|
PR ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL/LAT
|
Professional
|
Both
|
$2,389.00
|
|
|
Service Code
|
HCPCS 27332
|
| Min. Negotiated Rate |
$424.08 |
| Max. Negotiated Rate |
$1,552.85 |
| Rate for Payer: Aetna Commercial |
$860.52
|
| Rate for Payer: Aetna Medicare |
$1,194.50
|
| Rate for Payer: BCBS Complete |
$445.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,236.22
|
| Rate for Payer: BCN Commercial |
$953.41
|
| Rate for Payer: Cash Price |
$1,911.20
|
| Rate for Payer: Cash Price |
$1,911.20
|
| Rate for Payer: Meridian Medicaid |
$445.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$424.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,552.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,002.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,002.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$724.74
|
| Rate for Payer: UHC Exchange |
$724.74
|
| Rate for Payer: UHCCP Medicaid |
$424.08
|
|
|
PR ARTHRT W/EXPL DRG/RMVL LOOSE/FB IPHAL JT
|
Professional
|
Both
|
$733.00
|
|
|
Service Code
|
HCPCS 28024
|
| Min. Negotiated Rate |
$202.56 |
| Max. Negotiated Rate |
$678.87 |
| Rate for Payer: Aetna Commercial |
$400.11
|
| Rate for Payer: Aetna Medicare |
$366.50
|
| Rate for Payer: BCBS Complete |
$212.69
|
| Rate for Payer: BCBS Trust/PPO |
$678.87
|
| Rate for Payer: BCN Commercial |
$667.54
|
| Rate for Payer: Cash Price |
$586.40
|
| Rate for Payer: Cash Price |
$586.40
|
| Rate for Payer: Meridian Medicaid |
$212.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$475.79
|
| Rate for Payer: Priority Health Narrow Network |
$475.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$357.02
|
| Rate for Payer: UHC Exchange |
$357.02
|
| Rate for Payer: UHCCP Medicaid |
$202.56
|
|
|
PR ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT
|
Professional
|
Both
|
$836.00
|
|
|
Service Code
|
HCPCS 28022
|
| Min. Negotiated Rate |
$213.21 |
| Max. Negotiated Rate |
$708.10 |
| Rate for Payer: Aetna Commercial |
$430.37
|
| Rate for Payer: Aetna Medicare |
$418.00
|
| Rate for Payer: BCBS Complete |
$223.87
|
| Rate for Payer: BCBS Trust/PPO |
$383.55
|
| Rate for Payer: BCN Commercial |
$708.10
|
| Rate for Payer: Cash Price |
$668.80
|
| Rate for Payer: Cash Price |
$668.80
|
| Rate for Payer: Meridian Medicaid |
$223.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$505.29
|
| Rate for Payer: Priority Health Narrow Network |
$505.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.64
|
| Rate for Payer: UHC Exchange |
$378.64
|
| Rate for Payer: UHCCP Medicaid |
$213.21
|
|
|
PR ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/TARS JT
|
Professional
|
Both
|
$919.00
|
|
|
Service Code
|
HCPCS 28020
|
| Min. Negotiated Rate |
$235.58 |
| Max. Negotiated Rate |
$1,710.64 |
| Rate for Payer: Aetna Commercial |
$485.15
|
| Rate for Payer: Aetna Medicare |
$459.50
|
| Rate for Payer: BCBS Complete |
$247.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,710.64
|
| Rate for Payer: BCN Commercial |
$799.97
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Meridian Medicaid |
$247.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$563.82
|
| Rate for Payer: Priority Health Narrow Network |
$563.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$413.95
|
| Rate for Payer: UHC Exchange |
$413.95
|
| Rate for Payer: UHCCP Medicaid |
$235.58
|
|
|
PR ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL LOOSE/FB
|
Professional
|
Both
|
$1,377.00
|
|
|
Service Code
|
HCPCS 25101
|
| Min. Negotiated Rate |
$107.77 |
| Max. Negotiated Rate |
$895.05 |
| Rate for Payer: Aetna Commercial |
$537.23
|
| Rate for Payer: Aetna Medicare |
$688.50
|
| Rate for Payer: BCBS Complete |
$282.47
|
| Rate for Payer: BCBS Trust/PPO |
$107.77
|
| Rate for Payer: BCN Commercial |
$601.07
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Meridian Medicaid |
$282.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$269.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$636.07
|
| Rate for Payer: Priority Health Narrow Network |
$636.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$455.20
|
| Rate for Payer: UHC Exchange |
$455.20
|
| Rate for Payer: UHCCP Medicaid |
$269.02
|
|
|
PR ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Facility
