|
PR BX/EXC LYMPH NODE OPEN INT MAMMARY NODE
|
Professional
|
Both
|
$1,701.00
|
|
|
Service Code
|
HCPCS 38530
|
| Min. Negotiated Rate |
$368.70 |
| Max. Negotiated Rate |
$1,136.44 |
| Rate for Payer: Aetna Commercial |
$697.32
|
| Rate for Payer: Aetna Medicare |
$850.50
|
| Rate for Payer: BCBS Complete |
$387.14
|
| Rate for Payer: BCBS Trust/PPO |
$427.39
|
| Rate for Payer: BCN Commercial |
$825.38
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Meridian Medicaid |
$387.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,136.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,136.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$604.05
|
| Rate for Payer: UHC Exchange |
$604.05
|
| Rate for Payer: UHCCP Medicaid |
$368.70
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Professional
|
Both
|
$947.00
|
|
|
Service Code
|
HCPCS 38500
|
| Min. Negotiated Rate |
$164.65 |
| Max. Negotiated Rate |
$615.55 |
| Rate for Payer: Aetna Commercial |
$316.46
|
| Rate for Payer: Aetna Medicare |
$473.50
|
| Rate for Payer: BCBS Complete |
$172.88
|
| Rate for Payer: BCBS Trust/PPO |
$512.45
|
| Rate for Payer: BCN Commercial |
$495.52
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Meridian Medicaid |
$172.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$615.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$512.62
|
| Rate for Payer: Priority Health Narrow Network |
$512.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.85
|
| Rate for Payer: UHC Exchange |
$277.85
|
| Rate for Payer: UHCCP Medicaid |
$164.65
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Facility
|
IP
|
$947.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
38500
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$615.55 |
| Max. Negotiated Rate |
$947.00 |
| Rate for Payer: Aetna Commercial |
$852.30
|
| Rate for Payer: ASR ASR |
$918.59
|
| Rate for Payer: ASR Commercial |
$918.59
|
| Rate for Payer: BCBS Trust/PPO |
$771.71
|
| Rate for Payer: BCN Commercial |
$734.21
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cofinity Commercial |
$890.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$757.60
|
| Rate for Payer: Healthscope Commercial |
$947.00
|
| Rate for Payer: Healthscope Whirlpool |
$918.59
|
| Rate for Payer: Mclaren Commercial |
$852.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.95
|
| Rate for Payer: Nomi Health Commercial |
$776.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$615.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$833.36
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Professional
|
Both
|
$947.00
|
|
|
Service Code
|
HCPCS 38500
|
| Hospital Charge Code |
38500
|
| Min. Negotiated Rate |
$164.65 |
| Max. Negotiated Rate |
$615.55 |
| Rate for Payer: Aetna Commercial |
$316.46
|
| Rate for Payer: Aetna Medicare |
$473.50
|
| Rate for Payer: BCBS Complete |
$172.88
|
| Rate for Payer: BCBS Trust/PPO |
$512.45
|
| Rate for Payer: BCN Commercial |
$495.52
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Meridian Medicaid |
$172.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$615.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$512.62
|
| Rate for Payer: Priority Health Narrow Network |
$512.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.85
|
| Rate for Payer: UHC Exchange |
$277.85
|
| Rate for Payer: UHCCP Medicaid |
$164.65
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Facility
|
OP
|
$947.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
38500
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$615.55 |
| Max. Negotiated Rate |
$5,815.37 |
| Rate for Payer: Aetna Commercial |
$852.30
|
| Rate for Payer: Aetna Medicare |
$3,751.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,689.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,689.81
|
| Rate for Payer: ASR ASR |
$918.59
|
| Rate for Payer: ASR Commercial |
$918.59
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$775.50
|
| Rate for Payer: BCN Commercial |
$734.21
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cofinity Commercial |
$890.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$757.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Healthscope Commercial |
$947.00
|
| Rate for Payer: Healthscope Whirlpool |
$918.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,751.85
|
| Rate for Payer: Mclaren Commercial |
$852.30
|
