|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
OP
|
$893.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
55250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$580.45 |
| Max. Negotiated Rate |
$3,110.99 |
| Rate for Payer: Aetna Commercial |
$803.70
|
| Rate for Payer: Aetna Medicare |
$2,007.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: ASR ASR |
$866.21
|
| Rate for Payer: ASR Commercial |
$866.21
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$731.28
|
| Rate for Payer: BCN Commercial |
$692.34
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Commercial |
$839.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$714.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Healthscope Commercial |
$893.00
|
| Rate for Payer: Healthscope Whirlpool |
$866.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,007.09
|
| Rate for Payer: Mclaren Commercial |
$803.70
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.05
|
| Rate for Payer: Nomi Health Commercial |
$732.26
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Commercial |
$2,207.80
|
| Rate for Payer: PHP Medicaid |
$1,075.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$782.45
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$625.99
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$785.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$3,110.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP DNSP |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
PR VASOVASOSTOMY VASOVASORRHAPHY
|
Professional
|
Both
|
$952.00
|
|
|
Service Code
|
HCPCS 55400
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$2,224.67 |
| Rate for Payer: Aetna Commercial |
$641.17
|
| Rate for Payer: Aetna Medicare |
$476.00
|
| Rate for Payer: BCBS Complete |
$380.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,224.67
|
| Rate for Payer: BCN Commercial |
$722.27
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$799.44
|
| Rate for Payer: Priority Health Narrow Network |
$799.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$602.37
|
| Rate for Payer: UHC Exchange |
$602.37
|
|
|
PR VCRPEC LAT XTRCAVITARY DCMPRN THRC/LMBR EA SEG
|
Professional
|
Both
|
$2,770.00
|
|
|
Service Code
|
HCPCS 63103
|
| Min. Negotiated Rate |
$187.44 |
| Max. Negotiated Rate |
$4,342.63 |
| Rate for Payer: Aetna Commercial |
$381.03
|
| Rate for Payer: Aetna Medicare |
$1,385.00
|
| Rate for Payer: BCBS Complete |
$196.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,342.63
|
| Rate for Payer: BCN Commercial |
$429.06
|
| Rate for Payer: Cash Price |
$2,216.00
|
| Rate for Payer: Cash Price |
$2,216.00
|
| Rate for Payer: Meridian Medicaid |
$196.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,800.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$499.32
|
| Rate for Payer: Priority Health Narrow Network |
$499.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$351.59
|
| Rate for Payer: UHC Exchange |
$351.59
|
| Rate for Payer: UHCCP Medicaid |
$187.44
|
|
|
PR VCRPEC LES 1 SGM XDRL CERVICAL
|
Professional
|
Both
|
$4,705.00
|
|
|
Service Code
|
HCPCS 63300
|
| Min. Negotiated Rate |
$519.85 |
| Max. Negotiated Rate |
$3,125.09 |
| Rate for Payer: Aetna Commercial |
$2,360.58
|
| Rate for Payer: Aetna Medicare |
$2,352.50
|
| Rate for Payer: BCBS Complete |
$1,241.48
|
| Rate for Payer: BCBS Trust/PPO |
$519.85
|
| Rate for Payer: BCN Commercial |
$2,941.10
|
| Rate for Payer: Cash Price |
$3,764.00
|
| Rate for Payer: Cash Price |
$3,764.00
|
| Rate for Payer: Meridian Medicaid |
$1,241.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,182.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,058.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,125.09
|
| Rate for Payer: Priority Health Narrow Network |
$3,125.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,130.48
|
| Rate for Payer: UHC Exchange |
$2,130.48
|
| Rate for Payer: UHCCP Medicaid |
$1,182.36
|
|
|
PR VCRPEC LES 1 SGM XDRL THORACIC TTHRC
|
Professional
|
Both
|
$4,655.00
|
|
|
Service Code
|
HCPCS 63301
|
| Min. Negotiated Rate |
$1,378.75 |
| Max. Negotiated Rate |
$3,822.91 |
| Rate for Payer: Aetna Commercial |
$2,850.87
|
| Rate for Payer: Aetna Medicare |
$2,327.50
|
| Rate for Payer: BCBS Complete |
$1,447.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,593.88
