|
PR DIR RPR ANEURYSM & GRAFT POPLITEAL ARTERY
|
Professional
|
Both
|
$2,409.00
|
|
|
Service Code
|
HCPCS 35151
|
| Min. Negotiated Rate |
$774.89 |
| Max. Negotiated Rate |
$1,924.09 |
| Rate for Payer: Aetna Commercial |
$1,635.20
|
| Rate for Payer: Aetna Medicare |
$1,220.30
|
| Rate for Payer: BCBS Complete |
$813.63
|
| Rate for Payer: BCBS MAPPO |
$1,220.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,760.30
|
| Rate for Payer: BCN Commercial |
$1,767.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,220.30
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Cofinity Commercial |
$1,635.20
|
| Rate for Payer: Cofinity Commercial |
$1,757.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,220.30
|
| Rate for Payer: Healthscope Commercial |
$1,464.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,464.36
|
| Rate for Payer: Meridian Medicaid |
$813.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,281.32
|
| Rate for Payer: PACE SWMI |
$1,220.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,220.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$774.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,686.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,924.09
|
| Rate for Payer: Priority Health Medicare |
$1,220.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,924.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,256.91
|
|
|
PR DIR RPR ANEURYSM HEPATIC/CELIAC/RENAL/MESENTERIC
|
Professional
|
Both
|
$3,133.00
|
|
|
Service Code
|
HCPCS 35121
|
| Min. Negotiated Rate |
$283.70 |
| Max. Negotiated Rate |
$2,451.26 |
| Rate for Payer: Aetna Commercial |
$2,090.84
|
| Rate for Payer: Aetna Medicare |
$1,560.33
|
| Rate for Payer: BCBS Complete |
$1,035.05
|
| Rate for Payer: BCBS MAPPO |
$1,560.33
|
| Rate for Payer: BCBS Trust/PPO |
$283.70
|
| Rate for Payer: BCN Commercial |
$2,251.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.33
|
| Rate for Payer: Cash Price |
$2,506.40
|
| Rate for Payer: Cash Price |
$2,506.40
|
| Rate for Payer: Cofinity Commercial |
$2,246.88
|
| Rate for Payer: Cofinity Commercial |
$2,090.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.33
|
| Rate for Payer: Healthscope Commercial |
$1,872.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,872.40
|
| Rate for Payer: Meridian Medicaid |
$1,035.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,638.35
|
| Rate for Payer: PACE SWMI |
$1,560.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$985.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,193.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,451.26
|
| Rate for Payer: Priority Health Medicare |
$1,560.33
|
| Rate for Payer: Priority Health Narrow Network |
$2,451.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,607.14
|
|
|
PR DIR RPR ANEURYSM SPLENIC ARTERY
|
Professional
|
Both
|
$2,720.00
|
|
|
Service Code
|
HCPCS 35111
|
| Min. Negotiated Rate |
$829.42 |
| Max. Negotiated Rate |
$2,062.94 |
| Rate for Payer: Aetna Commercial |
$1,758.39
|
| Rate for Payer: Aetna Medicare |
$1,312.23
|
| Rate for Payer: BCBS Complete |
$870.89
|
| Rate for Payer: BCBS MAPPO |
$1,312.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.86
|
| Rate for Payer: BCN Commercial |
$1,895.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,312.23
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cofinity Commercial |
$1,758.39
|
| Rate for Payer: Cofinity Commercial |
$1,889.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,312.23
|
| Rate for Payer: Healthscope Commercial |
$1,574.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,574.68
|
| Rate for Payer: Meridian Medicaid |
$870.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,377.84
|
| Rate for Payer: PACE SWMI |
$1,312.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,312.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$829.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,904.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,062.94
