|
PR TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I ADDL VEIN
|
Professional
|
Both
|
$463.00
|
|
|
Service Code
|
HCPCS 37249
|
| Min. Negotiated Rate |
$91.38 |
| Max. Negotiated Rate |
$647.99 |
| Rate for Payer: Aetna Commercial |
$194.65
|
| Rate for Payer: Aetna Medicare |
$231.50
|
| Rate for Payer: BCBS Complete |
$95.95
|
| Rate for Payer: BCBS Trust/PPO |
$260.45
|
| Rate for Payer: BCN Commercial |
$647.99
|
| Rate for Payer: Cash Price |
$370.40
|
| Rate for Payer: Cash Price |
$370.40
|
| Rate for Payer: Meridian Medicaid |
$95.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.50
|
| Rate for Payer: Priority Health Narrow Network |
$225.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.48
|
| Rate for Payer: UHC Exchange |
$200.48
|
| Rate for Payer: UHCCP Medicaid |
$91.38
|
|
|
PR TRLUML BALO ANGIOP CTR DIALYSIS SEG W/IMG S&I
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
HCPCS 36907
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$1,983.24 |
| Rate for Payer: Aetna Commercial |
$196.77
|
| Rate for Payer: Aetna Medicare |
$162.00
|
| Rate for Payer: BCBS Complete |
$96.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,983.24
|
| Rate for Payer: BCN Commercial |
$867.89
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Meridian Medicaid |
$96.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.02
|
| Rate for Payer: Priority Health Narrow Network |
$226.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.70
|
| Rate for Payer: UHC Exchange |
$166.70
|
| Rate for Payer: UHCCP Medicaid |
$91.59
|
|
|
PR TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL
|
Professional
|
Both
|
$9,821.00
|
|
|
Service Code
|
HCPCS 0237T
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$9,819.16 |
| Rate for Payer: Aetna Commercial |
$4,395.81
|
| Rate for Payer: Aetna Medicare |
$4,910.50
|
| Rate for Payer: BCBS Complete |
$260.96
|
| Rate for Payer: BCBS Trust/PPO |
$100.60
|
| Rate for Payer: BCN Commercial |
$9,819.16
|
| Rate for Payer: Cash Price |
$7,856.80
|
| Rate for Payer: Cash Price |
$7,856.80
|
| Rate for Payer: Meridian Medicaid |
$260.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$248.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,383.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,548.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,548.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$473.86
|
| Rate for Payer: UHC Exchange |
$473.86
|
| Rate for Payer: UHCCP Medicaid |
$248.53
|
|
|
PR TRNSCONDLR POST CRNL FOSSA DCOMPR ART W/WO MOBIL
|
Professional
|
Both
|
$8,756.00
|
|
|
Service Code
|
HCPCS 61597
|
| Min. Negotiated Rate |
$1,813.13 |
| Max. Negotiated Rate |
$6,047.84 |
| Rate for Payer: Aetna Commercial |
$3,837.78
|
| Rate for Payer: Aetna Medicare |
$4,378.00
|
| Rate for Payer: BCBS Complete |
$1,981.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,813.13
|
| Rate for Payer: BCN Commercial |
$6,047.84
|
| Rate for Payer: Cash Price |
$7,004.80
|
| Rate for Payer: Cash Price |
$7,004.80
|
| Rate for Payer: Meridian Medicaid |
$1,981.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,887.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,691.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,112.76
|
| Rate for Payer: Priority Health Narrow Network |
$5,112.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,382.60
|
| Rate for Payer: UHC Exchange |
$3,382.60
|
| Rate for Payer: UHCCP Medicaid |
$1,887.61
|
|
|
PR TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS 38207
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$1,622.41 |
| Rate for Payer: Aetna Commercial |
$54.89
|
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: BCBS Complete |
$29.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,622.41
|
| Rate for Payer: BCN Commercial |
$64.99
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Meridian Medicaid |
$29.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.54
|
| Rate for Payer: Priority Health Narrow Network |
$88.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.94
|
| Rate for Payer: UHC Exchange |
$57.94
|
| Rate for Payer: UHCCP Medicaid |
$28.12
|
|