|
IP
|
$2,781.00
|
|
|
Service Code
|
CPT 27335
|
| Hospital Charge Code |
27335
|
| Min. Negotiated Rate |
$1,807.65 |
| Max. Negotiated Rate |
$2,781.00 |
| Rate for Payer: Aetna Commercial |
$2,502.90
|
| Rate for Payer: ASR ASR |
$2,697.57
|
| Rate for Payer: ASR Commercial |
$2,697.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,266.24
|
| Rate for Payer: BCN Commercial |
$2,156.11
|
| Rate for Payer: Cash Price |
$2,224.80
|
| Rate for Payer: Cofinity Commercial |
$2,614.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,224.80
|
| Rate for Payer: Healthscope Commercial |
$2,781.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,697.57
|
| Rate for Payer: Mclaren Commercial |
$2,502.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.85
|
| Rate for Payer: Nomi Health Commercial |
$2,280.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,447.28
|
|
|
PR ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Facility
|
OP
|
$2,781.00
|
|
|
Service Code
|
CPT 27335
|
| Hospital Charge Code |
27335
|
| Min. Negotiated Rate |
$1,807.65 |
| Max. Negotiated Rate |
$10,848.88 |
| Rate for Payer: Aetna Commercial |
$2,502.90
|
| Rate for Payer: Aetna Medicare |
$6,999.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: ASR ASR |
$2,697.57
|
| Rate for Payer: ASR Commercial |
$2,697.57
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,277.36
|
| Rate for Payer: BCN Commercial |
$2,156.11
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Cash Price |
$2,224.80
|
| Rate for Payer: Cash Price |
$2,224.80
|
| Rate for Payer: Cofinity Commercial |
$2,614.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,224.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Healthscope Commercial |
$2,781.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,697.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,999.28
|
| Rate for Payer: Mclaren Commercial |
$2,502.90
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.85
|
| Rate for Payer: Nomi Health Commercial |
$2,280.42
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Commercial |
$7,699.21
|
| Rate for Payer: PHP Medicaid |
$3,751.61
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,436.71
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,949.48
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,447.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$10,848.88
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP DNSP |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
PR ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Professional
|
Both
|
$2,781.00
|
|
|
Service Code
|
HCPCS 27335
|
| Min. Negotiated Rate |
$500.34 |
| Max. Negotiated Rate |
$1,807.65 |
| Rate for Payer: Aetna Commercial |
$1,022.94
|
| Rate for Payer: Aetna Medicare |
$1,390.50
|
| Rate for Payer: BCBS Complete |
$525.36
|
| Rate for Payer: BCBS Trust/PPO |
$901.28
|
| Rate for Payer: BCN Commercial |
$1,127.38
|
| Rate for Payer: Cash Price |
$2,224.80
|
| Rate for Payer: Cash Price |
$2,224.80
|
| Rate for Payer: Meridian Medicaid |
$525.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,185.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,185.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$874.22
|
| Rate for Payer: UHC Exchange |
$874.22
|
| Rate for Payer: UHCCP Medicaid |
$500.34
|
|
|
PR ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Professional
|
Both
|
$2,781.00
|
|
|
Service Code
|
HCPCS 27335
|
| Hospital Charge Code |
27335
|
| Min. Negotiated Rate |
$500.34 |
| Max. Negotiated Rate |
$1,807.65 |
| Rate for Payer: Aetna Commercial |
$1,022.94
|
| Rate for Payer: Aetna Medicare |
$1,390.50
|
| Rate for Payer: BCBS Complete |
$525.36
|
| Rate for Payer: BCBS Trust/PPO |
$901.28
|
| Rate for Payer: BCN Commercial |
$1,127.38
|
| Rate for Payer: Cash Price |
$2,224.80
|
| Rate for Payer: Cash Price |
$2,224.80
|
| Rate for Payer: Meridian Medicaid |
$525.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,185.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,185.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$874.22
|
| Rate for Payer: UHC Exchange |
$874.22
|
| Rate for Payer: UHCCP Medicaid |
$500.34
|
|
|
PR ARTIFICIAL INSEMINATION INTRA-CERVICAL