|
| Rate for Payer: Priority Health Medicare |
$1,312.23
|
| Rate for Payer: Priority Health Narrow Network |
$2,062.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,351.60
|
|
|
PR DIR RPR RUPTD ANEURSM ABDOM AORTA W/VISCERA VSLS
|
Professional
|
Both
|
$5,390.00
|
|
|
Service Code
|
HCPCS 35092
|
| Min. Negotiated Rate |
$1,617.31 |
| Max. Negotiated Rate |
$4,007.77 |
| Rate for Payer: Aetna Commercial |
$3,414.70
|
| Rate for Payer: Aetna Medicare |
$2,548.28
|
| Rate for Payer: BCBS Complete |
$1,698.18
|
| Rate for Payer: BCBS MAPPO |
$2,548.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,136.58
|
| Rate for Payer: BCN Commercial |
$3,681.69
|
| Rate for Payer: BCN Medicare Advantage |
$2,548.28
|
| Rate for Payer: Cash Price |
$4,312.00
|
| Rate for Payer: Cash Price |
$4,312.00
|
| Rate for Payer: Cofinity Commercial |
$3,669.52
|
| Rate for Payer: Cofinity Commercial |
$3,414.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,548.28
|
| Rate for Payer: Healthscope Commercial |
$3,057.94
|
| Rate for Payer: Healthscope Whirlpool |
$3,057.94
|
| Rate for Payer: Meridian Medicaid |
$1,698.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,675.69
|
| Rate for Payer: PACE SWMI |
$2,548.28
|
| Rate for Payer: PHP Medicare Advantage |
$2,548.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,617.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,773.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,007.77
|
| Rate for Payer: Priority Health Medicare |
$2,548.28
|
| Rate for Payer: Priority Health Narrow Network |
$4,007.77
|
| Rate for Payer: UHC Medicare Advantage |
$2,624.73
|
|
|
PR DIR RPR RUPTD ANEURSM HEPATIC/CELIAC/RENAL/MESEN
|
Professional
|
Both
|
$3,783.00
|
|
|
Service Code
|
HCPCS 35122
|
| Min. Negotiated Rate |
$1,178.96 |
| Max. Negotiated Rate |
$2,930.03 |
| Rate for Payer: Aetna Commercial |
$2,500.36
|
| Rate for Payer: Aetna Medicare |
$1,865.94
|
| Rate for Payer: BCBS Complete |
$1,237.91
|
| Rate for Payer: BCBS MAPPO |
$1,865.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,197.66
|
| Rate for Payer: BCN Commercial |
$2,691.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,865.94
|
| Rate for Payer: Cash Price |
$3,026.40
|
| Rate for Payer: Cash Price |
$3,026.40
|
| Rate for Payer: Cofinity Commercial |
$2,500.36
|
| Rate for Payer: Cofinity Commercial |
$2,686.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,865.94
|
| Rate for Payer: Healthscope Commercial |
$2,239.13
|
| Rate for Payer: Healthscope Whirlpool |
$2,239.13
|
| Rate for Payer: Meridian Medicaid |
$1,237.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,959.24
|
| Rate for Payer: PACE SWMI |
$1,865.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,865.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,178.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,648.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,930.03
|
| Rate for Payer: Priority Health Medicare |
$1,865.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,930.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,921.92
|
|
|
PR DIR RPR RUPTD ANEURYSM ABDOM AORTA W/ILIAC VSLS
|
Professional
|
Both
|
$3,490.00
|
|
|
Service Code
|
HCPCS 35103
|
| Min. Negotiated Rate |
$621.81 |
| Max. Negotiated Rate |
$3,446.55 |
| Rate for Payer: Aetna Commercial |
$2,935.52
|
| Rate for Payer: Aetna Medicare |
$2,190.69
|
| Rate for Payer: BCBS Complete |
$1,450.38
|
| Rate for Payer: BCBS MAPPO |
$2,190.69
|
| Rate for Payer: BCBS Trust/PPO |
$621.81
|
| Rate for Payer: BCN Commercial |
$3,166.15
|
| Rate for Payer: BCN Medicare Advantage |
$2,190.69
|
| Rate for Payer: Cash Price |
$2,792.00
|
| Rate for Payer: Cash Price |
$2,792.00
|
| Rate for Payer: Cofinity Commercial |
$2,935.52
|
| Rate for Payer: Cofinity Commercial |
$3,154.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,190.69
|
| Rate for Payer: Healthscope Commercial |
$2,628.83
|
| Rate for Payer: Healthscope Whirlpool |
$2,628.83
|
