|
PR TTRACH INTRO NDL WIRE DIL/STENT/TUBE O2 THER
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 31730
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$1,574.52 |
| Rate for Payer: Aetna Commercial |
$194.23
|
| Rate for Payer: Aetna Medicare |
$152.50
|
| Rate for Payer: BCBS Complete |
$122.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,167.54
|
| Rate for Payer: BCN Commercial |
$1,574.52
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$203.46
|
| Rate for Payer: Priority Health Narrow Network |
$203.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.13
|
| Rate for Payer: UHC Exchange |
$173.13
|
|
|
PR TUBE/NEEDLE CATH JEJUNOSTOMY ANY METHOD
|
Professional
|
Both
|
$1,243.00
|
|
|
Service Code
|
HCPCS 44015
|
| Min. Negotiated Rate |
$89.46 |
| Max. Negotiated Rate |
$2,262.71 |
| Rate for Payer: Aetna Commercial |
$192.38
|
| Rate for Payer: Aetna Medicare |
$621.50
|
| Rate for Payer: BCBS Complete |
$93.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,262.71
|
| Rate for Payer: BCN Commercial |
$205.73
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Meridian Medicaid |
$93.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$249.96
|
| Rate for Payer: Priority Health Narrow Network |
$249.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.03
|
| Rate for Payer: UHC Exchange |
$178.03
|
| Rate for Payer: UHCCP Medicaid |
$89.46
|
|
|
PR TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
HCPCS 32551
|
| Min. Negotiated Rate |
$98.19 |
| Max. Negotiated Rate |
$753.36 |
| Rate for Payer: Aetna Commercial |
$202.73
|
| Rate for Payer: Aetna Medicare |
$301.00
|
| Rate for Payer: BCBS Complete |
$103.10
|
| Rate for Payer: BCBS Trust/PPO |
$753.36
|
| Rate for Payer: BCN Commercial |
$223.81
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Meridian Medicaid |
$103.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.73
|
| Rate for Payer: Priority Health Narrow Network |
$212.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.46
|
| Rate for Payer: UHC Exchange |
$203.46
|
| Rate for Payer: UHCCP Medicaid |
$98.19
|
|
|
PR TUBOTUBAL ANASTATOMOSIS
|
Professional
|
Both
|
$1,653.00
|
|
|
Service Code
|
HCPCS 58750
|
| Min. Negotiated Rate |
$428.98 |
| Max. Negotiated Rate |
$1,360.16 |
| Rate for Payer: Aetna Commercial |
$1,090.66
|
| Rate for Payer: Aetna Medicare |
$826.50
|
| Rate for Payer: BCBS Complete |
$661.20
|
| Rate for Payer: BCBS Trust/PPO |
$428.98
|
| Rate for Payer: BCN Commercial |
$1,334.09
|
| Rate for Payer: Cash Price |
$1,322.40
|
| Rate for Payer: Cash Price |
$1,322.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,074.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,360.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,360.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,034.98
|
| Rate for Payer: UHC Exchange |
$1,034.98
|
|
|
PR TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA
|
Professional
|
Both
|
$3,910.00
|
|
|
Service Code
|
HCPCS 61108
|
| Min. Negotiated Rate |
$594.70 |
| Max. Negotiated Rate |
$2,541.50 |
| Rate for Payer: Aetna Commercial |
$1,160.13
|
| Rate for Payer: Aetna Medicare |
$1,955.00
|
| Rate for Payer: BCBS Complete |
$624.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,532.07
|
| Rate for Payer: BCN Commercial |
$1,862.28
|
| Rate for Payer: Cash Price |
$3,128.00
|
| Rate for Payer: Cash Price |
$3,128.00
|
| Rate for Payer: Meridian Medicaid |
$624.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$594.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,541.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,577.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,577.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,022.10
|
| Rate for Payer: UHC Exchange |
$1,022.10
|
| Rate for Payer: UHCCP Medicaid |
$594.70
|
|
|
PR TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE
|
Professional
|
Both
|
$2,479.00
|
|
|
Service Code
|
HCPCS 61107
|
| Min. Negotiated Rate |
$201.07 |
| Max. Negotiated Rate |
$1,611.35 |
| Rate for Payer: Aetna Commercial |
$405.53
