|
PR VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RPR NTRCL
|
Professional
|
Both
|
$3,181.00
|
|
|
Service Code
|
HCPCS 58263
|
| Min. Negotiated Rate |
$192.83 |
| Max. Negotiated Rate |
$2,226.70 |
| Rate for Payer: Aetna Commercial |
$1,191.05
|
| Rate for Payer: BCBS Complete |
$670.06
|
| Rate for Payer: BCBS Trust/PPO |
$192.83
|
| Rate for Payer: Cash Price |
$2,544.80
|
| Rate for Payer: Cash Price |
$2,544.80
|
| Rate for Payer: Meridian Medicaid |
$670.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$638.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,226.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,412.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,412.23
|
| Rate for Payer: Priority Health SBD |
$1,412.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,463.26
|
|
|
PR VAG HYSTER W/TOT/PRTL VAGINECT W/RPR ENTEROCELE
|
Professional
|
Both
|
$3,659.00
|
|
|
Service Code
|
HCPCS 58280
|
| Min. Negotiated Rate |
$237.74 |
| Max. Negotiated Rate |
$2,561.30 |
| Rate for Payer: Aetna Commercial |
$1,269.75
|
| Rate for Payer: BCBS Complete |
$714.34
|
| Rate for Payer: BCBS Trust/PPO |
$237.74
|
| Rate for Payer: Cash Price |
$2,927.20
|
| Rate for Payer: Cash Price |
$2,927.20
|
| Rate for Payer: Meridian Medicaid |
$714.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$680.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,561.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,506.43
|
| Rate for Payer: Priority Health Narrow Network |
$1,506.43
|
| Rate for Payer: Priority Health SBD |
$1,506.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,683.14
|
|
|
PR VAGINAL DELIVERY AFTER CESAREAN DELIVERY
|
Professional
|
Both
|
$2,103.00
|
|
|
Service Code
|
HCPCS 59612
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,472.10 |
| Rate for Payer: Aetna Commercial |
$1,000.61
|
| Rate for Payer: BCBS Complete |
$885.38
|
| Rate for Payer: BCBS Trust/PPO |
$187.55
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Meridian Medicaid |
$885.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$843.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,472.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,280.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,280.53
|
| Rate for Payer: Priority Health SBD |
$1,280.53
|
| Rate for Payer: UMR Bronson Commercial |
$967.38
|
|
|
PR VAGINAL DELIVERY ONLY
|
Professional
|
Both
|
$1,931.00
|
|
|
Service Code
|
HCPCS 59409
|
| Min. Negotiated Rate |
$45.96 |
| Max. Negotiated Rate |
$1,351.70 |
| Rate for Payer: Aetna Commercial |
$885.09
|
| Rate for Payer: BCBS Complete |
$777.93
|
| Rate for Payer: BCBS Trust/PPO |
$45.96
|
| Rate for Payer: Cash Price |
$1,544.80
|
| Rate for Payer: Cash Price |
$1,544.80
|
| Rate for Payer: Meridian Medicaid |
$777.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$740.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,351.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,131.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,131.33
|
| Rate for Payer: Priority Health SBD |
$1,131.33
|
| Rate for Payer: UMR Bronson Commercial |
$888.26
|
|
|
PR VAGINAL DELIVERY ONLY W/POSTPARTUM CARE
|
Professional
|
Both
|
$2,198.00
|
|
|
Service Code
|
HCPCS 59410
|
| Min. Negotiated Rate |
$52.30 |
| Max. Negotiated Rate |
$1,538.60 |
| Rate for Payer: Aetna Commercial |
$1,164.53
|
| Rate for Payer: BCBS Complete |
$1,050.64
|
| Rate for Payer: BCBS Trust/PPO |
$52.30
|
| Rate for Payer: Cash Price |
$1,758.40
|
| Rate for Payer: Cash Price |
$1,758.40
|
| Rate for Payer: Meridian Medicaid |
$1,050.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,000.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,538.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,498.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,498.68