| Rate for Payer: Meridian Medicaid |
$1,450.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,300.22
|
| Rate for Payer: PACE SWMI |
$2,190.69
|
| Rate for Payer: PHP Medicare Advantage |
$2,190.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,381.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,443.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,446.55
|
| Rate for Payer: Priority Health Medicare |
$2,190.69
|
| Rate for Payer: Priority Health Narrow Network |
$3,446.55
|
| Rate for Payer: UHC Medicare Advantage |
$2,256.41
|
|
|
PR DIR RPR RUPTD ANEURYSM ABDOMINAL AORTA
|
Professional
|
Both
|
$4,202.00
|
|
|
Service Code
|
HCPCS 35082
|
| Min. Negotiated Rate |
$750.19 |
| Max. Negotiated Rate |
$3,356.12 |
| Rate for Payer: Aetna Commercial |
$2,856.10
|
| Rate for Payer: Aetna Medicare |
$2,131.42
|
| Rate for Payer: BCBS Complete |
$1,414.59
|
| Rate for Payer: BCBS MAPPO |
$2,131.42
|
| Rate for Payer: BCBS Trust/PPO |
$750.19
|
| Rate for Payer: BCN Commercial |
$3,083.06
|
| Rate for Payer: BCN Medicare Advantage |
$2,131.42
|
| Rate for Payer: Cash Price |
$3,361.60
|
| Rate for Payer: Cash Price |
$3,361.60
|
| Rate for Payer: Cofinity Commercial |
$3,069.24
|
| Rate for Payer: Cofinity Commercial |
$2,856.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,131.42
|
| Rate for Payer: Healthscope Commercial |
$2,557.70
|
| Rate for Payer: Healthscope Whirlpool |
$2,557.70
|
| Rate for Payer: Meridian Medicaid |
$1,414.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,237.99
|
| Rate for Payer: PACE SWMI |
$2,131.42
|
| Rate for Payer: PHP Medicare Advantage |
$2,131.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,347.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,941.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,356.12
|
| Rate for Payer: Priority Health Medicare |
$2,131.42
|
| Rate for Payer: Priority Health Narrow Network |
$3,356.12
|
| Rate for Payer: UHC Medicare Advantage |
$2,195.36
|
|
|
PR DIR RPR RUPTD ANEURYSM AXIL-BRACHIAL ARM INCIS
|
Professional
|
Both
|
$3,850.00
|
|
|
Service Code
|
HCPCS 35013
|
| Min. Negotiated Rate |
$793.43 |
| Max. Negotiated Rate |
$2,695.00 |
| Rate for Payer: Aetna Commercial |
$1,673.28
|
| Rate for Payer: Aetna Medicare |
$1,248.72
|
| Rate for Payer: BCBS Complete |
$833.10
|
| Rate for Payer: BCBS MAPPO |
$1,248.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,152.22
|
| Rate for Payer: BCN Commercial |
$1,815.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,248.72
|
| Rate for Payer: Cash Price |
$3,080.00
|
| Rate for Payer: Cash Price |
$3,080.00
|
| Rate for Payer: Cofinity Commercial |
$1,673.28
|
| Rate for Payer: Cofinity Commercial |
$1,798.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,248.72
|
| Rate for Payer: Healthscope Commercial |
$1,498.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,498.46
|
| Rate for Payer: Meridian Medicaid |
$833.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,311.16
|
| Rate for Payer: PACE SWMI |
$1,248.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,248.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$793.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,695.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,976.76
|
| Rate for Payer: Priority Health Medicare |
$1,248.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,976.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,286.18
|
|
|
PR DIR RPR RUPTD ANEURYSM CAROTID-SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$2,492.00
|
|
|
Service Code
|
HCPCS 35002
|
| Min. Negotiated Rate |
$711.21 |
| Max. Negotiated Rate |
$2,959.01 |
| Rate for Payer: Aetna Commercial |
$1,504.38
|
| Rate for Payer: Aetna Medicare |
$1,122.67
|
| Rate for Payer: BCBS Complete |
$746.77
|
| Rate for Payer: BCBS MAPPO |
$1,122.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,959.01
|
| Rate for Payer: BCN Commercial |
$1,623.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,122.67
|