|
| Rate for Payer: Aetna Medicare |
$1,239.50
|
| Rate for Payer: BCBS Complete |
$211.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,532.60
|
| Rate for Payer: BCN Commercial |
$633.87
|
| Rate for Payer: Cash Price |
$1,983.20
|
| Rate for Payer: Cash Price |
$1,983.20
|
| Rate for Payer: Meridian Medicaid |
$211.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,611.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$535.17
|
| Rate for Payer: Priority Health Narrow Network |
$535.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.37
|
| Rate for Payer: UHC Exchange |
$376.37
|
| Rate for Payer: UHCCP Medicaid |
$201.07
|
|
|
PR TWIST DRILL HOLE SUBDURAL/VENTRICULAR PUNCTURE
|
Professional
|
Both
|
$2,149.00
|
|
|
Service Code
|
HCPCS 61105
|
| Min. Negotiated Rate |
$188.07 |
| Max. Negotiated Rate |
$1,396.85 |
| Rate for Payer: Aetna Commercial |
$593.07
|
| Rate for Payer: Aetna Medicare |
$1,074.50
|
| Rate for Payer: BCBS Complete |
$322.51
|
| Rate for Payer: BCBS Trust/PPO |
$188.07
|
| Rate for Payer: BCN Commercial |
$957.24
|
| Rate for Payer: Cash Price |
$1,719.20
|
| Rate for Payer: Cash Price |
$1,719.20
|
| Rate for Payer: Meridian Medicaid |
$322.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$307.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$812.70
|
| Rate for Payer: Priority Health Narrow Network |
$812.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$508.36
|
| Rate for Payer: UHC Exchange |
$508.36
|
| Rate for Payer: UHCCP Medicaid |
$307.15
|
|
|
PR TWO AREA LIPOSUCTION - 2 AREA 2.0 HR
|
Professional
|
Both
|
$2,754.00
|
|
|
Service Code
|
HCPCS 00528
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,101.60 |
| Max. Negotiated Rate |
$1,790.10 |
| Rate for Payer: Aetna Medicare |
$1,377.00
|
| Rate for Payer: BCBS Complete |
$1,101.60
|
| Rate for Payer: Cash Price |
$2,203.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,790.10
|
|
|
PR TX ANAL FSTL TRANS/SUPRA/XTRASPHNCTRC INCL SETON
|
Professional
|
Both
|
$1,465.00
|
|
|
Service Code
|
HCPCS 46280
|
| Min. Negotiated Rate |
$312.47 |
| Max. Negotiated Rate |
$5,471.60 |
| Rate for Payer: Aetna Commercial |
$637.07
|
| Rate for Payer: Aetna Medicare |
$732.50
|
| Rate for Payer: BCBS Complete |
$328.09
|
| Rate for Payer: BCBS Trust/PPO |
$5,471.60
|
| Rate for Payer: BCN Commercial |
$706.14
|
| Rate for Payer: Cash Price |
$1,172.00
|
| Rate for Payer: Cash Price |
$1,172.00
|
| Rate for Payer: Meridian Medicaid |
$328.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$312.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$952.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$866.86
|
| Rate for Payer: Priority Health Narrow Network |
$866.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$532.83
|
| Rate for Payer: UHC Exchange |
$532.83
|
| Rate for Payer: UHCCP Medicaid |
$312.47
|
|
|
PR TX ECTOPIC PREGNANCY ABDL PREGNANCY
|
Professional
|
Both
|
$1,505.00
|
|
|
Service Code
|
HCPCS 59130
|
| Min. Negotiated Rate |
$318.04 |
| Max. Negotiated Rate |
$1,397.13 |
| Rate for Payer: Aetna Commercial |
$1,039.81
|
| Rate for Payer: Aetna Medicare |
$752.50
|
| Rate for Payer: BCBS Complete |
$640.53
|
| Rate for Payer: BCBS Trust/PPO |
$318.04
|
| Rate for Payer: BCN Commercial |
$1,397.13
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Meridian Medicaid |
$640.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$610.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$978.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,338.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,338.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$950.27
|
| Rate for Payer: UHC Exchange |
$950.27
|
| Rate for Payer: UHCCP Medicaid |
$610.03
|
|
|
PR TX ECTOPIC PREGNANCY ABDOMINAL/VAGINAL APPR
|
Professional
|
Both
|
$1,729.00
|
|
|
Service Code
|
HCPCS 59120
|
| Min. Negotiated Rate |
$51.77 |
| Max. Negotiated Rate |
$1,203.12 |
| Rate for Payer: Aetna Commercial |
$892.36
|
| Rate for Payer: Aetna Medicare |
$864.50
|
| Rate for Payer: BCBS Complete |
$551.96
|
