|
PR INSERT GASTROSTOMY TUBE PERCUTANEOUS
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 49440
|
| Min. Negotiated Rate |
$126.31 |
| Max. Negotiated Rate |
$1,231.95 |
| Rate for Payer: Aetna Commercial |
$265.09
|
| Rate for Payer: Aetna Medicare |
$197.83
|
| Rate for Payer: BCBS Complete |
$132.63
|
| Rate for Payer: BCBS MAPPO |
$197.83
|
| Rate for Payer: BCBS Trust/PPO |
$583.24
|
| Rate for Payer: BCN Commercial |
$1,231.95
|
| Rate for Payer: BCN Medicare Advantage |
$197.83
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$265.09
|
| Rate for Payer: Cofinity Commercial |
$284.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.83
|
| Rate for Payer: Healthscope Commercial |
$237.40
|
| Rate for Payer: Healthscope Whirlpool |
$237.40
|
| Rate for Payer: Meridian Medicaid |
$132.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$207.72
|
| Rate for Payer: PACE SWMI |
$197.83
|
| Rate for Payer: PHP Medicare Advantage |
$197.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$349.85
|
| Rate for Payer: Priority Health Medicare |
$197.83
|
| Rate for Payer: Priority Health Narrow Network |
$349.85
|
| Rate for Payer: UHC Medicare Advantage |
$203.76
|
|
|
PR INSERTION BREAST IMPLANT SAME DAY OF MASTECTOMY
|
Professional
|
Both
|
$1,680.00
|
|
|
Service Code
|
HCPCS 19340
|
| Min. Negotiated Rate |
$487.13 |
| Max. Negotiated Rate |
$1,176.00 |
| Rate for Payer: Aetna Commercial |
$998.86
|
| Rate for Payer: Aetna Medicare |
$745.42
|
| Rate for Payer: BCBS Complete |
$511.49
|
| Rate for Payer: BCBS MAPPO |
$745.42
|
| Rate for Payer: BCBS Trust/PPO |
$562.50
|
| Rate for Payer: BCN Commercial |
$1,112.23
|
| Rate for Payer: BCN Medicare Advantage |
$745.42
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cofinity Commercial |
$998.86
|
| Rate for Payer: Cofinity Commercial |
$1,073.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$745.42
|
| Rate for Payer: Healthscope Commercial |
$894.50
|
| Rate for Payer: Healthscope Whirlpool |
$894.50
|
| Rate for Payer: Meridian Medicaid |
$511.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$782.69
|
| Rate for Payer: PACE SWMI |
$745.42
|
| Rate for Payer: PHP Medicare Advantage |
$745.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$487.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,176.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$935.52
|
| Rate for Payer: Priority Health Medicare |
$745.42
|
| Rate for Payer: Priority Health Narrow Network |
$935.52
|
| Rate for Payer: UHC Medicare Advantage |
$767.78
|
|
|
PR INSERTION CERVICAL DILATOR SEPARATE PROCEDURE
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 59200
|
| Min. Negotiated Rate |
$44.36 |
| Max. Negotiated Rate |
$155.89 |
| Rate for Payer: Aetna Commercial |
$59.44
|
| Rate for Payer: Aetna Medicare |
$44.36
|
| Rate for Payer: BCBS Complete |
$62.00
|
| Rate for Payer: BCBS MAPPO |
$44.36
|
| Rate for Payer: BCBS Trust/PPO |
$90.87
|
| Rate for Payer: BCN Commercial |
$155.89
|
| Rate for Payer: BCN Medicare Advantage |
$44.36
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$63.88
|
| Rate for Payer: Cofinity Commercial |
$59.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.36
|
| Rate for Payer: Healthscope Commercial |
$53.23
|
| Rate for Payer: Healthscope Whirlpool |
$53.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.58
|
| Rate for Payer: PACE SWMI |
$44.36
|
| Rate for Payer: PHP Medicare Advantage |
$44.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.33
|
| Rate for Payer: Priority Health Medicare |
$44.36
|
| Rate for Payer: Priority Health Narrow Network |
$62.33
|
| Rate for Payer: UHC Medicare Advantage |
$45.69
|
|
|
PR INSERTION DRUG DELIVERY IMPLANT
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 11981
|
| Min. Negotiated Rate |