|
PR TR PARASPI MUSC HIP FASC/TDN XTN GRF
|
Professional
|
Both
|
$6,317.00
|
|
|
Service Code
|
HCPCS 27105
|
| Min. Negotiated Rate |
$567.22 |
| Max. Negotiated Rate |
$4,106.05 |
| Rate for Payer: Aetna Commercial |
$1,161.46
|
| Rate for Payer: Aetna Medicare |
$3,158.50
|
| Rate for Payer: BCBS Complete |
$595.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,594.41
|
| Rate for Payer: BCN Commercial |
$1,280.34
|
| Rate for Payer: Cash Price |
$5,053.60
|
| Rate for Payer: Cash Price |
$5,053.60
|
| Rate for Payer: Meridian Medicaid |
$595.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$567.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,106.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,344.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,344.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$989.80
|
| Rate for Payer: UHC Exchange |
$989.80
|
| Rate for Payer: UHCCP Medicaid |
$567.22
|
|
|
PR TRPOS&/RIMPLTJ CAROTID SUBCLAVIAN ART
|
Professional
|
Both
|
$2,076.00
|
|
|
Service Code
|
HCPCS 35695
|
| Min. Negotiated Rate |
$642.62 |
| Max. Negotiated Rate |
$1,599.73 |
| Rate for Payer: Aetna Commercial |
$1,378.42
|
| Rate for Payer: Aetna Medicare |
$1,038.00
|
| Rate for Payer: BCBS Complete |
$674.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,523.09
|
| Rate for Payer: BCN Commercial |
$1,463.59
|
| Rate for Payer: Cash Price |
$1,660.80
|
| Rate for Payer: Cash Price |
$1,660.80
|
| Rate for Payer: Meridian Medicaid |
$674.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$642.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,349.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,599.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,599.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,428.30
|
| Rate for Payer: UHC Exchange |
$1,428.30
|
| Rate for Payer: UHCCP Medicaid |
$642.62
|
|
|
PR TRPOS&/RIMPLTJ SUBCLAVIAN CAROTID ART
|
Professional
|
Both
|
$2,142.00
|
|
|
Service Code
|
HCPCS 35694
|
| Min. Negotiated Rate |
$619.40 |
| Max. Negotiated Rate |
$1,541.75 |
| Rate for Payer: Aetna Commercial |
$1,327.34
|
| Rate for Payer: Aetna Medicare |
$1,071.00
|
| Rate for Payer: BCBS Complete |
$650.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,526.79
|
| Rate for Payer: BCN Commercial |
$1,409.84
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Meridian Medicaid |
$650.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,541.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,541.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,370.73
|
| Rate for Payer: UHC Exchange |
$1,370.73
|
| Rate for Payer: UHCCP Medicaid |
$619.40
|
|
|
PR TRPOS&/RIMPLTJ VERTEBRAL CAROTID ART
|
Professional
|
Both
|
$4,566.00
|
|
|
Service Code
|
HCPCS 35691
|
| Min. Negotiated Rate |
$592.78 |
| Max. Negotiated Rate |
$2,967.90 |
| Rate for Payer: Aetna Commercial |
$1,271.09
|
| Rate for Payer: Aetna Medicare |
$2,283.00
|
| Rate for Payer: BCBS Complete |
$622.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,610.26
|
| Rate for Payer: BCN Commercial |
$1,350.70
|
| Rate for Payer: Cash Price |
$3,652.80
|
| Rate for Payer: Cash Price |
$3,652.80
|
| Rate for Payer: Meridian Medicaid |
$622.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$592.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,967.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,476.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,476.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,321.36
|
| Rate for Payer: UHC Exchange |
$1,321.36
|
| Rate for Payer: UHCCP Medicaid |
$592.78
|
|
|
PR TRPOS&/RIMPLTJ VERTEBRAL SUBCLAVIAN ART
|
Professional
|
Both
|
$1,756.00
|
|
|
Service Code
|
HCPCS 35693
|
| Min. Negotiated Rate |
$526.11 |
| Max. Negotiated Rate |
$2,046.11 |
| Rate for Payer: Aetna Commercial |
$1,118.77
|
| Rate for Payer: Aetna Medicare |
$878.00
|
| Rate for Payer: BCBS Complete |
$552.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,046.11
|
| Rate for Payer: BCN Commercial |
$1,193.84
|
| Rate for Payer: Cash Price |
$1,404.80
|
| Rate for Payer: Cash Price |
$1,404.80
|
| Rate for Payer: Meridian Medicaid |