|
| Rate for Payer: Priority Health SBD |
$1,498.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,011.08
|
|
|
PR VAGINAL DELIVERY & POSTPARTUM CARE VBAC
|
Professional
|
Both
|
$2,370.00
|
|
|
Service Code
|
HCPCS 59614
|
| Min. Negotiated Rate |
$325.96 |
| Max. Negotiated Rate |
$1,659.00 |
| Rate for Payer: Aetna Commercial |
$1,263.20
|
| Rate for Payer: BCBS Complete |
$1,142.37
|
| Rate for Payer: BCBS Trust/PPO |
$325.96
|
| Rate for Payer: Cash Price |
$1,896.00
|
| Rate for Payer: Cash Price |
$1,896.00
|
| Rate for Payer: Meridian Medicaid |
$1,142.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,087.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,659.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,619.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,619.55
|
| Rate for Payer: Priority Health SBD |
$1,619.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,090.20
|
|
|
PR VAGINAL HYSTERECTOMY >250 GM RPR ENTEROCELE
|
Professional
|
Both
|
$2,194.00
|
|
|
Service Code
|
HCPCS 58294
|
| Min. Negotiated Rate |
$327.55 |
| Max. Negotiated Rate |
$1,728.94 |
| Rate for Payer: Aetna Commercial |
$1,463.27
|
| Rate for Payer: BCBS Complete |
$818.78
|
| Rate for Payer: BCBS Trust/PPO |
$327.55
|
| Rate for Payer: Cash Price |
$1,755.20
|
| Rate for Payer: Cash Price |
$1,755.20
|
| Rate for Payer: Meridian Medicaid |
$818.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$779.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,535.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,728.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,728.94
|
| Rate for Payer: Priority Health SBD |
$1,728.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,009.24
|
|
|
PR VAGINAL HYSTERECTOMY 250 GM/< W/RPR ENTEROCELE
|
Professional
|
Both
|
$2,703.00
|
|
|
Service Code
|
HCPCS 58270
|
| Min. Negotiated Rate |
$233.51 |
| Max. Negotiated Rate |
$1,892.10 |
| Rate for Payer: Aetna Commercial |
$1,070.18
|
| Rate for Payer: BCBS Complete |
$602.74
|
| Rate for Payer: BCBS Trust/PPO |
$233.51
|
| Rate for Payer: Cash Price |
$2,162.40
|
| Rate for Payer: Cash Price |
$2,162.40
|
| Rate for Payer: Meridian Medicaid |
$602.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,892.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,272.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,272.57
|
| Rate for Payer: Priority Health SBD |
$1,272.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,243.38
|
|
|
PR VAGINAL HYSTERECTOMY UTERUS > 250 GM
|
Professional
|
Both
|
$2,860.00
|
|
|
Service Code
|
HCPCS 58290
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,002.00 |
| Rate for Payer: Aetna Commercial |
$1,382.79
|
| Rate for Payer: BCBS Complete |
$774.72
|
| Rate for Payer: BCBS Trust/PPO |
$137.36
|
| Rate for Payer: Cash Price |
$2,288.00
|
| Rate for Payer: Cash Price |
$2,288.00
|
| Rate for Payer: Meridian Medicaid |
$774.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$737.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,002.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,634.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,634.74
|
| Rate for Payer: Priority Health SBD |
$1,634.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,315.60
|
|
|
PR VAGINAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$2,631.00
|
|
|
Service Code
|
HCPCS 58260
|
| Min. Negotiated Rate |
$240.90 |
| Max. Negotiated Rate |
$1,841.70 |
| Rate for Payer: Aetna Commercial |
$1,002.76
|
| Rate for Payer: BCBS Complete |
$566.06
|
| Rate for Payer: BCBS Trust/PPO |
$240.90
|
| Rate for Payer: Cash Price |
$2,104.80