|
| Rate for Payer: BCN Commercial |
$3,585.18
|
| Rate for Payer: Cash Price |
$3,724.00
|
| Rate for Payer: Cash Price |
$3,724.00
|
| Rate for Payer: Meridian Medicaid |
$1,447.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,378.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,025.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,822.91
|
| Rate for Payer: Priority Health Narrow Network |
$3,822.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,502.66
|
| Rate for Payer: UHC Exchange |
$2,502.66
|
| Rate for Payer: UHCCP Medicaid |
$1,378.75
|
|
|
PR VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR 1 SEG
|
Professional
|
Both
|
$9,223.00
|
|
|
Service Code
|
HCPCS 63087
|
| Min. Negotiated Rate |
$232.45 |
| Max. Negotiated Rate |
$5,994.95 |
| Rate for Payer: Aetna Commercial |
$3,114.02
|
| Rate for Payer: Aetna Medicare |
$4,611.50
|
| Rate for Payer: BCBS Complete |
$1,646.52
|
| Rate for Payer: BCBS Trust/PPO |
$232.45
|
| Rate for Payer: BCN Commercial |
$3,891.88
|
| Rate for Payer: Cash Price |
$7,378.40
|
| Rate for Payer: Cash Price |
$7,378.40
|
| Rate for Payer: Meridian Medicaid |
$1,646.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,568.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,994.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,157.88
|
| Rate for Payer: Priority Health Narrow Network |
$4,157.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,816.24
|
| Rate for Payer: UHC Exchange |
$2,816.24
|
| Rate for Payer: UHCCP Medicaid |
$1,568.11
|
|
|
PR VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR EA SEG
|
Professional
|
Both
|
$3,162.00
|
|
|
Service Code
|
HCPCS 63088
|
| Min. Negotiated Rate |
$165.29 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Commercial |
$335.33
|
| Rate for Payer: Aetna Medicare |
$1,581.00
|
| Rate for Payer: BCBS Complete |
$173.55
|
| Rate for Payer: BCBS Trust/PPO |
$342.34
|
| Rate for Payer: BCN Commercial |
$375.79
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Meridian Medicaid |
$173.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,055.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$440.76
|
| Rate for Payer: Priority Health Narrow Network |
$440.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$311.10
|
| Rate for Payer: UHC Exchange |
$311.10
|
| Rate for Payer: UHCCP Medicaid |
$165.29
|
|
|
PR VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC 1 SEG
|
Professional
|
Both
|
$7,274.00
|
|
|
Service Code
|
HCPCS 63090
|
| Min. Negotiated Rate |
$1,253.29 |
| Max. Negotiated Rate |
$4,728.10 |
| Rate for Payer: Aetna Commercial |
$2,534.05
|
| Rate for Payer: Aetna Medicare |
$3,637.00
|
| Rate for Payer: BCBS Complete |
$1,315.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,683.69
|
| Rate for Payer: BCN Commercial |
$3,133.20
|
| Rate for Payer: Cash Price |
$5,819.20
|
| Rate for Payer: Cash Price |
$5,819.20
|
| Rate for Payer: Meridian Medicaid |
$1,315.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,253.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,728.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,336.08
|
| Rate for Payer: Priority Health Narrow Network |
$3,336.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,308.67
|
| Rate for Payer: UHC Exchange |
$2,308.67
|
| Rate for Payer: UHCCP Medicaid |
$1,253.29
|
|
|
PR VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC EA SEG
|
Professional
|
Both
|
$2,478.00
|
|
|
Service Code
|
HCPCS 63091
|
| Min. Negotiated Rate |
$111.61 |
| Max. Negotiated Rate |
$2,079.39 |
| Rate for Payer: Aetna Commercial |
$230.26
|
| Rate for Payer: Aetna Medicare |
$1,239.00
|
| Rate for Payer: BCBS Complete |
$117.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,079.39
|
| Rate for Payer: BCN Commercial |
$281.41
|
| Rate for Payer: Cash Price |
$1,982.40
|
| Rate for Payer: Cash Price |
$1,982.40
|
| Rate for Payer: Meridian Medicaid |
$117.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,610.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$297.43
|
| Rate for Payer: Priority Health Narrow Network |
$297.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.64
|
| Rate for Payer: UHC Exchange |
$214.64
|
| Rate for Payer: UHCCP Medicaid |
$111.61
|
|
|
PR VEIN SCREEN
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 00515