$552.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$526.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,141.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,309.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,309.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,168.23
|
| Rate for Payer: UHC Exchange |
$1,168.23
|
| Rate for Payer: UHCCP Medicaid |
$526.11
|
|
|
PR TR TDN RESTORE INTRNSC FUNCJ RING&SM FNGR
|
Professional
|
Both
|
$2,775.00
|
|
|
Service Code
|
HCPCS 26497
|
| Min. Negotiated Rate |
$584.26 |
| Max. Negotiated Rate |
$2,458.71 |
| Rate for Payer: Aetna Commercial |
$1,202.33
|
| Rate for Payer: Aetna Medicare |
$1,387.50
|
| Rate for Payer: BCBS Complete |
$613.47
|
| Rate for Payer: BCBS Trust/PPO |
$2,458.71
|
| Rate for Payer: BCN Commercial |
$1,344.84
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Meridian Medicaid |
$613.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,399.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,399.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$964.25
|
| Rate for Payer: UHC Exchange |
$964.25
|
| Rate for Payer: UHCCP Medicaid |
$584.26
|
|
|
PR TR TOE-TO-HAND W/MVASC ANAST GRT TOE WRP/ARND
|
Professional
|
Both
|
$5,615.00
|
|
|
Service Code
|
HCPCS 26551
|
| Min. Negotiated Rate |
$201.28 |
| Max. Negotiated Rate |
$5,029.06 |
| Rate for Payer: Aetna Commercial |
$4,427.34
|
| Rate for Payer: Aetna Medicare |
$2,807.50
|
| Rate for Payer: BCBS Complete |
$2,217.26
|
| Rate for Payer: BCBS Trust/PPO |
$201.28
|
| Rate for Payer: BCN Commercial |
$4,818.85
|
| Rate for Payer: Cash Price |
$4,492.00
|
| Rate for Payer: Cash Price |
$4,492.00
|
| Rate for Payer: Meridian Medicaid |
$2,217.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,111.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,649.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,029.06
|
| Rate for Payer: Priority Health Narrow Network |
$5,029.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,711.67
|
| Rate for Payer: UHC Exchange |
$3,711.67
|
| Rate for Payer: UHCCP Medicaid |
$2,111.68
|
|
|
PR TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING DP
|
Professional
|
Both
|
$2,819.00
|
|
|
Service Code
|
HCPCS 27691
|
| Min. Negotiated Rate |
$484.15 |
| Max. Negotiated Rate |
$2,829.97 |
| Rate for Payer: Aetna Commercial |
$991.04
|
| Rate for Payer: Aetna Medicare |
$1,409.50
|
| Rate for Payer: BCBS Complete |
$508.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,829.97
|
| Rate for Payer: BCN Commercial |
$1,090.73
|
| Rate for Payer: Cash Price |
$2,255.20
|
| Rate for Payer: Cash Price |
$2,255.20
|
| Rate for Payer: Meridian Medicaid |
$508.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,832.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,145.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,145.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$863.36
|
| Rate for Payer: UHC Exchange |
$863.36
|
| Rate for Payer: UHCCP Medicaid |
$484.15
|
|
|
PR TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING EA TDN
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 27692
|
| Min. Negotiated Rate |
$65.39 |
| Max. Negotiated Rate |
$3,094.06 |
| Rate for Payer: Aetna Commercial |
$138.03
|
| Rate for Payer: Aetna Medicare |
$255.00
|
| Rate for Payer: BCBS Complete |
$68.66
|
| Rate for Payer: BCBS Trust/PPO |
$3,094.06
|
| Rate for Payer: BCN Commercial |
$145.14
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Meridian Medicaid |
$68.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.18
|
| Rate for Payer: Priority Health Narrow Network |
$154.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.62
|
| Rate for Payer: UHC Exchange |
$129.62
|
| Rate for Payer: UHCCP Medicaid |
$65.39
|
|
|
PR TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING SUPFC
|
Professional
|
Both
|
$1,995.00
|
|
|
Service Code
|
HCPCS 27690
|
| Min. Negotiated Rate |
$416.63 |
| Max. Negotiated Rate |
$1,296.75 |
| Rate for Payer: Aetna Commercial |
$854.26
|
| Rate for Payer: Aetna Medicare |
$997.50
|
| Rate for Payer: BCBS Complete |
$437.46
|
| Rate for Payer: BCBS Trust/PPO |
$627.07
|
| Rate for Payer: BCN Commercial |
