|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
12020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$305.50 |
| Max. Negotiated Rate |
$929.61 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: Aetna Medicare |
$599.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$749.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$749.69
|
| Rate for Payer: ASR ASR |
$455.90
|
| Rate for Payer: ASR Commercial |
$455.90
|
| Rate for Payer: BCBS Complete |
$337.54
|
| Rate for Payer: BCBS MAPPO |
$599.75
|
| Rate for Payer: BCBS Trust/PPO |
$384.88
|
| Rate for Payer: BCN Commercial |
$364.39
|
| Rate for Payer: BCN Medicare Advantage |
$599.75
|
| Rate for Payer: Cash Price |
$376.00
|
| 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: Health Alliance Plan Medicare Advantage |
$599.75
|
| Rate for Payer: Healthscope Commercial |
$470.00
|
| Rate for Payer: Healthscope Whirlpool |
$455.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$599.75
|
| Rate for Payer: Mclaren Commercial |
$423.00
|
| Rate for Payer: Mclaren Medicaid |
$321.47
|
| Rate for Payer: Mclaren Medicare |
$599.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.74
|
| Rate for Payer: Meridian Medicaid |
$337.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.50
|
| Rate for Payer: Nomi Health Commercial |
$385.40
|
| Rate for Payer: PACE Medicare |
$569.76
|
| Rate for Payer: PACE SWMI |
$599.75
|
| Rate for Payer: PHP Commercial |
$659.72
|
| Rate for Payer: PHP Medicaid |
$321.47
|
| Rate for Payer: PHP Medicare Advantage |
$599.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$701.63
|
| Rate for Payer: Priority Health Medicare |
$599.75
|
| Rate for Payer: Priority Health Narrow Network |
$561.30
|
| Rate for Payer: Railroad Medicare Medicare |
$599.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$413.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.75
|
| Rate for Payer: UHC Exchange |
$929.61
|
| Rate for Payer: UHC Medicare Advantage |
$599.75
|
| Rate for Payer: UHCCP DNSP |
$599.75
|
| Rate for Payer: UHCCP Medicaid |
$321.47
|
| Rate for Payer: VA VA |
$599.75
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
12020
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$441.27 |
| Rate for Payer: Aetna Commercial |
$203.61
|
| Rate for Payer: Aetna Medicare |
$235.00
|
| Rate for Payer: BCBS Complete |
$127.93
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$441.27
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Meridian Medicaid |
$127.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.56
|
| Rate for Payer: Priority Health Narrow Network |
$255.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.66
|
| Rate for Payer: UHC Exchange |
$195.66
|
| Rate for Payer: UHCCP Medicaid |
$121.84
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 12020
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$441.27 |
| Rate for Payer: Aetna Commercial |
$203.61
|
| Rate for Payer: Aetna Medicare |
$235.00
|
| Rate for Payer: BCBS Complete |
$127.93
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$441.27
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Meridian Medicaid |
$127.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.56
|
| Rate for Payer: Priority Health Narrow Network |
$255.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.66
|
| Rate for Payer: UHC Exchange |
$195.66
|
| Rate for Payer: UHCCP Medicaid |
$121.84
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE W/PACKING
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 12021
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$259.98 |
| Rate for Payer: Aetna Commercial |
$150.60
|
| Rate for Payer: Aetna Medicare |
$174.50
|
| Rate for Payer: BCBS Complete |
$95.06
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$259.98
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Meridian Medicaid |
$95.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.89
|
| Rate for Payer: Priority Health Narrow Network |
$191.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.16
|
| Rate for Payer: UHC Exchange |
$142.16
|
| Rate for Payer: UHCCP Medicaid |
$90.53
|
|
|
PR TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 28455
|
| Min. Negotiated Rate |
$151.02 |
| Max. Negotiated Rate |
$1,001.66 |
| Rate for Payer: Aetna Commercial |
$340.48
|
| Rate for Payer: Aetna Medicare |
$404.00
|
| Rate for Payer: BCBS Complete |
$158.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,001.66
|
| Rate for Payer: BCN Commercial |
$434.44
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Meridian Medicaid |
$158.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$151.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.22
|