| Rate for Payer: Cash Price |
$1,993.60
|
| Rate for Payer: Cash Price |
$1,993.60
|
| Rate for Payer: Cofinity Commercial |
$1,616.64
|
| Rate for Payer: Cofinity Commercial |
$1,504.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,122.67
|
| Rate for Payer: Healthscope Commercial |
$1,347.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,347.20
|
| Rate for Payer: Meridian Medicaid |
$746.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,178.80
|
| Rate for Payer: PACE SWMI |
$1,122.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,122.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$711.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,744.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,767.16
|
| Rate for Payer: Priority Health Medicare |
$1,122.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,767.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,156.35
|
|
|
PR DIR RPR RUPTD ANEURYSM & GRAFT ILIAC ARTERY
|
Professional
|
Both
|
$3,384.00
|
|
|
Service Code
|
HCPCS 35132
|
| Min. Negotiated Rate |
$1,019.21 |
| Max. Negotiated Rate |
$2,534.79 |
| Rate for Payer: Aetna Commercial |
$2,161.98
|
| Rate for Payer: Aetna Medicare |
$1,613.42
|
| Rate for Payer: BCBS Complete |
$1,070.17
|
| Rate for Payer: BCBS MAPPO |
$1,613.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,010.18
|
| Rate for Payer: BCN Commercial |
$2,328.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,613.42
|
| Rate for Payer: Cash Price |
$2,707.20
|
| Rate for Payer: Cash Price |
$2,707.20
|
| Rate for Payer: Cofinity Commercial |
$2,161.98
|
| Rate for Payer: Cofinity Commercial |
$2,323.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,613.42
|
| Rate for Payer: Healthscope Commercial |
$1,936.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,936.10
|
| Rate for Payer: Meridian Medicaid |
$1,070.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,694.09
|
| Rate for Payer: PACE SWMI |
$1,613.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,613.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,019.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,368.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,534.79
|
| Rate for Payer: Priority Health Medicare |
$1,613.42
|
| Rate for Payer: Priority Health Narrow Network |
$2,534.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,661.82
|
|
|
PR DIR RPR RUPTD ANEURYSM & GRF COMMON FEMORAL ART
|
Professional
|
Both
|
$2,559.00
|
|
|
Service Code
|
HCPCS 35142
|
| Min. Negotiated Rate |
$571.62 |
| Max. Negotiated Rate |
$2,051.23 |
| Rate for Payer: Aetna Commercial |
$1,742.13
|
| Rate for Payer: Aetna Medicare |
$1,300.10
|
| Rate for Payer: BCBS Complete |
$864.41
|
| Rate for Payer: BCBS MAPPO |
$1,300.10
|
| Rate for Payer: BCBS Trust/PPO |
$571.62
|
| Rate for Payer: BCN Commercial |
$1,884.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,300.10
|
| Rate for Payer: Cash Price |
$2,047.20
|
| Rate for Payer: Cash Price |
$2,047.20
|
| Rate for Payer: Cofinity Commercial |
$1,872.14
|
| Rate for Payer: Cofinity Commercial |
$1,742.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,300.10
|
| Rate for Payer: Healthscope Commercial |
$1,560.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,560.12
|
| Rate for Payer: Meridian Medicaid |
$864.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,365.10
|
| Rate for Payer: PACE SWMI |
$1,300.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,300.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$823.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,791.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,051.23
|
| Rate for Payer: Priority Health Medicare |
$1,300.10
|
| Rate for Payer: Priority Health Narrow Network |
$2,051.23
|
| Rate for Payer: UHC Medicare Advantage |
$1,339.10
|
|
|
PR DIR RPR RUPTD ANEURYSM & GRF POPLITEAL ARTERY
|
Professional
|
Both
|
$2,683.00
|
|
|
Service Code
|
HCPCS 35152
|
| Min. Negotiated Rate |
$872.02 |
| Max. Negotiated Rate |