$39.83 |
| Max. Negotiated Rate |
$977.96 |
| Rate for Payer: Aetna Commercial |
$83.05
|
| Rate for Payer: Aetna Medicare |
$61.98
|
| Rate for Payer: BCBS Complete |
$41.82
|
| Rate for Payer: BCBS MAPPO |
$61.98
|
| Rate for Payer: BCBS Trust/PPO |
$977.96
|
| Rate for Payer: BCN Commercial |
$147.09
|
| Rate for Payer: BCN Medicare Advantage |
$61.98
|
| Rate for Payer: Cash Price |
$178.40
|
| Rate for Payer: Cash Price |
$178.40
|
| Rate for Payer: Cofinity Commercial |
$89.25
|
| Rate for Payer: Cofinity Commercial |
$83.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$74.38
|
| Rate for Payer: Healthscope Whirlpool |
$74.38
|
| Rate for Payer: Meridian Medicaid |
$41.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.08
|
| Rate for Payer: PACE SWMI |
$61.98
|
| Rate for Payer: PHP Medicare Advantage |
$61.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.45
|
| Rate for Payer: Priority Health Medicare |
$61.98
|
| Rate for Payer: Priority Health Narrow Network |
$76.45
|
| Rate for Payer: UHC Medicare Advantage |
$63.84
|
|
|
PR INSERTION EPICARDIAL ELECTRODE OPEN
|
Professional
|
Both
|
$2,325.00
|
|
|
Service Code
|
HCPCS 33202
|
| Min. Negotiated Rate |
$485.85 |
| Max. Negotiated Rate |
$1,627.50 |
| Rate for Payer: Aetna Commercial |
$1,016.36
|
| Rate for Payer: Aetna Medicare |
$758.48
|
| Rate for Payer: BCBS Complete |
$510.14
|
| Rate for Payer: BCBS MAPPO |
$758.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,263.69
|
| Rate for Payer: BCN Commercial |
$1,110.28
|
| Rate for Payer: BCN Medicare Advantage |
$758.48
|
| Rate for Payer: Cash Price |
$1,860.00
|
| Rate for Payer: Cash Price |
$1,860.00
|
| Rate for Payer: Cofinity Commercial |
$1,092.21
|
| Rate for Payer: Cofinity Commercial |
$1,016.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$758.48
|
| Rate for Payer: Healthscope Commercial |
$910.18
|
| Rate for Payer: Healthscope Whirlpool |
$910.18
|
| Rate for Payer: Meridian Medicaid |
$510.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$796.40
|
| Rate for Payer: PACE SWMI |
$758.48
|
| Rate for Payer: PHP Medicare Advantage |
$758.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$485.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,627.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,208.61
|
| Rate for Payer: Priority Health Medicare |
$758.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,208.61
|
| Rate for Payer: UHC Medicare Advantage |
$781.23
|
|
|
PR INSERTION FLOW DIRECTED CATHETER FOR MONITORING
|
Professional
|
Both
|
$836.00
|
|
|
Service Code
|
HCPCS 93503
|
| Min. Negotiated Rate |
$54.74 |
| Max. Negotiated Rate |
$585.20 |
| Rate for Payer: Aetna Commercial |
$116.16
|
| Rate for Payer: Aetna Medicare |
$86.69
|
| Rate for Payer: BCBS Complete |
$57.48
|
| Rate for Payer: BCBS MAPPO |
$86.69
|
| Rate for Payer: BCBS Trust/PPO |
$456.45
|
| Rate for Payer: BCN Commercial |
$126.08
|
| Rate for Payer: BCN Medicare Advantage |
$86.69
|
| Rate for Payer: Cash Price |
$668.80
|
| Rate for Payer: Cash Price |
$668.80
|
| Rate for Payer: Cofinity Commercial |
$124.83
|
| Rate for Payer: Cofinity Commercial |
$116.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.69
|
| Rate for Payer: Healthscope Commercial |
$104.03
|
| Rate for Payer: Healthscope Whirlpool |
$104.03
|
| Rate for Payer: Meridian Medicaid |
$57.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$91.02
|
| Rate for Payer: PACE SWMI |
$86.69
|
| Rate for Payer: PHP Medicare Advantage |
$86.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.00
|
| Rate for Payer: Priority Health Medicare |
$86.69
|
| Rate for Payer: Priority Health Narrow Network |
$122.00
|
| Rate for Payer: UHC Medicare Advantage |
$89.29
|
|
|
PR INSERTION INDWELLING TUNNELED PLEURAL CATHETER