| Rate for Payer: Priority Health Narrow Network |
$357.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.74
|
| Rate for Payer: UHC Exchange |
$298.74
|
| Rate for Payer: UHCCP Medicaid |
$151.02
|
|
|
PR TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 28450
|
| Min. Negotiated Rate |
$127.80 |
| Max. Negotiated Rate |
$921.88 |
| Rate for Payer: Aetna Commercial |
$250.09
|
| Rate for Payer: Aetna Medicare |
$291.50
|
| Rate for Payer: BCBS Complete |
$134.19
|
| Rate for Payer: BCBS Trust/PPO |
$921.88
|
| Rate for Payer: BCN Commercial |
$313.24
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Meridian Medicaid |
$134.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$302.27
|
| Rate for Payer: Priority Health Narrow Network |
$302.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.06
|
| Rate for Payer: UHC Exchange |
$208.06
|
| Rate for Payer: UHCCP Medicaid |
$127.80
|
|
|
PR TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA
|
Professional
|
Both
|
$4,265.00
|
|
|
Service Code
|
HCPCS 27759
|
| Min. Negotiated Rate |
$647.31 |
| Max. Negotiated Rate |
$2,772.25 |
| Rate for Payer: Aetna Commercial |
$1,333.51
|
| Rate for Payer: Aetna Medicare |
$2,132.50
|
| Rate for Payer: BCBS Complete |
$679.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,209.30
|
| Rate for Payer: BCN Commercial |
$1,609.37
|
| Rate for Payer: Cash Price |
$3,412.00
|
| Rate for Payer: Cash Price |
$3,412.00
|
| Rate for Payer: Meridian Medicaid |
$679.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$647.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,772.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,533.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,533.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,156.25
|
| Rate for Payer: UHC Exchange |
$1,156.25
|
| Rate for Payer: UHCCP Medicaid |
$647.31
|
|
|
PR TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH
|
Professional
|
Both
|
$668.00
|
|
|
Service Code
|
HCPCS 69610
|
| Min. Negotiated Rate |
$184.67 |
| Max. Negotiated Rate |
$4,016.66 |
| Rate for Payer: Aetna Commercial |
$323.65
|
| Rate for Payer: Aetna Medicare |
$334.00
|
| Rate for Payer: BCBS Complete |
$193.90
|
| Rate for Payer: BCBS Trust/PPO |
$4,016.66
|
| Rate for Payer: BCN Commercial |
$565.40
|
| Rate for Payer: Cash Price |
$534.40
|
| Rate for Payer: Cash Price |
$534.40
|
| Rate for Payer: Meridian Medicaid |
$193.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$184.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$421.68
|
| Rate for Payer: Priority Health Narrow Network |
$421.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$331.26
|
| Rate for Payer: UHC Exchange |
$331.26
|
| Rate for Payer: UHCCP Medicaid |
$184.67
|
|
|
PR TYMPANOMETRY
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 92567
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$1,875.47 |
| Rate for Payer: Aetna Commercial |
$11.76
|
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,875.47
|
| Rate for Payer: BCN Commercial |
$23.95
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.47
|
| Rate for Payer: Priority Health Narrow Network |
$14.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.12
|
| Rate for Payer: UHC Exchange |
$14.12
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
|
|
PR TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 92550
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$1,749.20 |
| Rate for Payer: Aetna Commercial |
$24.41
|
| Rate for Payer: Aetna Medicare |
$19.00
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,749.20
|
| Rate for Payer: BCN Commercial |
$32.25
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.40
|
| Rate for Payer: Priority Health Narrow Network |
$29.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.79
|
| Rate for Payer: UHC Exchange |
$21.79
|
|
|
PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR
|
Professional
|
Both
|
$2,793.00
|
|
|
Service Code
|
HCPCS 69646
|
| Min. Negotiated Rate |
$1,001.74 |
| Max. Negotiated Rate |
$2,319.26 |
| Rate for Payer: Aetna Commercial |
$1,770.52
|
| Rate for Payer: Aetna Medicare |
$1,396.50
|
| Rate for Payer: BCBS Complete |
$1,051.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,089.35
|
| Rate for Payer: BCN Commercial |
$2,319.26
|
| Rate for Payer: Cash Price |
$2,234.40
|
| Rate for Payer: Cash Price |
$2,234.40
|
| Rate for Payer: Meridian Medicaid |
$1,051.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,001.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,815.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,300.07
|
| Rate for Payer: Priority Health Narrow Network |
$2,300.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,694.65