$2,435.46 |
| Rate for Payer: Aetna Commercial |
$1,848.61
|
| Rate for Payer: Aetna Medicare |
$1,379.56
|
| Rate for Payer: BCBS Complete |
$915.62
|
| Rate for Payer: BCBS MAPPO |
$1,379.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,435.46
|
| Rate for Payer: BCN Commercial |
$1,992.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,379.56
|
| Rate for Payer: Cash Price |
$2,146.40
|
| Rate for Payer: Cash Price |
$2,146.40
|
| Rate for Payer: Cofinity Commercial |
$1,986.57
|
| Rate for Payer: Cofinity Commercial |
$1,848.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,379.56
|
| Rate for Payer: Healthscope Commercial |
$1,655.47
|
| Rate for Payer: Healthscope Whirlpool |
$1,655.47
|
| Rate for Payer: Meridian Medicaid |
$915.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,448.54
|
| Rate for Payer: PACE SWMI |
$1,379.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,379.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$872.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,878.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,168.79
|
| Rate for Payer: Priority Health Medicare |
$1,379.56
|
| Rate for Payer: Priority Health Narrow Network |
$2,168.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,420.95
|
|
|
PR DIR RPR RUPTD ANEURYSM RADIAL/ULNAR ARTERY
|
Professional
|
Both
|
$3,357.00
|
|
|
Service Code
|
HCPCS 35045
|
| Min. Negotiated Rate |
$606.84 |
| Max. Negotiated Rate |
$2,349.90 |
| Rate for Payer: Aetna Commercial |
$1,280.85
|
| Rate for Payer: Aetna Medicare |
$955.86
|
| Rate for Payer: BCBS Complete |
$637.18
|
| Rate for Payer: BCBS MAPPO |
$955.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,582.22
|
| Rate for Payer: BCN Commercial |
$1,389.31
|
| Rate for Payer: BCN Medicare Advantage |
$955.86
|
| Rate for Payer: Cash Price |
$2,685.60
|
| Rate for Payer: Cash Price |
$2,685.60
|
| Rate for Payer: Cofinity Commercial |
$1,376.44
|
| Rate for Payer: Cofinity Commercial |
$1,280.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$955.86
|
| Rate for Payer: Healthscope Commercial |
$1,147.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,147.03
|
| Rate for Payer: Meridian Medicaid |
$637.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,003.65
|
| Rate for Payer: PACE SWMI |
$955.86
|
| Rate for Payer: PHP Medicare Advantage |
$955.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$606.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,349.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,512.35
|
| Rate for Payer: Priority Health Medicare |
$955.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,512.35
|
| Rate for Payer: UHC Medicare Advantage |
$984.54
|
|
|
PR DISARTICULATION HIP
|
Professional
|
Both
|
$5,325.00
|
|
|
Service Code
|
HCPCS 27295
|
| Min. Negotiated Rate |
$808.12 |
| Max. Negotiated Rate |
$3,727.50 |
| Rate for Payer: Aetna Commercial |
$1,665.18
|
| Rate for Payer: Aetna Medicare |
$1,242.67
|
| Rate for Payer: BCBS Complete |
$848.53
|
| Rate for Payer: BCBS MAPPO |
$1,242.67
|
| Rate for Payer: BCBS Trust/PPO |
$3,334.10
|
| Rate for Payer: BCN Commercial |
$1,837.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,242.67
|
| Rate for Payer: Cash Price |
$4,260.00
|
| Rate for Payer: Cash Price |
$4,260.00
|
| Rate for Payer: Cofinity Commercial |
$1,789.44
|
| Rate for Payer: Cofinity Commercial |
$1,665.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,242.67
|
| Rate for Payer: Healthscope Commercial |
$1,491.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,491.20
|
| Rate for Payer: Meridian Medicaid |
$848.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,304.80
|
| Rate for Payer: PACE SWMI |
$1,242.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,242.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,727.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,920.56
|
| Rate for Payer: Priority Health Medicare |