$935.81
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: Meridian Medicaid |
$437.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$416.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,296.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$984.14
|
| Rate for Payer: Priority Health Narrow Network |
$984.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$730.19
|
| Rate for Payer: UHC Exchange |
$730.19
|
| Rate for Payer: UHCCP Medicaid |
$416.63
|
|
|
PR TR/TRNSPL TDN CARP/MTCRPL HAND W/O FR GRF EA TDN
|
Professional
|
Both
|
$2,062.00
|
|
|
Service Code
|
HCPCS 26480
|
| Min. Negotiated Rate |
$467.96 |
| Max. Negotiated Rate |
$1,340.30 |
| Rate for Payer: Aetna Commercial |
$1,042.22
|
| Rate for Payer: Aetna Medicare |
$1,031.00
|
| Rate for Payer: BCBS Complete |
$491.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,024.37
|
| Rate for Payer: BCN Commercial |
$1,168.91
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Meridian Medicaid |
$491.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,340.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,214.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,214.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$827.26
|
| Rate for Payer: UHC Exchange |
$827.26
|
| Rate for Payer: UHCCP Medicaid |
$467.96
|
|
|
PR TRURL DRAINAGE PROSTATIC ABSCESS
|
Professional
|
Both
|
$827.00
|
|
|
Service Code
|
HCPCS 52700
|
| Min. Negotiated Rate |
$283.70 |
| Max. Negotiated Rate |
$707.82 |
| Rate for Payer: Aetna Commercial |
$564.73
|
| Rate for Payer: Aetna Medicare |
$413.50
|
| Rate for Payer: BCBS Complete |
$299.24
|
| Rate for Payer: BCBS Trust/PPO |
$283.70
|
| Rate for Payer: BCN Commercial |
$640.16
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Meridian Medicaid |
$299.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$707.82
|
| Rate for Payer: Priority Health Narrow Network |
$707.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$522.65
|
| Rate for Payer: UHC Exchange |
$522.65
|
| Rate for Payer: UHCCP Medicaid |
$284.99
|
|
|
PR TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPY
|
Professional
|
Both
|
$3,550.00
|
|
|
Service Code
|
HCPCS 53854
|
| Min. Negotiated Rate |
$246.23 |
| Max. Negotiated Rate |
$2,456.58 |
| Rate for Payer: Aetna Commercial |
$482.70
|
| Rate for Payer: Aetna Medicare |
$1,775.00
|
| Rate for Payer: BCBS Complete |
$258.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,462.86
|
| Rate for Payer: BCN Commercial |
$2,456.58
|
| Rate for Payer: Cash Price |
$2,840.00
|
| Rate for Payer: Cash Price |
$2,840.00
|
| Rate for Payer: Meridian Medicaid |
$258.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$246.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,307.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.42
|
| Rate for Payer: Priority Health Narrow Network |
$611.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.32
|
| Rate for Payer: UHC Exchange |
$457.32
|
| Rate for Payer: UHCCP Medicaid |
$246.23
|
|
|
PR TRURL DSTRJ PRSTATE TISS RF THERMOTH
|
Professional
|
Both
|
$2,935.00
|
|
|
Service Code
|
HCPCS 53852
|
| Min. Negotiated Rate |
$246.23 |
| Max. Negotiated Rate |
$2,032.41 |
| Rate for Payer: Aetna Commercial |
$482.28
|
| Rate for Payer: Aetna Medicare |
$1,467.50
|
| Rate for Payer: BCBS Complete |
$258.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,575.92
|
| Rate for Payer: BCN Commercial |
$2,032.41
|
| Rate for Payer: Cash Price |
$2,348.00
|
| Rate for Payer: Cash Price |
$2,348.00
|
| Rate for Payer: Meridian Medicaid |
$258.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$246.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,907.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.42
|
| Rate for Payer: Priority Health Narrow Network |
$611.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$747.16
|
| Rate for Payer: UHC Exchange |
$747.16
|
| Rate for Payer: UHCCP Medicaid |
$246.23
|
|
|
PR TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 52601
|
| Min. Negotiated Rate |
$465.62 |
| Max. Negotiated Rate |
$1,157.34 |
| Rate for Payer: Aetna Commercial |
$935.09
|
| Rate for Payer: Aetna Medicare |