|
| Rate for Payer: UHC Exchange |
$1,694.65
|
| Rate for Payer: UHCCP Medicaid |
$1,001.74
|
|
|
PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 69645
|
| Min. Negotiated Rate |
$947.00 |
| Max. Negotiated Rate |
$2,184.39 |
| Rate for Payer: Aetna Commercial |
$1,673.47
|
| Rate for Payer: Aetna Medicare |
$1,326.00
|
| Rate for Payer: BCBS Complete |
$994.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,502.49
|
| Rate for Payer: BCN Commercial |
$2,184.39
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Meridian Medicaid |
$994.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$947.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,161.93
|
| Rate for Payer: Priority Health Narrow Network |
$2,161.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,592.59
|
| Rate for Payer: UHC Exchange |
$1,592.59
|
| Rate for Payer: UHCCP Medicaid |
$947.00
|
|
|
PR TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP
|
Professional
|
Both
|
$1,888.00
|
|
|
Service Code
|
HCPCS 69633
|
| Min. Negotiated Rate |
$134.72 |
| Max. Negotiated Rate |
$1,553.99 |
| Rate for Payer: Aetna Commercial |
$1,193.27
|
| Rate for Payer: Aetna Medicare |
$944.00
|
| Rate for Payer: BCBS Complete |
$705.62
|
| Rate for Payer: BCBS Trust/PPO |
$134.72
|
| Rate for Payer: BCN Commercial |
$1,553.99
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Meridian Medicaid |
$705.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$672.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,545.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,545.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,139.48
|
| Rate for Payer: UHC Exchange |
$1,139.48
|
| Rate for Payer: UHCCP Medicaid |
$672.02
|
|
|
PR TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ
|
Professional
|
Both
|
$3,145.00
|
|
|
Service Code
|
HCPCS 69631
|
| Min. Negotiated Rate |
$567.01 |
| Max. Negotiated Rate |
$2,248.97 |
| Rate for Payer: Aetna Commercial |
$1,012.12
|
| Rate for Payer: Aetna Medicare |
$1,572.50
|
| Rate for Payer: BCBS Complete |
$595.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,248.97
|
| Rate for Payer: BCN Commercial |
$1,316.99
|
| Rate for Payer: Cash Price |
$2,516.00
|
| Rate for Payer: Cash Price |
$2,516.00
|
| Rate for Payer: Meridian Medicaid |
$595.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$567.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,044.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,850.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,850.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$961.75
|
| Rate for Payer: UHC Exchange |
$961.75
|
| Rate for Payer: UHCCP Medicaid |
$567.01
|
|
|
PR TYMPANOSTOMY GENERAL ANESTHESIA
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 69436
|
| Min. Negotiated Rate |
$103.31 |
| Max. Negotiated Rate |
$2,059.84 |
| Rate for Payer: Aetna Commercial |
$176.44
|
| Rate for Payer: Aetna Medicare |
$188.50
|
| Rate for Payer: BCBS Complete |
$108.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,059.84
|
| Rate for Payer: BCN Commercial |
$234.56
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Meridian Medicaid |
$108.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.40
|
| Rate for Payer: Priority Health Narrow Network |
$235.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.22
|
| Rate for Payer: UHC Exchange |
$179.22
|
| Rate for Payer: UHCCP Medicaid |
$103.31
|
|
|
PR TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
HCPCS 69433
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$2,182.94 |
| Rate for Payer: Aetna Commercial |
$145.46
|
| Rate for Payer: Aetna Medicare |
$164.50
|
| Rate for Payer: BCBS Complete |
$90.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,182.94
|
| Rate for Payer: BCN Commercial |
$239.92
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Meridian Medicaid |
$90.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.53
|
| Rate for Payer: Priority Health Narrow Network |
$195.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.86
|
| Rate for Payer: UHC Exchange |
$142.86
|
| Rate for Payer: UHCCP Medicaid |
$85.84
|
|
|
PR TYMPNOPLSTY W/O MSTDC 1ST/REVJ W/OSICLE RECNSTJ
|
Professional
|
Both
|
$1,954.00
|
|
|
Service Code
|
HCPCS 69632
|
| Min. Negotiated Rate |
$124.68 |
| Max. Negotiated Rate |
$1,601.40 |
| Rate for Payer: Aetna Commercial |
$1,230.77
|
| Rate for Payer: Aetna Medicare |
$977.00
|
| Rate for Payer: BCBS Complete |
$724.41
|
| Rate for Payer: BCBS Trust/PPO |
$124.68
|
| Rate for Payer: BCN Commercial |
$1,601.40
|
| Rate for Payer: Cash Price |
$1,563.20
|
| Rate for Payer: Cash Price |
$1,563.20
|
| Rate for Payer: Meridian Medicaid |