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 58321
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$121.19 |
| Rate for Payer: Aetna Commercial |
$58.02
|
| Rate for Payer: Aetna Medicare |
$67.00
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: BCBS Trust/PPO |
$80.30
|
| Rate for Payer: BCN Commercial |
$121.19
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.42
|
| Rate for Payer: Priority Health Narrow Network |
$71.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.90
|
| Rate for Payer: UHC Exchange |
$53.90
|
|
|
PR ARTIFICIAL INSEMINATION INTRA-UTERINE
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 58322
|
| Min. Negotiated Rate |
$67.71 |
| Max. Negotiated Rate |
$307.47 |
| Rate for Payer: Aetna Commercial |
$69.05
|
| Rate for Payer: Aetna Medicare |
$122.50
|
| Rate for Payer: BCBS Complete |
$98.00
|
| Rate for Payer: BCBS Trust/PPO |
$307.47
|
| Rate for Payer: BCN Commercial |
$134.38
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.31
|
| Rate for Payer: Priority Health Narrow Network |
$85.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.71
|
| Rate for Payer: UHC Exchange |
$67.71
|
|
|
PR ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX CUTDOWN
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 36625
|
| Min. Negotiated Rate |
$66.03 |
| Max. Negotiated Rate |
$664.07 |
| Rate for Payer: Aetna Commercial |
$142.11
|
| Rate for Payer: Aetna Medicare |
$160.00
|
| Rate for Payer: BCBS Complete |
$69.33
|
| Rate for Payer: BCBS Trust/PPO |
$664.07
|
| Rate for Payer: BCN Commercial |
$151.98
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Meridian Medicaid |
$69.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.86
|
| Rate for Payer: Priority Health Narrow Network |
$164.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.44
|
| Rate for Payer: UHC Exchange |
$138.44
|
| Rate for Payer: UHCCP Medicaid |
$66.03
|
|
|
PR ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 36620
|
| Min. Negotiated Rate |
$27.48 |
| Max. Negotiated Rate |
$962.03 |
| Rate for Payer: Aetna Commercial |
$59.84
|
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: BCBS Complete |
$28.85
|
| Rate for Payer: BCBS Trust/PPO |
$962.03
|
| Rate for Payer: BCN Commercial |
$64.02
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Meridian Medicaid |
$28.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.13
|
| Rate for Payer: Priority Health Narrow Network |
$69.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.48
|
| Rate for Payer: UHC Exchange |
$64.48
|
| Rate for Payer: UHCCP Medicaid |
$27.48
|
|
|
PR ARTL CATHJ PROLNG NFS THER CHEMOTX CUTDOWN
|
Professional
|
Both
|
$558.00
|
|
|
Service Code
|
HCPCS 36640
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$802.49 |
| Rate for Payer: Aetna Commercial |
$154.82
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: BCBS Complete |
$78.06
|
| Rate for Payer: BCBS Trust/PPO |
$802.49
|
| Rate for Payer: BCN Commercial |
$168.11
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Meridian Medicaid |
$78.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.14
|
| Rate for Payer: Priority Health Narrow Network |
$186.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$156.16
|
| Rate for Payer: UHC Exchange |
$156.16
|
| Rate for Payer: UHCCP Medicaid |
$74.34
|
|
|
PR ARVEN ANAST OPN F/ARM VEIN TRPOS
|
Professional
|
Both
|
$1,524.00
|
|
|
Service Code
|
HCPCS 36820
|
| Min. Negotiated Rate |
$457.31 |
| Max. Negotiated Rate |
$1,134.92 |
| Rate for Payer: Aetna Commercial |
$967.99
|
| Rate for Payer: Aetna Medicare |
$762.00
|
| Rate for Payer: BCBS Complete |
$480.18
|
| Rate for Payer: BCBS Trust/PPO |
$769.73
|
| Rate for Payer: BCN Commercial |
$1,035.02
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Meridian Medicaid |
$480.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$457.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,134.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,134.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,051.78
|
| Rate for Payer: UHC Exchange |
$1,051.78
|
| Rate for Payer: UHCCP Medicaid |
$457.31
|
|
|
PR ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS
|
Professional
|
Both
|