| Rate for Payer: BCBS Trust/PPO |
$51.77
|
| Rate for Payer: BCN Commercial |
$1,203.12
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Meridian Medicaid |
$551.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$525.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,123.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,153.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,153.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$908.40
|
| Rate for Payer: UHC Exchange |
$908.40
|
| Rate for Payer: UHCCP Medicaid |
$525.68
|
|
|
PR TX ECTOPIC PREGNANCY NTRSTL PRTL RESCJ UTER
|
Professional
|
Both
|
$1,817.00
|
|
|
Service Code
|
HCPCS 59136
|
| Min. Negotiated Rate |
$101.96 |
| Max. Negotiated Rate |
$1,324.80 |
| Rate for Payer: Aetna Commercial |
$986.02
|
| Rate for Payer: Aetna Medicare |
$908.50
|
| Rate for Payer: BCBS Complete |
$608.11
|
| Rate for Payer: BCBS Trust/PPO |
$101.96
|
| Rate for Payer: BCN Commercial |
$1,324.80
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Meridian Medicaid |
$608.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$579.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,181.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,269.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,269.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,005.59
|
| Rate for Payer: UHC Exchange |
$1,005.59
|
| Rate for Payer: UHCCP Medicaid |
$579.15
|
|
|
PR TX ECTOPIC PREGNANCY W/O SALPING&/OOPHORECTOMY
|
Professional
|
Both
|
$1,467.00
|
|
|
Service Code
|
HCPCS 59121
|
| Min. Negotiated Rate |
$286.34 |
| Max. Negotiated Rate |
$1,203.12 |
| Rate for Payer: Aetna Commercial |
$893.35
|
| Rate for Payer: Aetna Medicare |
$733.50
|
| Rate for Payer: BCBS Complete |
$552.20
|
| Rate for Payer: BCBS Trust/PPO |
$286.34
|
| Rate for Payer: BCN Commercial |
$1,203.12
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Meridian Medicaid |
$552.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$525.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$953.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,153.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,153.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$910.60
|
| Rate for Payer: UHC Exchange |
$910.60
|
| Rate for Payer: UHCCP Medicaid |
$525.90
|
|
|
PR TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE
|
Professional
|
Both
|
$3,514.00
|
|
|
Service Code
|
HCPCS 24516
|
| Min. Negotiated Rate |
$345.51 |
| Max. Negotiated Rate |
$2,284.10 |
| Rate for Payer: Aetna Commercial |
$1,148.79
|
| Rate for Payer: Aetna Medicare |
$1,757.00
|
| Rate for Payer: BCBS Complete |
$586.64
|
| Rate for Payer: BCBS Trust/PPO |
$345.51
|
| Rate for Payer: BCN Commercial |
$1,263.24
|
| Rate for Payer: Cash Price |
$2,811.20
|
| Rate for Payer: Cash Price |
$2,811.20
|
| Rate for Payer: Meridian Medicaid |
$586.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$558.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,284.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,324.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,324.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$990.16
|
| Rate for Payer: UHC Exchange |
$990.16
|
| Rate for Payer: UHCCP Medicaid |
$558.70
|
|
|
PR TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 59812
|
| Min. Negotiated Rate |
$198.73 |
| Max. Negotiated Rate |
$1,118.94 |
| Rate for Payer: Aetna Commercial |
$335.23
|
| Rate for Payer: Aetna Medicare |
$382.50
|
| Rate for Payer: BCBS Complete |
$208.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,118.94
|
| Rate for Payer: BCN Commercial |
$536.56
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Meridian Medicaid |
$208.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.49
|
| Rate for Payer: Priority Health Narrow Network |
$435.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$334.55
|
| Rate for Payer: UHC Exchange |
$334.55
|
| Rate for Payer: UHCCP Medicaid |
$198.73
|
|
|
PR TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW
|
Professional
|
Both
|
$4,106.00
|
|
|
Service Code