$795.00
|
| Rate for Payer: BCBS Complete |
$488.90
|
| Rate for Payer: BCBS Trust/PPO |
$659.32
|
| Rate for Payer: BCN Commercial |
$1,048.70
|
| Rate for Payer: Cash Price |
$1,272.00
|
| Rate for Payer: Cash Price |
$1,272.00
|
| Rate for Payer: Meridian Medicaid |
$488.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,157.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,157.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,005.17
|
| Rate for Payer: UHC Exchange |
$1,005.17
|
| Rate for Payer: UHCCP Medicaid |
$465.62
|
|
|
PR TRURL RESCJ POSTOP BLADDER NECK CONTRACTURE
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
HCPCS 52640
|
| Min. Negotiated Rate |
$209.59 |
| Max. Negotiated Rate |
$733.28 |
| Rate for Payer: Aetna Commercial |
$405.73
|
| Rate for Payer: Aetna Medicare |
$362.00
|
| Rate for Payer: BCBS Complete |
$220.07
|
| Rate for Payer: BCBS Trust/PPO |
$733.28
|
| Rate for Payer: BCN Commercial |
$467.17
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Meridian Medicaid |
$220.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$518.75
|
| Rate for Payer: Priority Health Narrow Network |
$518.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$356.56
|
| Rate for Payer: UHC Exchange |
$356.56
|
| Rate for Payer: UHCCP Medicaid |
$209.59
|
|
|
PR TRURL RESCJ RESIDUAL/REGROWTH OBSTR PRSTATE TISS
|
Professional
|
Both
|
$789.00
|
|
|
Service Code
|
HCPCS 52630
|
| Min. Negotiated Rate |
$262.20 |
| Max. Negotiated Rate |
$727.47 |
| Rate for Payer: Aetna Commercial |
$515.11
|
| Rate for Payer: Aetna Medicare |
$394.50
|
| Rate for Payer: BCBS Complete |
$275.31
|
| Rate for Payer: BCBS Trust/PPO |
$727.47
|
| Rate for Payer: BCN Commercial |
$586.90
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Meridian Medicaid |
$275.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$262.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$649.78
|
| Rate for Payer: Priority Health Narrow Network |
$649.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$533.35
|
| Rate for Payer: UHC Exchange |
$533.35
|
| Rate for Payer: UHCCP Medicaid |
$262.20
|
|
|
PR TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS 95921
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$1,174.41 |
| Rate for Payer: Aetna Commercial |
$96.18
|
| Rate for Payer: Aetna Medicare |
$77.00
|
| Rate for Payer: BCBS Complete |
$29.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,174.41
|
| Rate for Payer: BCN Commercial |
$127.55
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Meridian Medicaid |
$29.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.80
|
| Rate for Payer: Priority Health Narrow Network |
$58.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.82
|
| Rate for Payer: UHC Exchange |
$77.82
|
| Rate for Payer: UHCCP Medicaid |
$27.69
|
|
|
PR TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 95924
|
| Min. Negotiated Rate |
$53.89 |
| Max. Negotiated Rate |
$987.92 |
| Rate for Payer: Aetna Commercial |
$163.67
|
| Rate for Payer: Aetna Medicare |
$90.50
|
| Rate for Payer: BCBS Complete |
$56.58
|
| Rate for Payer: BCBS Trust/PPO |
$987.92
|
| Rate for Payer: BCN Commercial |
$221.37
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Meridian Medicaid |
$56.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.34
|
| Rate for Payer: Priority Health Narrow Network |
$115.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.61
|
| Rate for Payer: UHC Exchange |
$164.61
|
| Rate for Payer: UHCCP Medicaid |
$53.89
|
|
|
PR TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 95922
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$759.70 |
| Rate for Payer: Aetna Commercial |
$113.87
|
| Rate for Payer: Aetna Medicare |
$92.50
|
| Rate for Payer: BCBS Complete |
$29.97
|
| Rate for Payer: BCBS Trust/PPO |
$759.70
|
| Rate for Payer: BCN Commercial |
$141.23
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Meridian Medicaid |
$29.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.25
|
| 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 |
$94.29
|
| Rate for Payer: UHC Exchange |
$94.29
|
| Rate for Payer: UHCCP Medicaid |
$28.54
|
|