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
|
|
PR VEN CATHJ SLCTV ORGAN BLD SAMPLING
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 36500
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Aetna Commercial |
$244.57
|
| Rate for Payer: Aetna Medicare |
$174.50
|
| Rate for Payer: BCBS Complete |
$120.32
|
| Rate for Payer: BCBS Trust/PPO |
$428.45
|
| Rate for Payer: BCN Commercial |
$259.49
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Meridian Medicaid |
$120.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.46
|
| Rate for Payer: Priority Health Narrow Network |
$283.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.45
|
| Rate for Payer: UHC Exchange |
$238.45
|
| Rate for Payer: UHCCP Medicaid |
$114.59
|
|
|
PR VENOUS ANASTOMOSIS OPEN SPLENORENAL PROXIMAL
|
Professional
|
Both
|
$4,367.00
|
|
|
Service Code
|
HCPCS 37180
|
| Min. Negotiated Rate |
$1,358.51 |
| Max. Negotiated Rate |
$3,376.55 |
| Rate for Payer: Aetna Commercial |
$2,874.90
|
| Rate for Payer: Aetna Medicare |
$2,183.50
|
| Rate for Payer: BCBS Complete |
$1,426.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,647.77
|
| Rate for Payer: BCN Commercial |
$3,088.45
|
| Rate for Payer: Cash Price |
$3,493.60
|
| Rate for Payer: Cash Price |
$3,493.60
|
| Rate for Payer: Meridian Medicaid |
$1,426.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,358.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,838.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,376.55
|
| Rate for Payer: Priority Health Narrow Network |
$3,376.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,873.11
|
| Rate for Payer: UHC Exchange |
$1,873.11
|
| Rate for Payer: UHCCP Medicaid |
$1,358.51
|
|
|
PR VENTILATING TUBE RMVL REQUIRING GENERAL ANES
|
Professional
|
Both
|
$613.00
|
|
|
Service Code
|
HCPCS 69424
|
| Min. Negotiated Rate |
$39.41 |
| Max. Negotiated Rate |
$2,176.60 |
| Rate for Payer: Aetna Commercial |
$67.67
|
| Rate for Payer: Aetna Medicare |
$306.50
|
| Rate for Payer: BCBS Complete |
$41.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,176.60
|
| Rate for Payer: BCN Commercial |
$188.63
|
| Rate for Payer: Cash Price |
$490.40
|
| Rate for Payer: Cash Price |
$490.40
|
| Rate for Payer: Meridian Medicaid |
$41.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.52
|
| Rate for Payer: Priority Health Narrow Network |
$88.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.63
|
| Rate for Payer: UHC Exchange |
$68.63
|
| Rate for Payer: UHCCP Medicaid |
$39.41
|
|
|
PR VENTILATION ASSIST & MGMT INPATIENT 1ST DAY
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 94002
|
| Min. Negotiated Rate |
$57.94 |
| Max. Negotiated Rate |
$1,687.92 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Medicare |
$86.00
|
| Rate for Payer: BCBS Complete |
$60.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,687.92
|
| Rate for Payer: BCN Commercial |
$131.94
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Meridian Medicaid |
$60.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.13
|
| Rate for Payer: Priority Health Narrow Network |
$122.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.23
|
| Rate for Payer: UHC Exchange |
$96.23
|
| Rate for Payer: UHCCP Medicaid |
$57.94
|
|
|
PR VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 94003
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$1,092.52 |
| Rate for Payer: Aetna Commercial |
$72.70
|
| Rate for Payer: Aetna Medicare |
$63.00
|
| Rate for Payer: BCBS Complete |
$42.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,092.52
|
| Rate for Payer: BCN Commercial |
$92.36
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Meridian Medicaid |
$42.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.94
|
| Rate for Payer: Priority Health Narrow Network |
$85.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.02
|
| Rate for Payer: UHC Exchange |
$69.02
|
| Rate for Payer: UHCCP Medicaid |
$40.68
|
|
|
PR VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/INJ
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 61026
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$593.81 |
| Rate for Payer: Aetna Commercial |
$135.98
|
| Rate for Payer: Aetna Medicare |
$281.50
|
| Rate for Payer: BCBS Complete |
$76.49
|
| Rate for Payer: BCBS Trust/PPO |