$724.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$689.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,270.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,586.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,586.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,181.57
|
| Rate for Payer: UHC Exchange |
$1,181.57
|
| Rate for Payer: UHCCP Medicaid |
$689.91
|
|
|
PR TYMPP ANTRT/MASTOID W/O OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$3,636.00
|
|
|
Service Code
|
HCPCS 69635
|
| Min. Negotiated Rate |
$329.13 |
| Max. Negotiated Rate |
$2,363.40 |
| Rate for Payer: Aetna Commercial |
$1,428.81
|
| Rate for Payer: Aetna Medicare |
$1,818.00
|
| Rate for Payer: BCBS Complete |
$860.16
|
| Rate for Payer: BCBS Trust/PPO |
$329.13
|
| Rate for Payer: BCN Commercial |
$1,893.13
|
| Rate for Payer: Cash Price |
$2,908.80
|
| Rate for Payer: Cash Price |
$2,908.80
|
| Rate for Payer: Meridian Medicaid |
$860.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$819.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,363.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,875.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,875.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,330.44
|
| Rate for Payer: UHC Exchange |
$1,330.44
|
| Rate for Payer: UHCCP Medicaid |
$819.20
|
|
|
PR UMBILECTOMY OMPHALECTOMY EXC UMBILICUS SPX
|
Professional
|
Both
|
$2,006.00
|
|
|
Service Code
|
HCPCS 49250
|
| Min. Negotiated Rate |
$385.96 |
| Max. Negotiated Rate |
$1,303.90 |
| Rate for Payer: Aetna Commercial |
$790.38
|
| Rate for Payer: Aetna Medicare |
$1,003.00
|
| Rate for Payer: BCBS Complete |
$405.26
|
| Rate for Payer: BCBS Trust/PPO |
$996.37
|
| Rate for Payer: BCN Commercial |
$870.33
|
| Rate for Payer: Cash Price |
$1,604.80
|
| Rate for Payer: Cash Price |
$1,604.80
|
| Rate for Payer: Meridian Medicaid |
$405.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,303.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,071.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,071.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$693.73
|
| Rate for Payer: UHC Exchange |
$693.73
|
| Rate for Payer: UHCCP Medicaid |
$385.96
|
|
|
PR UNILATERAL BREAST AUGMENTATION GEL
|
Professional
|
Both
|
$2,774.00
|
|
|
Service Code
|
HCPCS 00362
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,109.60 |
| Max. Negotiated Rate |
$1,803.10 |
| Rate for Payer: Aetna Medicare |
$1,387.00
|
| Rate for Payer: BCBS Complete |
$1,109.60
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.10
|
|
|
PR UNILATERAL BREAST AUGMENTATION SALINE
|
Professional
|
Both
|
$2,162.00
|
|
|
Service Code
|
HCPCS 00363
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$864.80 |
| Max. Negotiated Rate |
$1,405.30 |
| Rate for Payer: Aetna Medicare |
$1,081.00
|
| Rate for Payer: BCBS Complete |
$864.80
|
| Rate for Payer: Cash Price |
$1,729.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,405.30
|
|
|
PR UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 91299
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$749.66 |
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: BCBS Trust/PPO |
$749.66
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
|
|
PR UNLISTED EVALUATION AND MANAGEMENT SERVICE
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 99499
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$75.02 |
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$75.02
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
|
|
PR UNLISTED PSYCHIATRIC SERVICE/PROCEDURE
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 90899
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$681.51 |
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: BCBS Trust/PPO |
$681.51
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
|
|
PR UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS
|
Professional
|
Both
|
$993.00
|
|
|
Service Code
|
HCPCS 33214
|
| Min. Negotiated Rate |
$302.25 |
| Max. Negotiated Rate |
$1,455.47 |
| Rate for Payer: Aetna Commercial |
$643.11
|
| Rate for Payer: Aetna Medicare |
$496.50
|
| Rate for Payer: BCBS Complete |
$317.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,455.47
|
| Rate for Payer: BCN Commercial |
$693.44
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Meridian Medicaid |
$317.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$302.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$645.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$751.46
|
| Rate for Payer: Priority Health Narrow Network |
$751.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$642.79
|
| Rate for Payer: UHC Exchange |
$642.79
|
| Rate for Payer: UHCCP Medicaid |
$302.25
|
|