$1,242.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,920.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,279.95
|
|
|
PR DISARTICULATION KNEE
|
Professional
|
Both
|
$2,875.00
|
|
|
Service Code
|
HCPCS 27598
|
| Min. Negotiated Rate |
$442.83 |
| Max. Negotiated Rate |
$2,012.50 |
| Rate for Payer: Aetna Commercial |
$922.90
|
| Rate for Payer: Aetna Medicare |
$688.73
|
| Rate for Payer: BCBS Complete |
$464.97
|
| Rate for Payer: BCBS MAPPO |
$688.73
|
| Rate for Payer: BCBS Trust/PPO |
$797.73
|
| Rate for Payer: BCN Commercial |
$1,014.00
|
| Rate for Payer: BCN Medicare Advantage |
$688.73
|
| Rate for Payer: Cash Price |
$2,300.00
|
| Rate for Payer: Cash Price |
$2,300.00
|
| Rate for Payer: Cofinity Commercial |
$991.77
|
| Rate for Payer: Cofinity Commercial |
$922.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$688.73
|
| Rate for Payer: Healthscope Commercial |
$826.48
|
| Rate for Payer: Healthscope Whirlpool |
$826.48
|
| Rate for Payer: Meridian Medicaid |
$464.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$723.17
|
| Rate for Payer: PACE SWMI |
$688.73
|
| Rate for Payer: PHP Medicare Advantage |
$688.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$442.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,012.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,059.60
|
| Rate for Payer: Priority Health Medicare |
$688.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,059.60
|
| Rate for Payer: UHC Medicare Advantage |
$709.39
|
|
|
PR DISARTICULATION SHOULDER
|
Professional
|
Both
|
$1,957.00
|
|
|
Service Code
|
HCPCS 23920
|
| Min. Negotiated Rate |
$491.15 |
| Max. Negotiated Rate |
$1,718.84 |
| Rate for Payer: Aetna Commercial |
$1,482.52
|
| Rate for Payer: Aetna Medicare |
$1,106.36
|
| Rate for Payer: BCBS Complete |
$759.07
|
| Rate for Payer: BCBS MAPPO |
$1,106.36
|
| Rate for Payer: BCBS Trust/PPO |
$491.15
|
| Rate for Payer: BCN Commercial |
$1,644.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,106.36
|
| Rate for Payer: Cash Price |
$1,565.60
|
| Rate for Payer: Cash Price |
$1,565.60
|
| Rate for Payer: Cofinity Commercial |
$1,482.52
|
| Rate for Payer: Cofinity Commercial |
$1,593.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,106.36
|
| Rate for Payer: Healthscope Commercial |
$1,327.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,327.63
|
| Rate for Payer: Meridian Medicaid |
$759.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,161.68
|
| Rate for Payer: PACE SWMI |
$1,106.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,106.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$722.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,369.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,718.84
|
| Rate for Payer: Priority Health Medicare |
$1,106.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,718.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,139.55
|
|
|
PR DISARTICULATION THROUGH WRIST
|
Professional
|
Both
|
$1,404.00
|
|
|
Service Code
|
HCPCS 25920
|
| Min. Negotiated Rate |
$129.43 |
| Max. Negotiated Rate |
$1,128.03 |
| Rate for Payer: Aetna Commercial |
$963.86
|
| Rate for Payer: Aetna Medicare |
$719.30
|
| Rate for Payer: BCBS Complete |
$496.72
|
| Rate for Payer: BCBS MAPPO |
$719.30
|
| Rate for Payer: BCBS Trust/PPO |
$129.43
|
| Rate for Payer: BCN Commercial |
$1,079.48
|
| Rate for Payer: BCN Medicare Advantage |
$719.30
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Cofinity Commercial |
$963.86
|
| Rate for Payer: Cofinity Commercial |
$1,035.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.30
|
| Rate for Payer: Healthscope Commercial |
$863.16
|
| Rate for Payer: Healthscope Whirlpool |
$863.16
|
| Rate for Payer: Meridian Medicaid |
$496.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$755.26
|
| Rate for Payer: PACE SWMI |
$719.30
|
| Rate for Payer: PHP Medicare Advantage |
$719.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$982.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,128.03
|