|
Professional
|
Both
|
$1,912.00
|
|
|
Service Code
|
HCPCS 32550
|
| Min. Negotiated Rate |
$127.80 |
| Max. Negotiated Rate |
$1,338.40 |
| Rate for Payer: Aetna Commercial |
$268.09
|
| Rate for Payer: Aetna Medicare |
$200.07
|
| Rate for Payer: BCBS Complete |
$134.19
|
| Rate for Payer: BCBS MAPPO |
$200.07
|
| Rate for Payer: BCBS Trust/PPO |
$421.58
|
| Rate for Payer: BCN Commercial |
$1,161.10
|
| Rate for Payer: BCN Medicare Advantage |
$200.07
|
| Rate for Payer: Cash Price |
$1,529.60
|
| Rate for Payer: Cash Price |
$1,529.60
|
| Rate for Payer: Cofinity Commercial |
$288.10
|
| Rate for Payer: Cofinity Commercial |
$268.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.07
|
| Rate for Payer: Healthscope Commercial |
$240.08
|
| Rate for Payer: Healthscope Whirlpool |
$240.08
|
| Rate for Payer: Meridian Medicaid |
$134.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$210.07
|
| Rate for Payer: PACE SWMI |
$200.07
|
| Rate for Payer: PHP Medicare Advantage |
$200.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,338.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.82
|
| Rate for Payer: Priority Health Medicare |
$200.07
|
| Rate for Payer: Priority Health Narrow Network |
$277.82
|
| Rate for Payer: UHC Medicare Advantage |
$206.07
|
|
|
PR INSERTION INTRA-AORTIC BALLOON ASSIST DEV PERQ
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
HCPCS 33967
|
| Min. Negotiated Rate |
$161.24 |
| Max. Negotiated Rate |
$815.17 |
| Rate for Payer: Aetna Commercial |
$338.99
|
| Rate for Payer: Aetna Medicare |
$252.98
|
| Rate for Payer: BCBS Complete |
$169.30
|
| Rate for Payer: BCBS MAPPO |
$252.98
|
| Rate for Payer: BCBS Trust/PPO |
$815.17
|
| Rate for Payer: BCN Commercial |
$367.97
|
| Rate for Payer: BCN Medicare Advantage |
$252.98
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cofinity Commercial |
$338.99
|
| Rate for Payer: Cofinity Commercial |
$364.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$252.98
|
| Rate for Payer: Healthscope Commercial |
$303.58
|
| Rate for Payer: Healthscope Whirlpool |
$303.58
|
| Rate for Payer: Meridian Medicaid |
$169.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$265.63
|
| Rate for Payer: PACE SWMI |
$252.98
|
| Rate for Payer: PHP Medicare Advantage |
$252.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$400.56
|
| Rate for Payer: Priority Health Medicare |
$252.98
|
| Rate for Payer: Priority Health Narrow Network |
$400.56
|
| Rate for Payer: UHC Medicare Advantage |
$260.57
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
58300
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$417.36 |
| Rate for Payer: Aetna Commercial |
$60.86
|
| Rate for Payer: BCBS Complete |
$33.55
|
| Rate for Payer: BCBS Trust/PPO |
$417.36
|
| Rate for Payer: BCN Commercial |
$130.36
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Meridian Medicaid |
$33.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.01
|
| Rate for Payer: Priority Health Narrow Network |
$71.01
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
58300
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: ASR ASR |
$281.30
|
| Rate for Payer: BCBS Complete |
$116.00
|
| Rate for Payer: BCBS Trust/PPO |
$224.84
|
| Rate for Payer: BCN Commercial |
$224.84
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$272.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.00
|
| Rate for Payer: Healthscope Commercial |
$290.00
|
| Rate for Payer: Healthscope Whirlpool |
$281.30
|
| Rate for Payer: Mclaren Commercial |
$261.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.90
|
| Rate for Payer: Priority Health Narrow Network |
$205.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.20
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 58300