|
| Rate for Payer: Cash Price |
$2,104.80
|
| Rate for Payer: Meridian Medicaid |
$566.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$539.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,193.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,193.03
|
| Rate for Payer: Priority Health SBD |
$1,193.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,210.26
|
|
|
PR VAGINAL HYSTERECTOMY W/TOT/PRTL VAGINECTOMY
|
Professional
|
Both
|
$2,369.00
|
|
|
Service Code
|
HCPCS 58275
|
| Min. Negotiated Rate |
$263.09 |
| Max. Negotiated Rate |
$1,658.30 |
| Rate for Payer: Aetna Commercial |
$1,185.50
|
| Rate for Payer: BCBS Complete |
$667.82
|
| Rate for Payer: BCBS Trust/PPO |
$263.09
|
| Rate for Payer: Cash Price |
$1,895.20
|
| Rate for Payer: Cash Price |
$1,895.20
|
| Rate for Payer: Meridian Medicaid |
$667.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$636.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,404.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,404.17
|
| Rate for Payer: Priority Health SBD |
$1,404.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,089.74
|
|
|
PR VAGINECTOMY COMPLETE REMOVAL VAGINAL WALL
|
Professional
|
Both
|
$1,985.00
|
|
|
Service Code
|
HCPCS 57110
|
| Min. Negotiated Rate |
$579.79 |
| Max. Negotiated Rate |
$2,148.07 |
| Rate for Payer: Aetna Commercial |
$1,082.64
|
| Rate for Payer: BCBS Complete |
$608.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,148.07
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Meridian Medicaid |
$608.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$579.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,389.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,283.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,283.92
|
| Rate for Payer: Priority Health SBD |
$1,283.92
|
| Rate for Payer: UMR Bronson Commercial |
$913.10
|
|
|
PR VAGINECTOMY PARTIAL REMOVAL VAGINAL WALL
|
Professional
|
Both
|
$1,954.00
|
|
|
Service Code
|
HCPCS 57106
|
| Min. Negotiated Rate |
$346.76 |
| Max. Negotiated Rate |
$3,372.14 |
| Rate for Payer: Aetna Commercial |
$627.43
|
| Rate for Payer: BCBS Complete |
$364.10
|
| Rate for Payer: BCBS Trust/PPO |
$3,372.14
|
| Rate for Payer: Cash Price |
$1,563.20
|
| Rate for Payer: Cash Price |
$1,563.20
|
| Rate for Payer: Meridian Medicaid |
$364.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$346.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,367.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$764.11
|
| Rate for Payer: Priority Health Narrow Network |
$764.11
|
| Rate for Payer: Priority Health SBD |
$764.11
|
| Rate for Payer: UMR Bronson Commercial |
$898.84
|
|
|
PR VAGINECTOMY PRTL RMVL VAG WALL & PARAVAGINAL T
|
Professional
|
Both
|
$2,521.00
|
|
|
Service Code
|
HCPCS 57107
|
| Min. Negotiated Rate |
$936.35 |
| Max. Negotiated Rate |
$3,758.85 |
| Rate for Payer: Aetna Commercial |
$1,723.00
|
| Rate for Payer: BCBS Complete |
$983.17
|
| Rate for Payer: BCBS Trust/PPO |
$3,758.85
|
| Rate for Payer: Cash Price |
$2,016.80
|
| Rate for Payer: Cash Price |
$2,016.80
|
| Rate for Payer: Meridian Medicaid |
$983.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$936.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,063.18
|
| Rate for Payer: Priority Health Narrow Network |
$2,063.18
|
| Rate for Payer: Priority Health SBD |
$2,063.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,159.66
|
|
|
PR VAGINOPLASTY INTERSEX STATE
|
Professional
|
Both
|
$2,483.00
|
|
|
Service Code
|
HCPCS 57335
|
| Min. Negotiated Rate |
$755.51 |
| Max. Negotiated Rate |
$1,738.10 |
| Rate for Payer: Aetna Commercial |
$1,408.00
|
| Rate for Payer: BCBS Complete |