| Rate for Payer: Priority Health Medicare |
$719.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,128.03
|
| Rate for Payer: UHC Medicare Advantage |
$740.88
|
|
|
PR DISARTICULATION THRU WRIST RE-AMPUTATION
|
Professional
|
Both
|
$2,313.00
|
|
|
Service Code
|
HCPCS 25924
|
| Min. Negotiated Rate |
$69.19 |
| Max. Negotiated Rate |
$1,619.10 |
| Rate for Payer: Aetna Commercial |
$941.50
|
| Rate for Payer: Aetna Medicare |
$702.61
|
| Rate for Payer: BCBS Complete |
$485.32
|
| Rate for Payer: BCBS MAPPO |
$702.61
|
| Rate for Payer: BCBS Trust/PPO |
$69.19
|
| Rate for Payer: BCN Commercial |
$1,054.56
|
| Rate for Payer: BCN Medicare Advantage |
$702.61
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cofinity Commercial |
$1,011.76
|
| Rate for Payer: Cofinity Commercial |
$941.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$702.61
|
| Rate for Payer: Healthscope Commercial |
$843.13
|
| Rate for Payer: Healthscope Whirlpool |
$843.13
|
| Rate for Payer: Meridian Medicaid |
$485.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$737.74
|
| Rate for Payer: PACE SWMI |
$702.61
|
| Rate for Payer: PHP Medicare Advantage |
$702.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$462.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,619.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,101.99
|
| Rate for Payer: Priority Health Medicare |
$702.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,101.99
|
| Rate for Payer: UHC Medicare Advantage |
$723.69
|
|
|
PR DISCECTOMY ANT DCMPRN CORD CERVICAL 1 NTRSPC
|
Professional
|
Both
|
$5,633.00
|
|
|
Service Code
|
HCPCS 63075
|
| Min. Negotiated Rate |
$170.11 |
| Max. Negotiated Rate |
$3,943.10 |
| Rate for Payer: Aetna Commercial |
$1,815.41
|
| Rate for Payer: Aetna Medicare |
$1,354.78
|
| Rate for Payer: BCBS Complete |
$917.86
|
| Rate for Payer: BCBS MAPPO |
$1,354.78
|
| Rate for Payer: BCBS Trust/PPO |
$170.11
|
| Rate for Payer: BCN Commercial |
$2,197.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,354.78
|
| Rate for Payer: Cash Price |
$4,506.40
|
| Rate for Payer: Cash Price |
$4,506.40
|
| Rate for Payer: Cofinity Commercial |
$1,950.88
|
| Rate for Payer: Cofinity Commercial |
$1,815.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,354.78
|
| Rate for Payer: Healthscope Commercial |
$1,625.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,625.74
|
| Rate for Payer: Meridian Medicaid |
$917.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,422.52
|
| Rate for Payer: PACE SWMI |
$1,354.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,354.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$874.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,943.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,312.45
|
| Rate for Payer: Priority Health Medicare |
$1,354.78
|
| Rate for Payer: Priority Health Narrow Network |
$2,312.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,395.42
|
|
|
PR DISCECTOMY ANT DCMPRN CORD CERVICAL EA NTRSPC
|
Professional
|
Both
|
$1,890.00
|
|
|
Service Code
|
HCPCS 63076
|
| Min. Negotiated Rate |
$153.79 |
| Max. Negotiated Rate |
$1,323.00 |
| Rate for Payer: Aetna Commercial |
$324.19
|
| Rate for Payer: Aetna Medicare |
$241.93
|
| Rate for Payer: BCBS Complete |
$161.48
|
| Rate for Payer: BCBS MAPPO |
$241.93
|
| Rate for Payer: BCBS Trust/PPO |
$174.34
|
| Rate for Payer: BCN Commercial |
$389.03
|
| Rate for Payer: BCN Medicare Advantage |
$241.93
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cofinity Commercial |
$348.38
|
| Rate for Payer: Cofinity Commercial |
$324.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.93
|
| Rate for Payer: Healthscope Commercial |
$290.32
|
| Rate for Payer: Healthscope Whirlpool |
$290.32
|
| Rate for Payer: Meridian Medicaid |
$161.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$254.03
|
| Rate for Payer: PACE SWMI |
$241.93
|
| Rate for Payer: PHP Medicare Advantage |