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$417.36 |
| Rate for Payer: Aetna Commercial |
$60.86
|
| Rate for Payer: BCBS Complete |
$33.55
|
| Rate for Payer: BCBS Trust/PPO |
$417.36
|
| Rate for Payer: BCN Commercial |
$130.36
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Meridian Medicaid |
$33.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.01
|
| Rate for Payer: Priority Health Narrow Network |
$71.01
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
58300
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: ASR ASR |
$281.30
|
| Rate for Payer: BCBS Trust/PPO |
$224.84
|
| Rate for Payer: BCN Commercial |
$224.84
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$272.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.00
|
| Rate for Payer: Healthscope Commercial |
$290.00
|
| Rate for Payer: Healthscope Whirlpool |
$281.30
|
| Rate for Payer: Mclaren Commercial |
$261.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.20
|
|
|
PR INSERTION PICC W/O IMG GDN < 5 YR
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 36568
|
| Min. Negotiated Rate |
$57.51 |
| Max. Negotiated Rate |
$967.32 |
| Rate for Payer: Aetna Commercial |
$122.50
|
| Rate for Payer: Aetna Medicare |
$91.42
|
| Rate for Payer: BCBS Complete |
$60.39
|
| Rate for Payer: BCBS MAPPO |
$91.42
|
| Rate for Payer: BCBS Trust/PPO |
$967.32
|
| Rate for Payer: BCN Commercial |
$132.43
|
| Rate for Payer: BCN Medicare Advantage |
$91.42
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$131.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.42
|
| Rate for Payer: Healthscope Commercial |
$109.70
|
| Rate for Payer: Healthscope Whirlpool |
$109.70
|
| Rate for Payer: Meridian Medicaid |
$60.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$95.99
|
| Rate for Payer: PACE SWMI |
$91.42
|
| Rate for Payer: PHP Medicare Advantage |
$91.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.15
|
| Rate for Payer: Priority Health Medicare |
$91.42
|
| Rate for Payer: Priority Health Narrow Network |
$144.15
|
| Rate for Payer: UHC Medicare Advantage |
$94.16
|
|
|
PR INSERTION PICC W/O IMG GDN 5 YR/>
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 36569
|
| Min. Negotiated Rate |
$59.43 |
| Max. Negotiated Rate |
$563.70 |
| Rate for Payer: Aetna Commercial |
$123.39
|
| Rate for Payer: Aetna Medicare |
$92.08
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS MAPPO |
$92.08
|
| Rate for Payer: BCBS Trust/PPO |
$563.70
|
| Rate for Payer: BCN Commercial |
$134.38
|
| Rate for Payer: BCN Medicare Advantage |
$92.08
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cofinity Commercial |
$132.60
|
| Rate for Payer: Cofinity Commercial |
$123.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.08
|
| Rate for Payer: Healthscope Commercial |
$110.50
|
| Rate for Payer: Healthscope Whirlpool |
$110.50
|
| Rate for Payer: Meridian Medicaid |
$62.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$96.68
|
| Rate for Payer: PACE SWMI |
$92.08
|
| Rate for Payer: PHP Medicare Advantage |
$92.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.29
|
| Rate for Payer: Priority Health Medicare |
$92.08
|
| Rate for Payer: Priority Health Narrow Network |
$146.29
|
| Rate for Payer: UHC Medicare Advantage |
$94.84
|
|
|
PR INSERTION PICC W/RS&I < 5 YR
|
Professional
|
Both
|
$827.00
|
|
|
Service Code
|
HCPCS 36572
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$1,072.45 |
| Rate for Payer: Aetna Commercial |
$107.45
|
| Rate for Payer: Aetna Medicare |
$80.19
|
| Rate for Payer: BCBS Complete |
$53.22
|
| Rate for Payer: BCBS MAPPO |
$80.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,072.45
|
| Rate for Payer: BCN Commercial |
$552.21
|
| Rate for Payer: BCN Medicare Advantage |
$80.19