$793.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,671.54
|
| Rate for Payer: Cash Price |
$1,986.40
|
| Rate for Payer: Cash Price |
$1,986.40
|
| Rate for Payer: Meridian Medicaid |
$793.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$755.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,738.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,673.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,673.55
|
| Rate for Payer: Priority Health SBD |
$1,673.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,142.18
|
|
|
PR VAGOTOMY PFRMD W/PRTL DSTL GSTRCT
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 43635
|
| Min. Negotiated Rate |
$71.14 |
| Max. Negotiated Rate |
$806.71 |
| Rate for Payer: Aetna Commercial |
$151.79
|
| Rate for Payer: BCBS Complete |
$74.70
|
| Rate for Payer: BCBS Trust/PPO |
$806.71
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Meridian Medicaid |
$74.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.38
|
| Rate for Payer: Priority Health Narrow Network |
$196.38
|
| Rate for Payer: Priority Health SBD |
$196.38
|
| Rate for Payer: UMR Bronson Commercial |
$92.00
|
|
|
PR VALVOTOMY MITRAL VALVE OPEN HEART W/BYPASS
|
Professional
|
Both
|
$8,748.00
|
|
|
Service Code
|
HCPCS 33422
|
| Min. Negotiated Rate |
$495.02 |
| Max. Negotiated Rate |
$6,123.60 |
| Rate for Payer: Aetna Commercial |
$2,232.21
|
| Rate for Payer: BCBS Complete |
$1,092.54
|
| Rate for Payer: BCBS Trust/PPO |
$495.02
|
| Rate for Payer: Cash Price |
$6,998.40
|
| Rate for Payer: Cash Price |
$6,998.40
|
| Rate for Payer: Meridian Medicaid |
$1,092.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,040.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,123.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,593.83
|
| Rate for Payer: Priority Health Narrow Network |
$2,593.83
|
| Rate for Payer: Priority Health SBD |
$2,593.83
|
| Rate for Payer: UMR Bronson Commercial |
$4,024.08
|
|
|
PR VALVULOPLASTY MITRAL VALVE W/CARDIAC BYPASS
|
Professional
|
Both
|
$8,346.00
|
|
|
Service Code
|
HCPCS 33425
|
| Min. Negotiated Rate |
$763.39 |
| Max. Negotiated Rate |
$5,842.20 |
| Rate for Payer: Aetna Commercial |
$3,670.08
|
| Rate for Payer: BCBS Complete |
$1,794.34
|
| Rate for Payer: BCBS Trust/PPO |
$763.39
|
| Rate for Payer: Cash Price |
$6,676.80
|
| Rate for Payer: Cash Price |
$6,676.80
|
| Rate for Payer: Meridian Medicaid |
$1,794.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,708.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,842.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,253.00
|
| Rate for Payer: Priority Health Narrow Network |
$4,253.00
|
| Rate for Payer: Priority Health SBD |
$4,253.00
|
| Rate for Payer: UMR Bronson Commercial |
$3,839.16
|
|
|
PR VALVULOPLASTY TRICUSPID VALVE W/O RING INSERTION
|
Professional
|
Both
|
$7,396.00
|
|
|
Service Code
|
HCPCS 33463
|
| Min. Negotiated Rate |
$1,183.92 |
| Max. Negotiated Rate |
$5,177.20 |
| Rate for Payer: Aetna Commercial |
$4,125.63
|
| Rate for Payer: BCBS Complete |
$2,019.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,183.92
|
| Rate for Payer: Cash Price |
$5,916.80
|
| Rate for Payer: Cash Price |
$5,916.80
|
| Rate for Payer: Meridian Medicaid |
$2,019.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,923.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,177.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,781.23
|
| Rate for Payer: Priority Health Narrow Network |
$4,781.23
|
| Rate for Payer: Priority Health SBD |
$4,781.23
|
| Rate for Payer: UMR Bronson Commercial |
$3,402.16
|
|
|
PR VALVULOPLASTY TRICUSPID VALVE W/RING INSERTION
|
Professional
|
Both
|
$5,015.98
|
|
|
Service Code
|
HCPCS 33464
|
| Min. Negotiated Rate |
$309.58 |