$241.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$153.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,323.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$409.37
|
| Rate for Payer: Priority Health Medicare |
$241.93
|
| Rate for Payer: Priority Health Narrow Network |
$409.37
|
| Rate for Payer: UHC Medicare Advantage |
$249.19
|
|
|
PR DISCECTOMY ANT DCMPRN CORD THORACIC 1 NTRSPC
|
Professional
|
Both
|
$5,580.00
|
|
|
Service Code
|
HCPCS 63077
|
| Min. Negotiated Rate |
$145.28 |
| Max. Negotiated Rate |
$3,906.00 |
| Rate for Payer: Aetna Commercial |
$2,045.82
|
| Rate for Payer: Aetna Medicare |
$1,526.73
|
| Rate for Payer: BCBS Complete |
$982.04
|
| Rate for Payer: BCBS MAPPO |
$1,526.73
|
| Rate for Payer: BCBS Trust/PPO |
$145.28
|
| Rate for Payer: BCN Commercial |
$2,469.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,526.73
|
| Rate for Payer: Cash Price |
$4,464.00
|
| Rate for Payer: Cash Price |
$4,464.00
|
| Rate for Payer: Cofinity Commercial |
$2,198.49
|
| Rate for Payer: Cofinity Commercial |
$2,045.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,526.73
|
| Rate for Payer: Healthscope Commercial |
$1,832.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,832.08
|
| Rate for Payer: Meridian Medicaid |
$982.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,603.07
|
| Rate for Payer: PACE SWMI |
$1,526.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,526.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$935.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,906.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,598.39
|
| Rate for Payer: Priority Health Medicare |
$1,526.73
|
| Rate for Payer: Priority Health Narrow Network |
$2,598.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,572.53
|
|
|
PR DISEASE MANAGEMENT PROGRAM
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS S0315
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS Trust/PPO |
$111.47
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
|
|
PR DISEASE MGMT PER DIEM
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS S0317
|
| Min. Negotiated Rate |
$58.11 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$175.00
|
| Rate for Payer: Aetna Commercial |
$175.00
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS Trust/PPO |
$58.11
|
| Rate for Payer: BCBS Trust/PPO |
$58.11
|
| Rate for Payer: BCN Commercial |
$1,000.00
|
| Rate for Payer: BCN Commercial |
$1,000.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
|
|
PR DISE DYN EVAL SLEEP DISORDERED BREATHING FLX DX
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 42975
|
| Min. Negotiated Rate |
$61.98 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Aetna Commercial |
$126.35
|
| Rate for Payer: Aetna Medicare |
$94.29
|
| Rate for Payer: BCBS Complete |
$65.08
|
| Rate for Payer: BCBS MAPPO |
$94.29
|
| Rate for Payer: BCBS Trust/PPO |
$284.23
|
| Rate for Payer: BCN Commercial |
$139.76
|
| Rate for Payer: BCN Medicare Advantage |
$94.29
|
| Rate for Payer: Cash Price |
$178.40
|
| Rate for Payer: Cash Price |
$178.40
|
| Rate for Payer: Cofinity Commercial |
$135.78
|
| Rate for Payer: Cofinity Commercial |
$126.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.29
|
| Rate for Payer: Healthscope Commercial |
$113.15
|
| Rate for Payer: Healthscope Whirlpool |
$113.15
|
| Rate for Payer: Meridian Medicaid |
$65.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$99.00
|
| Rate for Payer: PACE SWMI |
$94.29
|
| Rate for Payer: PHP Medicare Advantage |
$94.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$168.16
|
| Rate for Payer: Priority Health Medicare |
$94.29
|
| Rate for Payer: Priority Health Narrow Network |
$168.16
|
| Rate for Payer: UHC Medicare Advantage |
$97.12
|
|
|
PR DISPENSING FEE BINAURAL
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS V5160
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$289.59
|
| Rate for Payer: BCBS Complete |
$190.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.50
|
|