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Cofinity Commercial |
$115.47
|
| Rate for Payer: Cofinity Commercial |
$107.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.19
|
| Rate for Payer: Healthscope Commercial |
$96.23
|
| Rate for Payer: Healthscope Whirlpool |
$96.23
|
| Rate for Payer: Meridian Medicaid |
$53.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.20
|
| Rate for Payer: PACE SWMI |
$80.19
|
| Rate for Payer: PHP Medicare Advantage |
$80.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.60
|
| Rate for Payer: Priority Health Medicare |
$80.19
|
| Rate for Payer: Priority Health Narrow Network |
$126.60
|
| Rate for Payer: UHC Medicare Advantage |
$82.60
|
|
|
PR INSERTION PICC W/RS&I 5 YR/>
|
Professional
|
Both
|
$761.00
|
|
|
Service Code
|
HCPCS 36573
|
| Min. Negotiated Rate |
$51.97 |
| Max. Negotiated Rate |
$921.36 |
| Rate for Payer: Aetna Commercial |
$110.40
|
| Rate for Payer: Aetna Medicare |
$82.39
|
| Rate for Payer: BCBS Complete |
$54.57
|
| Rate for Payer: BCBS MAPPO |
$82.39
|
| Rate for Payer: BCBS Trust/PPO |
$921.36
|
| Rate for Payer: BCN Commercial |
$565.89
|
| Rate for Payer: BCN Medicare Advantage |
$82.39
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Cofinity Commercial |
$118.64
|
| Rate for Payer: Cofinity Commercial |
$110.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.39
|
| Rate for Payer: Healthscope Commercial |
$98.87
|
| Rate for Payer: Healthscope Whirlpool |
$98.87
|
| Rate for Payer: Meridian Medicaid |
$54.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$86.51
|
| Rate for Payer: PACE SWMI |
$82.39
|
| Rate for Payer: PHP Medicare Advantage |
$82.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.39
|
| Rate for Payer: Priority Health Medicare |
$82.39
|
| Rate for Payer: Priority Health Narrow Network |
$131.39
|
| Rate for Payer: UHC Medicare Advantage |
$84.86
|
|
|
PR INSERTION/RPLCMT PERIPHERAL/GASTRIC NPGR
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 64590
|
| Min. Negotiated Rate |
$157.22 |
| Max. Negotiated Rate |
$1,604.98 |
| Rate for Payer: Aetna Commercial |
$210.67
|
| Rate for Payer: Aetna Medicare |
$157.22
|
| Rate for Payer: BCBS Complete |
$197.48
|
| Rate for Payer: BCBS MAPPO |
$157.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,604.98
|
| Rate for Payer: BCN Commercial |
$384.59
|
| Rate for Payer: BCN Medicare Advantage |
$157.22
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cofinity Commercial |
$210.67
|
| Rate for Payer: Cofinity Commercial |
$226.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.22
|
| Rate for Payer: Healthscope Commercial |
$188.66
|
| Rate for Payer: Healthscope Whirlpool |
$188.66
|
| Rate for Payer: Meridian Medicaid |
$197.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$165.08
|
| Rate for Payer: PACE SWMI |
$157.22
|
| Rate for Payer: PHP Medicare Advantage |
$157.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$682.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.22
|
| Rate for Payer: Priority Health Medicare |
$157.22
|
| Rate for Payer: Priority Health Narrow Network |
$271.22
|
| Rate for Payer: UHC Medicare Advantage |
$161.94
|
|
|
PR INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 33285
|
| Min. Negotiated Rate |
$54.74 |
| Max. Negotiated Rate |
$6,374.79 |
| Rate for Payer: Aetna Commercial |
$115.95
|
| Rate for Payer: Aetna Medicare |
$86.53
|
| Rate for Payer: BCBS Complete |
$57.48
|
| Rate for Payer: BCBS MAPPO |
$86.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,495.09
|
| Rate for Payer: BCN Commercial |
$6,374.79
|
| Rate for Payer: BCN Medicare Advantage |
$86.53
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cofinity Commercial |
$124.60
|
| Rate for Payer: Cofinity Commercial |
$115.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.53