|
HCPCS 27245
|
| Min. Negotiated Rate |
$793.43 |
| Max. Negotiated Rate |
$2,668.90 |
| Rate for Payer: Aetna Commercial |
$1,639.86
|
| Rate for Payer: Aetna Medicare |
$2,053.00
|
| Rate for Payer: BCBS Complete |
$833.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,447.01
|
| Rate for Payer: BCN Commercial |
$1,792.96
|
| Rate for Payer: Cash Price |
$3,284.80
|
| Rate for Payer: Cash Price |
$3,284.80
|
| Rate for Payer: Meridian Medicaid |
$833.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$793.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,668.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,880.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,880.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,442.04
|
| Rate for Payer: UHC Exchange |
$1,442.04
|
| Rate for Payer: UHCCP Medicaid |
$793.43
|
|
|
PR TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT
|
Professional
|
Both
|
$3,471.00
|
|
|
Service Code
|
HCPCS 27244
|
| Min. Negotiated Rate |
$794.49 |
| Max. Negotiated Rate |
$2,256.15 |
| Rate for Payer: Aetna Commercial |
$1,641.64
|
| Rate for Payer: Aetna Medicare |
$1,735.50
|
| Rate for Payer: BCBS Complete |
$834.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,189.73
|
| Rate for Payer: BCN Commercial |
$1,976.34
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Meridian Medicaid |
$834.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$794.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,882.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,882.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,421.60
|
| Rate for Payer: UHC Exchange |
$1,421.60
|
| Rate for Payer: UHCCP Medicaid |
$794.49
|
|
|
PR TX MISSED ABORTION FIRST TRIMESTER SURGICAL
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 59820
|
| Min. Negotiated Rate |
$249.85 |
| Max. Negotiated Rate |
$1,022.79 |
| Rate for Payer: Aetna Commercial |
$413.43
|
| Rate for Payer: Aetna Medicare |
$408.00
|
| Rate for Payer: BCBS Complete |
$262.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,022.79
|
| Rate for Payer: BCN Commercial |
$650.43
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Meridian Medicaid |
$262.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$249.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.20
|
| Rate for Payer: Priority Health Narrow Network |
$548.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$400.15
|
| Rate for Payer: UHC Exchange |
$400.15
|
| Rate for Payer: UHCCP Medicaid |
$249.85
|
|
|
PR TX MISSED ABORTION SECOND TRIMESTER SURGICAL
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 59821
|
| Min. Negotiated Rate |
$244.10 |
| Max. Negotiated Rate |
$2,210.41 |
| Rate for Payer: Aetna Commercial |
$407.50
|
| Rate for Payer: Aetna Medicare |
$408.00
|
| Rate for Payer: BCBS Complete |
$256.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,210.41
|
| Rate for Payer: BCN Commercial |
$641.15
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Meridian Medicaid |
$256.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$244.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$535.63
|
| Rate for Payer: Priority Health Narrow Network |
$535.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.72
|
| Rate for Payer: UHC Exchange |
$403.72
|
| Rate for Payer: UHCCP Medicaid |
$244.10
|
|
|
PR TX OPEN TENDON FLEXOR TOE 1 TENDON SPX
|
Professional
|
Both
|
$635.00
|
|
|
Service Code
|
HCPCS 28232
|
| Min. Negotiated Rate |
$156.77 |
| Max. Negotiated Rate |
$1,182.86 |
| Rate for Payer: Aetna Commercial |
$316.96
|
| Rate for Payer: Aetna Medicare |
$317.50
|
| Rate for Payer: BCBS Complete |
$164.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.86
|
| Rate for Payer: BCN Commercial |
$547.32
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Meridian Medicaid |
$164.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$372.48
|
| Rate for Payer: Priority Health Narrow Network |
$372.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.03
|
| Rate for Payer: UHC Exchange |
$289.03
|
