,153.00
|
|
|
Service Code
|
HCPCS 27391
|
| Min. Negotiated Rate |
$380.63 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna Commercial |
$733.56
|
| Rate for Payer: Aetna Medicare |
$576.50
|
| Rate for Payer: BCBS Complete |
$399.66
|
| Rate for Payer: BCBS Trust/PPO |
$924.00
|
| Rate for Payer: BCN Commercial |
$858.11
|
| Rate for Payer: Cash Price |
$922.40
|
| Rate for Payer: Cash Price |
$922.40
|
| Rate for Payer: Meridian Medicaid |
$399.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$380.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$900.69
|
| Rate for Payer: Priority Health Narrow Network |
$900.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$649.26
|
| Rate for Payer: UHC Exchange |
$649.26
|
| Rate for Payer: UHCCP Medicaid |
$380.63
|
|
|
PR TENOTOMY PERCUTANEOUS TOE SINGLE TENDON
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 28010
|
| Min. Negotiated Rate |
$136.11 |
| Max. Negotiated Rate |
$3,603.53 |
| Rate for Payer: Aetna Commercial |
$272.02
|
| Rate for Payer: Aetna Medicare |
$197.00
|
| Rate for Payer: BCBS Complete |
$142.92
|
| Rate for Payer: BCBS Trust/PPO |
$3,603.53
|
| Rate for Payer: BCN Commercial |
$340.12
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Meridian Medicaid |
$142.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$321.60
|
| Rate for Payer: Priority Health Narrow Network |
$321.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.74
|
| Rate for Payer: UHC Exchange |
$242.74
|
| Rate for Payer: UHCCP Medicaid |
$136.11
|
|
|
PR TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 27606
|
| Min. Negotiated Rate |
$175.94 |
| Max. Negotiated Rate |
$852.15 |
| Rate for Payer: Aetna Commercial |
$365.88
|
| Rate for Payer: Aetna Medicare |
$433.50
|
| Rate for Payer: BCBS Complete |
$184.74
|
| Rate for Payer: BCBS Trust/PPO |
$852.15
|
| Rate for Payer: BCN Commercial |
$396.32
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Meridian Medicaid |
$184.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$414.21
|
| Rate for Payer: Priority Health Narrow Network |
$414.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.93
|
| Rate for Payer: UHC Exchange |
$335.93
|
| Rate for Payer: UHCCP Medicaid |
$175.94
|
|
|
PR TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES
|
Professional
|
Both
|
$762.00
|
|
|
Service Code
|
HCPCS 27605
|
| Min. Negotiated Rate |
$118.64 |
| Max. Negotiated Rate |
$832.60 |
| Rate for Payer: Aetna Commercial |
$244.41
|
| Rate for Payer: Aetna Medicare |
$381.00
|
| Rate for Payer: BCBS Complete |
$124.57
|
| Rate for Payer: BCBS Trust/PPO |
$832.60
|
| Rate for Payer: BCN Commercial |
$481.83
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Meridian Medicaid |
$124.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.90
|
| Rate for Payer: Priority Health Narrow Network |
$280.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.76
|
| Rate for Payer: UHC Exchange |
$223.76
|
| Rate for Payer: UHCCP Medicaid |
$118.64
|
|
|
PR TENOTOMY PRQ ADDUCTOR/HAMSTRING 1 TENDON SPX
|
Professional
|
Both
|
$1,181.00
|
|
|
Service Code
|
HCPCS 27306
|
| Min. Negotiated Rate |
$225.35 |
| Max. Negotiated Rate |
$767.65 |
| Rate for Payer: Aetna Commercial |
$444.87
|
| Rate for Payer: Aetna Medicare |
$590.50
|
| Rate for Payer: BCBS Complete |
$236.62
|
| Rate for Payer: BCN Commercial |
$494.05
|
| Rate for Payer: Cash Price |
$944.80
|
| Rate for Payer: Cash Price |
$944.80
|
| Rate for Payer: Meridian Medicaid |
$236.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$767.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$533.28
|
| Rate for Payer: Priority Health Narrow Network |
$533.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$429.18
|
| Rate for Payer: UHC Exchange |
$429.18
|
| Rate for Payer: UHCCP Medicaid |
$225.35
|
|
|
PR TENOTOMY PRQ ADDUCTOR/HAMSTRING MULTIPLE TENDON
|
Professional
|
Both
|
$845.00
|
|
|
Service Code
|
HCPCS 27307
|
| Min. Negotiated Rate |
$268.81 |
| Max. Negotiated Rate |
$2,244.75 |
| Rate for Payer: Aetna Commercial |
$639.94
|
| Rate for Payer: Aetna Medicare |
$422.50
|
| Rate for Payer: BCBS Complete |
$282.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,244.75
|