|
| Rate for Payer: Healthscope Commercial |
$103.84
|
| Rate for Payer: Healthscope Whirlpool |
$103.84
|
| Rate for Payer: Meridian Medicaid |
$57.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$90.86
|
| Rate for Payer: PACE SWMI |
$86.53
|
| Rate for Payer: PHP Medicare Advantage |
$86.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.78
|
| Rate for Payer: Priority Health Medicare |
$86.53
|
| Rate for Payer: Priority Health Narrow Network |
$137.78
|
| Rate for Payer: UHC Medicare Advantage |
$89.13
|
|
|
PR INSERTION TANDEM CUFF
|
Professional
|
Both
|
$1,487.00
|
|
|
Service Code
|
HCPCS 53444
|
| Min. Negotiated Rate |
$504.60 |
| Max. Negotiated Rate |
$2,999.16 |
| Rate for Payer: Aetna Commercial |
$1,037.44
|
| Rate for Payer: Aetna Medicare |
$774.21
|
| Rate for Payer: BCBS Complete |
$529.83
|
| Rate for Payer: BCBS MAPPO |
$774.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,999.16
|
| Rate for Payer: BCN Commercial |
$1,143.01
|
| Rate for Payer: BCN Medicare Advantage |
$774.21
|
| Rate for Payer: Cash Price |
$1,189.60
|
| Rate for Payer: Cash Price |
$1,189.60
|
| Rate for Payer: Cofinity Commercial |
$1,037.44
|
| Rate for Payer: Cofinity Commercial |
$1,114.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.21
|
| Rate for Payer: Healthscope Commercial |
$929.05
|
| Rate for Payer: Healthscope Whirlpool |
$929.05
|
| Rate for Payer: Meridian Medicaid |
$529.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$812.92
|
| Rate for Payer: PACE SWMI |
$774.21
|
| Rate for Payer: PHP Medicare Advantage |
$774.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$504.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,040.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,263.89
|
| Rate for Payer: Priority Health Medicare |
$774.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,263.89
|
| Rate for Payer: UHC Medicare Advantage |
$797.44
|
|
|
PR INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN
|
Professional
|
Both
|
$1,282.00
|
|
|
Service Code
|
HCPCS 49421
|
| Min. Negotiated Rate |
$143.35 |
| Max. Negotiated Rate |
$2,980.67 |
| Rate for Payer: Aetna Commercial |
$301.51
|
| Rate for Payer: Aetna Medicare |
$225.01
|
| Rate for Payer: BCBS Complete |
$150.52
|
| Rate for Payer: BCBS MAPPO |
$225.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,980.67
|
| Rate for Payer: BCN Commercial |
$327.41
|
| Rate for Payer: BCN Medicare Advantage |
$225.01
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Cofinity Commercial |
$324.01
|
| Rate for Payer: Cofinity Commercial |
$301.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.01
|
| Rate for Payer: Healthscope Commercial |
$270.01
|
| Rate for Payer: Healthscope Whirlpool |
$270.01
|
| Rate for Payer: Meridian Medicaid |
$150.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$236.26
|
| Rate for Payer: PACE SWMI |
$225.01
|
| Rate for Payer: PHP Medicare Advantage |
$225.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$393.93
|
| Rate for Payer: Priority Health Medicare |
$225.01
|
| Rate for Payer: Priority Health Narrow Network |
$393.93
|
| Rate for Payer: UHC Medicare Advantage |
$231.76
|
|
|
PR INSERTION VAGINAL RADIATION DEVICE
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 57156
|
| Min. Negotiated Rate |
$96.28 |
| Max. Negotiated Rate |
$2,560.67 |
| Rate for Payer: Aetna Commercial |
$199.08
|
| Rate for Payer: Aetna Medicare |
$148.57
|
| Rate for Payer: BCBS Complete |
$101.09
|
| Rate for Payer: BCBS MAPPO |
$148.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,560.67
|
| Rate for Payer: BCN Commercial |
$335.23
|
| Rate for Payer: BCN Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$199.08
|
| Rate for Payer: Cofinity Commercial |
$213.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.57