| Max. Negotiated Rate |
$3,796.05 |
| Rate for Payer: Aetna Commercial |
$3,273.60
|
| Rate for Payer: BCBS Complete |
$1,602.01
|
| Rate for Payer: BCBS Trust/PPO |
$309.58
|
| Rate for Payer: Cash Price |
$4,012.78
|
| Rate for Payer: Cash Price |
$4,012.78
|
| Rate for Payer: Meridian Medicaid |
$1,602.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,525.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,511.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,796.05
|
| Rate for Payer: Priority Health SBD |
$3,796.05
|
| Rate for Payer: UMR Bronson Commercial |
$2,307.35
|
|
|
PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 90716
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$177.68 |
| Rate for Payer: Aetna Commercial |
$177.68
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: BCBS Trust/PPO |
$160.76
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.40
|
| Rate for Payer: UMR Bronson Commercial |
$97.52
|
|
|
PR VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX
|
Professional
|
Both
|
$1,309.00
|
|
|
Service Code
|
HCPCS 37500
|
| Min. Negotiated Rate |
$395.54 |
| Max. Negotiated Rate |
$1,413.20 |
| Rate for Payer: Aetna Commercial |
$846.67
|
| Rate for Payer: BCBS Complete |
$415.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,413.20
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Meridian Medicaid |
$415.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$916.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$982.53
|
| Rate for Payer: Priority Health Narrow Network |
$982.53
|
| Rate for Payer: Priority Health SBD |
$982.53
|
| Rate for Payer: UMR Bronson Commercial |
$602.14
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I
|
Professional
|
Both
|
$1,485.00
|
|
|
Service Code
|
HCPCS 37242
|
| Min. Negotiated Rate |
$294.79 |
| Max. Negotiated Rate |
$1,039.50 |
| Rate for Payer: Aetna Commercial |
$637.38
|
| Rate for Payer: BCBS Complete |
$309.53
|
| Rate for Payer: BCBS Trust/PPO |
$658.79
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Meridian Medicaid |
$309.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$294.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$737.83
|
| Rate for Payer: Priority Health Narrow Network |
$737.83
|
| Rate for Payer: Priority Health SBD |
$737.83
|
| Rate for Payer: UMR Bronson Commercial |
$683.10
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE
|
Professional
|
Both
|
$9,512.00
|
|
|
Service Code
|
HCPCS 37244
|
| Min. Negotiated Rate |
$408.32 |
| Max. Negotiated Rate |
$6,658.40 |
| Rate for Payer: Aetna Commercial |
$883.47
|
| Rate for Payer: BCBS Complete |
$428.74
|
| Rate for Payer: BCBS Trust/PPO |
$624.45
|
| Rate for Payer: Cash Price |
$7,609.60
|
| Rate for Payer: Cash Price |
$7,609.60
|
| Rate for Payer: Meridian Medicaid |
$428.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,658.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,025.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,025.09
|
| Rate for Payer: Priority Health SBD |
$1,025.09
|
| Rate for Payer: UMR Bronson Commercial |
$4,375.52
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 37241
|
| Min. Negotiated Rate |
$264.76 |
| Max. Negotiated Rate |
$665.48 |
| Rate for Payer: Aetna Commercial |
$579.41
|
| Rate for Payer: BCBS Complete |
$278.00
|
| Rate for Payer: BCBS Trust/PPO |
$583.24
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Meridian Medicaid |
$278.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$264.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$665.48
|
| Rate for Payer: Priority Health Narrow Network |
$665.48
|
| Rate for Payer: Priority Health SBD |
$665.48
|
| Rate for Payer: UMR Bronson Commercial |
$311.42
|
|