| Rate for Payer: BCN Commercial |
$602.05
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Meridian Medicaid |
$282.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$632.51
|
| Rate for Payer: Priority Health Narrow Network |
$632.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$529.96
|
| Rate for Payer: UHC Exchange |
$529.96
|
| Rate for Payer: UHCCP Medicaid |
$268.81
|
|
|
PR TENOTOMY SHOULDER AREA 1 TENDON
|
Professional
|
Both
|
$1,732.00
|
|
|
Service Code
|
HCPCS 23405
|
| Min. Negotiated Rate |
$87.87 |
| Max. Negotiated Rate |
$1,125.80 |
| Rate for Payer: Aetna Commercial |
$826.45
|
| Rate for Payer: Aetna Medicare |
$866.00
|
| Rate for Payer: BCBS Complete |
$420.68
|
| Rate for Payer: BCBS Trust/PPO |
$87.87
|
| Rate for Payer: BCN Commercial |
$908.45
|
| Rate for Payer: Cash Price |
$1,385.60
|
| Rate for Payer: Cash Price |
$1,385.60
|
| Rate for Payer: Meridian Medicaid |
$420.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,125.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$952.08
|
| Rate for Payer: Priority Health Narrow Network |
$952.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$718.13
|
| Rate for Payer: UHC Exchange |
$718.13
|
| Rate for Payer: UHCCP Medicaid |
$400.65
|
|
|
PR TERBUTALINE SULFATE INJ
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS J3105
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Commercial |
$8.03
|
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.18
|
| 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: UHC All Payor (Choice/PPO) + Core |
$3.66
|
| Rate for Payer: UHC Exchange |
$3.66
|
|
|
PR TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION
|
Professional
|
Both
|
$439.00
|
|
|
Service Code
|
HCPCS 95923
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$759.17 |
| Rate for Payer: Aetna Commercial |
$139.62
|
| Rate for Payer: Aetna Medicare |
$219.50
|
| Rate for Payer: BCBS Complete |
$29.30
|
| Rate for Payer: BCBS Trust/PPO |
$759.17
|
| Rate for Payer: BCN Commercial |
$179.83
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Meridian Medicaid |
$29.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.26
|
| Rate for Payer: Priority Health Narrow Network |
$59.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.89
|
| Rate for Payer: UHC Exchange |
$128.89
|
| Rate for Payer: UHCCP Medicaid |
$27.90
|
|
|
PR TESTOSTERONE CYPIONAT 100 MG
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1070
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCN Commercial |
$5.03
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
|
|
PR TESTOSTERONE CYPIONAT 200 MG
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS J1080
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCN Commercial |
$5.07
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
|
|
PR TESTOSTERONE CYPIONATE 1 ML
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS J1060
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna Medicare |
$3.00
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
|
|
PR TESTOSTERONE ENANTHATE INJ
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS J3130
|
| Min. Negotiated Rate |
$9.08 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCN Commercial |
$9.08
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
|
|
PR TESTOSTERONE PELLET 75 MG
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS S0189
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$106.79 |
| Rate for Payer: Aetna Commercial |
$100.93
|
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: BCBS Trust/PPO |
$106.47
|
| Rate for Payer: BCN Commercial |
$106.79
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.13
|
| Rate for Payer: UHC Exchange |
$105.13
|
|
|
PR TESTOSTERONE UNDECANOATE 1MG
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J3145
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$1.89
|
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.87
|
| Rate for Payer: BCN Commercial |
$1.87
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.89
|
| Rate for Payer: UHC Exchange |
$1.89
|
|
|
PR TETANUS IMMUNIZATION, IM
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 90703
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
|