| Rate for Payer: UHCCP Medicaid |
$156.77
|
|
|
PR TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
HCPCS 28230
|
| Min. Negotiated Rate |
$185.95 |
| Max. Negotiated Rate |
$920.30 |
| Rate for Payer: Aetna Commercial |
$375.41
|
| Rate for Payer: Aetna Medicare |
$310.50
|
| Rate for Payer: BCBS Complete |
$195.25
|
| Rate for Payer: BCBS Trust/PPO |
$920.30
|
| Rate for Payer: BCN Commercial |
$630.40
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Meridian Medicaid |
$195.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$185.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$439.15
|
| Rate for Payer: Priority Health Narrow Network |
$439.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$337.49
|
| Rate for Payer: UHC Exchange |
$337.49
|
| Rate for Payer: UHCCP Medicaid |
$185.95
|
|
|
PR TX SEPTIC ABORTION SURGICAL
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 59830
|
| Min. Negotiated Rate |
$298.84 |
| Max. Negotiated Rate |
$1,227.77 |
| Rate for Payer: Aetna Commercial |
$503.21
|
| Rate for Payer: Aetna Medicare |
$500.00
|
| Rate for Payer: BCBS Complete |
$313.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,227.77
|
| Rate for Payer: BCN Commercial |
$685.61
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Meridian Medicaid |
$313.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$657.19
|
| Rate for Payer: Priority Health Narrow Network |
$657.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$497.47
|
| Rate for Payer: UHC Exchange |
$497.47
|
| Rate for Payer: UHCCP Medicaid |
$298.84
|
|
|
PR TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU
|
Professional
|
Both
|
$6,455.00
|
|
|
Service Code
|
HCPCS 27176
|
| Min. Negotiated Rate |
$600.23 |
| Max. Negotiated Rate |
$4,195.75 |
| Rate for Payer: Aetna Commercial |
$1,230.99
|
| Rate for Payer: Aetna Medicare |
$3,227.50
|
| Rate for Payer: BCBS Complete |
$630.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,365.66
|
| Rate for Payer: BCN Commercial |
$1,355.11
|
| Rate for Payer: Cash Price |
$5,164.00
|
| Rate for Payer: Cash Price |
$5,164.00
|
| Rate for Payer: Meridian Medicaid |
$630.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$600.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,195.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,421.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,421.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,048.69
|
| Rate for Payer: UHC Exchange |
$1,048.69
|
| Rate for Payer: UHCCP Medicaid |
$600.23
|
|
|
PR TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES
|
Professional
|
Both
|
$873.00
|
|
|
Service Code
|
HCPCS 27257
|
| Min. Negotiated Rate |
$234.30 |
| Max. Negotiated Rate |
$2,684.82 |
| Rate for Payer: Aetna Commercial |
$483.93
|
| Rate for Payer: Aetna Medicare |
$436.50
|
| Rate for Payer: BCBS Complete |
$246.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,684.82
|
| Rate for Payer: BCN Commercial |
$528.75
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Meridian Medicaid |
$246.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$555.68
|
| Rate for Payer: Priority Health Narrow Network |
$555.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.18
|
| Rate for Payer: UHC Exchange |
$389.18
|
| Rate for Payer: UHCCP Medicaid |
$234.30
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
12020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$305.50 |
| Max. Negotiated Rate |
$470.00 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: ASR ASR |
$455.90
|
| Rate for Payer: ASR Commercial |
$455.90
|
| Rate for Payer: BCBS Trust/PPO |
$383.00
|
| Rate for Payer: BCN Commercial |
$364.39
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$441.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Healthscope Commercial |
$470.00
|
| Rate for Payer: Healthscope Whirlpool |
$455.90
|
| Rate for Payer: Mclaren Commercial |
$423.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.50
|
| Rate for Payer: Nomi Health Commercial |
$385.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$413.60
|
|