$2,435.00
|
|
|
Service Code
|
HCPCS 36819
|
| Min. Negotiated Rate |
$156.91 |
| Max. Negotiated Rate |
$1,582.75 |
| Rate for Payer: Aetna Commercial |
$981.67
|
| Rate for Payer: Aetna Medicare |
$1,217.50
|
| Rate for Payer: BCBS Complete |
$479.28
|
| Rate for Payer: BCBS Trust/PPO |
$156.91
|
| Rate for Payer: BCN Commercial |
$1,044.31
|
| Rate for Payer: Cash Price |
$1,948.00
|
| Rate for Payer: Cash Price |
$1,948.00
|
| Rate for Payer: Meridian Medicaid |
$479.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$456.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,582.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,140.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,140.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,046.96
|
| Rate for Payer: UHC Exchange |
$1,046.96
|
| Rate for Payer: UHCCP Medicaid |
$456.46
|
|
|
PR ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS
|
Professional
|
Both
|
$2,009.00
|
|
|
Service Code
|
HCPCS 36818
|
| Min. Negotiated Rate |
$431.75 |
| Max. Negotiated Rate |
$1,305.85 |
| Rate for Payer: Aetna Commercial |
$926.10
|
| Rate for Payer: Aetna Medicare |
$1,004.50
|
| Rate for Payer: BCBS Complete |
$453.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,179.17
|
| Rate for Payer: BCN Commercial |
$986.64
|
| Rate for Payer: Cash Price |
$1,607.20
|
| Rate for Payer: Cash Price |
$1,607.20
|
| Rate for Payer: Meridian Medicaid |
$453.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,077.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,077.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$877.70
|
| Rate for Payer: UHC Exchange |
$877.70
|
| Rate for Payer: UHCCP Medicaid |
$431.75
|
|
|
PR ARYSM VASC MALFRMJ/CRTD-OCCLUSION CRTD ART
|
Professional
|
Both
|
$8,427.00
|
|
|
Service Code
|
HCPCS 61705
|
| Min. Negotiated Rate |
$404.15 |
| Max. Negotiated Rate |
$5,477.55 |
| Rate for Payer: Aetna Commercial |
$3,364.49
|
| Rate for Payer: Aetna Medicare |
$4,213.50
|
| Rate for Payer: BCBS Complete |
$1,775.33
|
| Rate for Payer: BCBS Trust/PPO |
$404.15
|
| Rate for Payer: BCN Commercial |
$3,832.21
|
| Rate for Payer: Cash Price |
$6,741.60
|
| Rate for Payer: Cash Price |
$6,741.60
|
| Rate for Payer: Meridian Medicaid |
$1,775.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,690.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,477.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,495.12
|
| Rate for Payer: Priority Health Narrow Network |
$4,495.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,004.27
|
| Rate for Payer: UHC Exchange |
$3,004.27
|
| Rate for Payer: UHCCP Medicaid |
$1,690.79
|
|
|
PR ARYTENOIDECTOMY/ARYTENOIDOPEXY XTRNL APPROACH
|
Professional
|
Both
|
$2,087.00
|
|
|
Service Code
|
HCPCS 31400
|
| Min. Negotiated Rate |
$652.21 |
| Max. Negotiated Rate |
$1,845.88 |
| Rate for Payer: Aetna Commercial |
$1,275.34
|
| Rate for Payer: Aetna Medicare |
$1,043.50
|
| Rate for Payer: BCBS Complete |
$684.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,845.88
|
| Rate for Payer: BCN Commercial |
$1,491.93
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Meridian Medicaid |
$684.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$652.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,356.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,413.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,413.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,091.88
|
| Rate for Payer: UHC Exchange |
$1,091.88
|
| Rate for Payer: UHCCP Medicaid |
$652.21
|
|
|
PR AS-AORT GRF W/CARD BYP & AORTIC ROOT RPLCMT
|
Professional
|
Both
|
$6,622.00
|
|
|
Service Code
|
HCPCS 33863
|
| Min. Negotiated Rate |
$745.43 |
| Max. Negotiated Rate |
$4,902.36 |
| Rate for Payer: Aetna Commercial |
$4,233.55
|
| Rate for Payer: Aetna Medicare |
$3,311.00
|
| Rate for Payer: BCBS Complete |
$2,068.09
|
| Rate for Payer: BCBS Trust/PPO |
$745.43
|
| Rate for Payer: BCN Commercial |
$4,494.37
|
| Rate for Payer: Cash Price |
$5,297.60
|
| Rate for Payer: Cash Price |
$5,297.60
|
| Rate for Payer: Meridian Medicaid |
$2,068.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,969.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,304.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,902.36