| Rate for Payer: Mclaren Medicaid |
$2,010.99
|
| Rate for Payer: Mclaren Medicare |
$3,751.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,939.44
|
| Rate for Payer: Meridian Medicaid |
$2,111.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,314.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.95
|
| Rate for Payer: Nomi Health Commercial |
$776.54
|
| Rate for Payer: PACE Medicare |
$3,564.26
|
| Rate for Payer: PACE SWMI |
$3,751.85
|
| Rate for Payer: PHP Commercial |
$4,127.04
|
| Rate for Payer: PHP Medicaid |
$2,010.99
|
| Rate for Payer: PHP Medicare Advantage |
$3,751.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,010.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$615.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,790.33
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$3,032.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$833.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,751.85
|
| Rate for Payer: UHC Exchange |
$5,815.37
|
| Rate for Payer: UHC Medicare Advantage |
$3,751.85
|
| Rate for Payer: UHCCP DNSP |
$3,751.85
|
| Rate for Payer: UHCCP Medicaid |
$2,010.99
|
| Rate for Payer: VA VA |
$3,751.85
|
|
|
PR BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD
|
Professional
|
Both
|
$1,847.00
|
|
|
Service Code
|
HCPCS 38520
|
| Hospital Charge Code |
38520
|
| Min. Negotiated Rate |
$303.53 |
| Max. Negotiated Rate |
$1,200.55 |
| Rate for Payer: Aetna Commercial |
$576.38
|
| Rate for Payer: Aetna Medicare |
$923.50
|
| Rate for Payer: BCBS Complete |
$318.71
|
| Rate for Payer: BCBS Trust/PPO |
$460.15
|
| Rate for Payer: BCN Commercial |
$685.61
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Meridian Medicaid |
$318.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$303.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$939.38
|
| Rate for Payer: Priority Health Narrow Network |
$939.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$515.96
|
| Rate for Payer: UHC Exchange |
$515.96
|
| Rate for Payer: UHCCP Medicaid |
$303.53
|
|
|
PR BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD
|
Professional
|
Both
|
$1,847.00
|
|
|
Service Code
|
HCPCS 38520
|
| Min. Negotiated Rate |
$303.53 |
| Max. Negotiated Rate |
$1,200.55 |
| Rate for Payer: Aetna Commercial |
$576.38
|
| Rate for Payer: Aetna Medicare |
$923.50
|
| Rate for Payer: BCBS Complete |
$318.71
|
| Rate for Payer: BCBS Trust/PPO |
$460.15
|
| Rate for Payer: BCN Commercial |
$685.61
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Meridian Medicaid |
$318.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$303.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$939.38
|
| Rate for Payer: Priority Health Narrow Network |
$939.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$515.96
|
| Rate for Payer: UHC Exchange |
$515.96
|
| Rate for Payer: UHCCP Medicaid |
$303.53
|
|
|
PR BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
CPT 38520
|
| Hospital Charge Code |
38520
|
| Min. Negotiated Rate |
$1,200.55 |
| Max. Negotiated Rate |
$1,847.00 |
| Rate for Payer: Aetna Commercial |
$1,662.30
|
| Rate for Payer: ASR ASR |
$1,791.59
|
| Rate for Payer: ASR Commercial |
$1,791.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,505.12
|
| Rate for Payer: BCN Commercial |
$1,431.98
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cofinity Commercial |
$1,736.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,477.60
|
| Rate for Payer: Healthscope Commercial |
$1,847.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,791.59
|
| Rate for Payer: Mclaren Commercial |
$1,662.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,569.95
|
| Rate for Payer: Nomi Health Commercial |
$1,514.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,625.36
|
|
|
PR BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
CPT 38520
|
| Hospital Charge Code |
38520
|
| Min. Negotiated Rate |
$1,200.55 |
| Max. Negotiated Rate |
$5,815.37 |
| Rate for Payer: Aetna Commercial |
$1,662.30
|
| Rate for Payer: Aetna Medicare |
$3,751.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,689.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,689.81
|
| Rate for Payer: ASR ASR |
$1,791.59
|
| Rate for Payer: ASR Commercial |
$1,791.59
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,512.51
|
| Rate for Payer: BCN Commercial |
$1,431.98