$593.81
|
| Rate for Payer: BCN Commercial |
$155.89
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Meridian Medicaid |
$76.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.24
|
| Rate for Payer: Priority Health Narrow Network |
$188.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.36
|
| Rate for Payer: UHC Exchange |
$147.36
|
| Rate for Payer: UHCCP Medicaid |
$72.85
|
|
|
PR VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX
|
Professional
|
Both
|
$458.00
|
|
|
Service Code
|
HCPCS 61020
|
| Min. Negotiated Rate |
$68.59 |
| Max. Negotiated Rate |
$330.19 |
| Rate for Payer: Aetna Commercial |
$134.44
|
| Rate for Payer: Aetna Medicare |
$229.00
|
| Rate for Payer: BCBS Complete |
$72.02
|
| Rate for Payer: BCBS Trust/PPO |
$330.19
|
| Rate for Payer: BCN Commercial |
$155.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Meridian Medicaid |
$72.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.26
|
| Rate for Payer: Priority Health Narrow Network |
$184.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.22
|
| Rate for Payer: UHC Exchange |
$152.22
|
| Rate for Payer: UHCCP Medicaid |
$68.59
|
|
|
PR VENTRICULOCISTERNOSTOMY
|
Professional
|
Both
|
$4,753.00
|
|
|
Service Code
|
HCPCS 62180
|
| Min. Negotiated Rate |
$1,044.98 |
| Max. Negotiated Rate |
$3,278.48 |
| Rate for Payer: Aetna Commercial |
$2,066.64
|
| Rate for Payer: Aetna Medicare |
$2,376.50
|
| Rate for Payer: BCBS Complete |
$1,097.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,771.92
|
| Rate for Payer: BCN Commercial |
$3,278.48
|
| Rate for Payer: Cash Price |
$3,802.40
|
| Rate for Payer: Cash Price |
$3,802.40
|
| Rate for Payer: Meridian Medicaid |
$1,097.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,044.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,089.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,777.04
|
| Rate for Payer: Priority Health Narrow Network |
$2,777.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,851.26
|
| Rate for Payer: UHC Exchange |
$1,851.26
|
| Rate for Payer: UHCCP Medicaid |
$1,044.98
|
|
|
PR VENTRICULOCISTERNOSTOMY 3RD VENTRICLE
|
Professional
|
Both
|
$6,548.00
|
|
|
Service Code
|
HCPCS 62200
|
| Min. Negotiated Rate |
$900.14 |
| Max. Negotiated Rate |
$4,256.20 |
| Rate for Payer: Aetna Commercial |
$1,779.36
|
| Rate for Payer: Aetna Medicare |
$3,274.00
|
| Rate for Payer: BCBS Complete |
$945.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,335.01
|
| Rate for Payer: BCN Commercial |
$2,824.27
|
| Rate for Payer: Cash Price |
$5,238.40
|
| Rate for Payer: Cash Price |
$5,238.40
|
| Rate for Payer: Meridian Medicaid |
$945.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$900.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,256.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,391.45
|
| Rate for Payer: Priority Health Narrow Network |
$2,391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,587.80
|
| Rate for Payer: UHC Exchange |
$1,587.80
|
| Rate for Payer: UHCCP Medicaid |
$900.14
|
|
|
PR VENTRICULOCISTERNOSTOMY 3RD VNTRC NEURONDSC
|
Professional
|
Both
|
$5,950.00
|
|
|
Service Code
|
HCPCS 62201
|
| Min. Negotiated Rate |
$796.41 |
| Max. Negotiated Rate |
$9,012.27 |
| Rate for Payer: Aetna Commercial |
$1,562.86
|
| Rate for Payer: Aetna Medicare |
$2,975.00
|
| Rate for Payer: BCBS Complete |
$836.23
|
| Rate for Payer: BCBS Trust/PPO |
$9,012.27
|
| Rate for Payer: BCN Commercial |
$2,500.89
|
| Rate for Payer: Cash Price |
$4,760.00
|
| Rate for Payer: Cash Price |
$4,760.00
|
| Rate for Payer: Meridian Medicaid |
$836.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$796.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,867.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,115.63
|
| Rate for Payer: Priority Health Narrow Network |
$2,115.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,369.91
|
| Rate for Payer: UHC Exchange |
$1,369.91
|
| Rate for Payer: UHCCP Medicaid |
$796.41
|
|
|
PR VENTRICULOMYOTOMY-MYECTOMY
|
Professional
|
Both
|
$9,098.00
|
|
|
Service Code
|
HCPCS 33416
|
| Min. Negotiated Rate |
$718.49 |
| Max. Negotiated Rate |
$5,913.70 |
| Rate for Payer: Aetna Commercial |
$2,713.83
|
| Rate for Payer: Aetna Medicare |
$4,549.00
|
| Rate for Payer: BCBS Complete |
$1,336.53
|
| Rate for Payer: BCBS Trust/PPO |