|
| Rate for Payer: Healthscope Commercial |
$178.28
|
| Rate for Payer: Healthscope Whirlpool |
$178.28
|
| Rate for Payer: Meridian Medicaid |
$101.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$156.00
|
| Rate for Payer: PACE SWMI |
$148.57
|
| Rate for Payer: PHP Medicare Advantage |
$148.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.51
|
| Rate for Payer: Priority Health Medicare |
$148.57
|
| Rate for Payer: Priority Health Narrow Network |
$213.51
|
| Rate for Payer: UHC Medicare Advantage |
$153.03
|
|
|
PR INSERTION VASCULAR PEDICLE CARPAL BONE
|
Professional
|
Both
|
$1,211.00
|
|
|
Service Code
|
HCPCS 25430
|
| Min. Negotiated Rate |
$264.89 |
| Max. Negotiated Rate |
$1,128.54 |
| Rate for Payer: Aetna Commercial |
$968.15
|
| Rate for Payer: Aetna Medicare |
$722.50
|
| Rate for Payer: BCBS Complete |
$499.19
|
| Rate for Payer: BCBS MAPPO |
$722.50
|
| Rate for Payer: BCBS Trust/PPO |
$264.89
|
| Rate for Payer: BCN Commercial |
$1,079.97
|
| Rate for Payer: BCN Medicare Advantage |
$722.50
|
| Rate for Payer: Cash Price |
$968.80
|
| Rate for Payer: Cash Price |
$968.80
|
| Rate for Payer: Cofinity Commercial |
$968.15
|
| Rate for Payer: Cofinity Commercial |
$1,040.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.50
|
| Rate for Payer: Healthscope Commercial |
$867.00
|
| Rate for Payer: Healthscope Whirlpool |
$867.00
|
| Rate for Payer: Meridian Medicaid |
$499.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$758.62
|
| Rate for Payer: PACE SWMI |
$722.50
|
| Rate for Payer: PHP Medicare Advantage |
$722.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$475.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$847.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,128.54
|
| Rate for Payer: Priority Health Medicare |
$722.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,128.54
|
| Rate for Payer: UHC Medicare Advantage |
$744.18
|
|
|
PR INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
HCPCS 20650
|
| Min. Negotiated Rate |
$63.44 |
| Max. Negotiated Rate |
$332.30 |
| Rate for Payer: Aetna Commercial |
$214.53
|
| Rate for Payer: Aetna Medicare |
$160.10
|
| Rate for Payer: BCBS Complete |
$113.17
|
| Rate for Payer: BCBS MAPPO |
$160.10
|
| Rate for Payer: BCBS Trust/PPO |
$63.44
|
| Rate for Payer: BCN Commercial |
$332.30
|
| Rate for Payer: BCN Medicare Advantage |
$160.10
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cofinity Commercial |
$214.53
|
| Rate for Payer: Cofinity Commercial |
$230.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.10
|
| Rate for Payer: Healthscope Commercial |
$192.12
|
| Rate for Payer: Healthscope Whirlpool |
$192.12
|
| Rate for Payer: Meridian Medicaid |
$113.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$168.10
|
| Rate for Payer: PACE SWMI |
$160.10
|
| Rate for Payer: PHP Medicare Advantage |
$160.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$250.22
|
| Rate for Payer: Priority Health Medicare |
$160.10
|
| Rate for Payer: Priority Health Narrow Network |
$250.22
|
| Rate for Payer: UHC Medicare Advantage |
$164.90
|
|
|
PR INSERT POST SPINOUS PROCESS DISTRACTION DEVICE, LUMBAR, EA ADD
|
Professional
|
Both
|
$519.00
|
|
|
Service Code
|
HCPCS 0172T
|
| Min. Negotiated Rate |
$207.60 |
| Max. Negotiated Rate |
$363.30 |
| Rate for Payer: BCBS Complete |
$207.60
|
| Rate for Payer: Cash Price |
$415.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$363.30
|
|
|
PR INSERT POST SPINOUS PROCESS DISTRACTION DEVICE, LUMBAR, SINGLE
|
Professional
|
Both
|
$2,680.00
|
|
|
Service Code
|
HCPCS 0171T
|
| Min. Negotiated Rate |
$1,072.00 |
| Max. Negotiated Rate |
$1,876.00 |
| Rate for Payer: BCBS Complete |
$1,072.00
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,876.00
|
|