|
| Rate for Payer: Priority Health Narrow Network |
$4,902.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,157.41
|
| Rate for Payer: UHC Exchange |
$4,157.41
|
| Rate for Payer: UHCCP Medicaid |
$1,969.61
|
|
|
PR AS-AORT GRF W/CARD BYP F/AORTIC DISSECTION
|
Professional
|
Both
|
$7,125.00
|
|
|
Service Code
|
HCPCS 33858
|
| Min. Negotiated Rate |
$313.81 |
| Max. Negotiated Rate |
$5,288.99 |
| Rate for Payer: Aetna Commercial |
$4,563.31
|
| Rate for Payer: Aetna Medicare |
$3,562.50
|
| Rate for Payer: BCBS Complete |
$2,231.81
|
| Rate for Payer: BCBS Trust/PPO |
$313.81
|
| Rate for Payer: BCN Commercial |
$4,851.59
|
| Rate for Payer: Cash Price |
$5,700.00
|
| Rate for Payer: Cash Price |
$5,700.00
|
| Rate for Payer: Meridian Medicaid |
$2,231.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,125.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,631.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,288.99
|
| Rate for Payer: Priority Health Narrow Network |
$5,288.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,561.03
|
| Rate for Payer: UHC Exchange |
$4,561.03
|
| Rate for Payer: UHCCP Medicaid |
$2,125.53
|
|
|
PR AS-AORT GRF W/CARD BYP F/AORTIC DS OTH/THN DSJ
|
Professional
|
Both
|
$5,111.00
|
|
|
Service Code
|
HCPCS 33859
|
| Min. Negotiated Rate |
$1,128.45 |
| Max. Negotiated Rate |
$3,802.01 |
| Rate for Payer: Aetna Commercial |
$3,277.53
|
| Rate for Payer: Aetna Medicare |
$2,555.50
|
| Rate for Payer: BCBS Complete |
$1,604.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,128.45
|
| Rate for Payer: BCN Commercial |
$3,484.76
|
| Rate for Payer: Cash Price |
$4,088.80
|
| Rate for Payer: Cash Price |
$4,088.80
|
| Rate for Payer: Meridian Medicaid |
$1,604.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,528.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,322.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,802.01
|
| Rate for Payer: Priority Health Narrow Network |
$3,802.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,272.85
|
| Rate for Payer: UHC Exchange |
$3,272.85
|
| Rate for Payer: UHCCP Medicaid |
$1,528.28
|
|
|
PR ASCEND AORTA GRAFT INCL VAVLE SUSPENSION
|
Professional
|
Both
|
$10,055.00
|
|
|
Service Code
|
HCPCS 33860
|
| Min. Negotiated Rate |
$4,022.00 |
| Max. Negotiated Rate |
$6,535.75 |
| Rate for Payer: Aetna Medicare |
$5,027.50
|
| Rate for Payer: BCBS Complete |
$4,022.00
|
| Rate for Payer: Cash Price |
$8,044.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,535.75
|
|
|
PR ASCENDING AORTA GRF VALVE SPARE ROOT REMODEL
|
Professional
|
Both
|
$5,228.00
|
|
|
Service Code
|
HCPCS 33864
|
| Min. Negotiated Rate |
$1,166.49 |
| Max. Negotiated Rate |
$5,006.60 |
| Rate for Payer: Aetna Commercial |
$4,324.43
|
| Rate for Payer: Aetna Medicare |
$2,614.00
|
| Rate for Payer: BCBS Complete |
$2,113.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,166.49
|
| Rate for Payer: BCN Commercial |
$4,594.06
|
| Rate for Payer: Cash Price |
$4,182.40
|
| Rate for Payer: Cash Price |
$4,182.40
|
| Rate for Payer: Meridian Medicaid |
$2,113.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,013.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,398.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,006.60
|
| Rate for Payer: Priority Health Narrow Network |
$5,006.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,265.31
|
| Rate for Payer: UHC Exchange |
$4,265.31
|
| Rate for Payer: UHCCP Medicaid |
$2,013.28
|
|
|
PR ASPIRATION AND/OR INJECTION THYROID CYST
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 60300
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$3,338.86 |
| Rate for Payer: Aetna Commercial |
$63.32
|
| Rate for Payer: Aetna Medicare |
$81.00
|
| Rate for Payer: BCBS Complete |
$32.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,338.86
|
| Rate for Payer: BCN Commercial |
$157.35
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Meridian Medicaid |
$32.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.00
|
| Rate for Payer: Priority Health Narrow Network |
$77.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.27
|
| Rate for Payer: UHC Exchange |
$58.27
|
| Rate for Payer: UHCCP Medicaid |
$30.67
|
|