$718.49
|
| Rate for Payer: BCN Commercial |
$2,899.81
|
| Rate for Payer: Cash Price |
$7,278.40
|
| Rate for Payer: Cash Price |
$7,278.40
|
| Rate for Payer: Meridian Medicaid |
$1,336.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,272.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,913.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,167.01
|
| Rate for Payer: Priority Health Narrow Network |
$3,167.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,657.19
|
| Rate for Payer: UHC Exchange |
$2,657.19
|
| Rate for Payer: UHCCP Medicaid |
$1,272.89
|
|
|
PR VERMILIONECTOMY LIP SHV W/MUCOSAL ADVMNT
|
Professional
|
Both
|
$749.00
|
|
|
Service Code
|
HCPCS 40500
|
| Min. Negotiated Rate |
$240.05 |
| Max. Negotiated Rate |
$776.51 |
| Rate for Payer: Aetna Commercial |
$478.94
|
| Rate for Payer: Aetna Medicare |
$374.50
|
| Rate for Payer: BCBS Complete |
$252.05
|
| Rate for Payer: BCBS Trust/PPO |
$449.06
|
| Rate for Payer: BCN Commercial |
$776.51
|
| Rate for Payer: Cash Price |
$599.20
|
| Rate for Payer: Cash Price |
$599.20
|
| Rate for Payer: Meridian Medicaid |
$252.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$240.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$669.98
|
| Rate for Payer: Priority Health Narrow Network |
$669.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$433.56
|
| Rate for Payer: UHC Exchange |
$433.56
|
| Rate for Payer: UHCCP Medicaid |
$240.05
|
|
|
PR VERTEB CORPECT LAT XTRCAVITARY DCMPRN LMBR 1 SEG
|
Professional
|
Both
|
$8,574.00
|
|
|
Service Code
|
HCPCS 63102
|
| Min. Negotiated Rate |
$1,488.44 |
| Max. Negotiated Rate |
$5,573.10 |
| Rate for Payer: Aetna Commercial |
$2,933.25
|
| Rate for Payer: Aetna Medicare |
$4,287.00
|
| Rate for Payer: BCBS Complete |
$1,562.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,448.21
|
| Rate for Payer: BCN Commercial |
$3,359.17
|
| Rate for Payer: Cash Price |
$6,859.20
|
| Rate for Payer: Cash Price |
$6,859.20
|
| Rate for Payer: Meridian Medicaid |
$1,562.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,488.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,573.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,933.81
|
| Rate for Payer: Priority Health Narrow Network |
$3,933.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,619.17
|
| Rate for Payer: UHC Exchange |
$2,619.17
|
| Rate for Payer: UHCCP Medicaid |
$1,488.44
|
|
|
PR VERTEB CORPECT LAT XTRCAVITARY DCMPRN THRC 1 SEG
|
Professional
|
Both
|
$4,871.00
|
|
|
Service Code
|
HCPCS 63101
|
| Min. Negotiated Rate |
$1,504.42 |
| Max. Negotiated Rate |
$4,010.01 |
| Rate for Payer: Aetna Commercial |
$3,005.13
|
| Rate for Payer: Aetna Medicare |
$2,435.50
|
| Rate for Payer: BCBS Complete |
$1,579.64
|
| Rate for Payer: BCBS Trust/PPO |
$3,418.10
|
| Rate for Payer: BCN Commercial |
$3,417.81
|
| Rate for Payer: Cash Price |
$3,896.80
|
| Rate for Payer: Cash Price |
$3,896.80
|
| Rate for Payer: Meridian Medicaid |
$1,579.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,504.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,166.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,010.01
|
| Rate for Payer: Priority Health Narrow Network |
$4,010.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,700.36
|
| Rate for Payer: UHC Exchange |
$2,700.36
|
| Rate for Payer: UHCCP Medicaid |
$1,504.42
|
|
|
PR VERTEBRAL CORPECTOMY ANT DCMPRN CERVICAL 1 SEG
|
Professional
|
Both
|
$6,437.00
|
|
|
Service Code
|
HCPCS 63081
|
| Min. Negotiated Rate |
$206.57 |
| Max. Negotiated Rate |
$4,184.05 |
| Rate for Payer: Aetna Commercial |
$2,269.94
|
| Rate for Payer: Aetna Medicare |
$3,218.50
|
| Rate for Payer: BCBS Complete |
$1,200.33
|
| Rate for Payer: BCBS Trust/PPO |
$206.57
|
| Rate for Payer: BCN Commercial |
$2,843.71
|
| Rate for Payer: Cash Price |
$5,149.60
|
| Rate for Payer: Cash Price |
$5,149.60
|
| Rate for Payer: Meridian Medicaid |
$1,200.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,143.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,184.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,037.52
|
| Rate for Payer: Priority Health Narrow Network |
$3,037.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,063.20
|
| Rate for Payer: UHC Exchange |
$2,063.20
|
| Rate for Payer: UHCCP Medicaid |
$1,143.17
|
|