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cofinity Commercial |
$1,736.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,477.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Healthscope Commercial |
$1,847.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,791.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,751.85
|
| Rate for Payer: Mclaren Commercial |
$1,662.30
|
| Rate for Payer: Mclaren Medicaid |
$2,010.99
|
| Rate for Payer: Mclaren Medicare |
$3,751.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,939.44
|
| Rate for Payer: Meridian Medicaid |
$2,111.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,314.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,569.95
|
| Rate for Payer: Nomi Health Commercial |
$1,514.54
|
| Rate for Payer: PACE Medicare |
$3,564.26
|
| Rate for Payer: PACE SWMI |
$3,751.85
|
| Rate for Payer: PHP Commercial |
$4,127.04
|
| Rate for Payer: PHP Medicaid |
$2,010.99
|
| Rate for Payer: PHP Medicare Advantage |
$3,751.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,010.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,618.34
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,294.75
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,625.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,751.85
|
| Rate for Payer: UHC Exchange |
$5,815.37
|
| Rate for Payer: UHC Medicare Advantage |
$3,751.85
|
| Rate for Payer: UHCCP DNSP |
$3,751.85
|
| Rate for Payer: UHCCP Medicaid |
$2,010.99
|
| Rate for Payer: VA VA |
$3,751.85
|
|
|
PR BX INTESTINE CAPSULE TUBE PRORAL 1/> SPECIMENS
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 44100
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$2,539.54 |
| Rate for Payer: Aetna Commercial |
$142.56
|
| Rate for Payer: Aetna Medicare |
$182.50
|
| Rate for Payer: BCBS Complete |
$70.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,539.54
|
| Rate for Payer: BCN Commercial |
$152.96
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Meridian Medicaid |
$70.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.93
|
| Rate for Payer: Priority Health Narrow Network |
$187.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.48
|
| Rate for Payer: UHC Exchange |
$144.48
|
| Rate for Payer: UHCCP Medicaid |
$66.88
|
|
|
PR BX LVR NDL DONE PURPOSE TM OTH MAJOR PX
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 47001
|
| Min. Negotiated Rate |
$66.24 |
| Max. Negotiated Rate |
$1,355.62 |
| Rate for Payer: Aetna Commercial |
$140.29
|
| Rate for Payer: Aetna Medicare |
$114.00
|
| Rate for Payer: BCBS Complete |
$69.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,355.62
|
| Rate for Payer: BCN Commercial |
$150.03
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Meridian Medicaid |
$69.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.15
|
| Rate for Payer: Priority Health Narrow Network |
$183.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.15
|
| Rate for Payer: UHC Exchange |
$128.15
|
| Rate for Payer: UHCCP Medicaid |
$66.24
|
|
|
PR BX NASOPHARYNX SURVEY UNKNOWN PRIMARY LESION
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 42806
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$355.76 |
| Rate for Payer: Aetna Commercial |
$178.76
|
| Rate for Payer: Aetna Medicare |
$202.00
|
| Rate for Payer: BCBS Complete |
$96.17
|
| Rate for Payer: BCBS Trust/PPO |
$314.34
|
| Rate for Payer: BCN Commercial |
$355.76
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Meridian Medicaid |
$96.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$256.54
|
| Rate for Payer: Priority Health Narrow Network |
$256.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.60
|
| Rate for Payer: UHC Exchange |
$161.60
|
| Rate for Payer: UHCCP Medicaid |
$91.59
|
|
|
PR BX OF BREAST, NEEDLE CORE, IMAGE GUIDE
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 19102
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna Medicare |
$207.00
|
| Rate for Payer: BCBS Complete |
$165.60
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.10
|
|
|
PR BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 55706
|
| Min. Negotiated Rate |
$241.97 |
| Max. Negotiated Rate |
$1,743.92 |
| Rate for Payer: Aetna Commercial |
$479.18
|
| Rate for Payer: Aetna Medicare |
$357.50
|
| Rate for Payer: BCBS Complete |
$254.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,743.92
|
| Rate for Payer: BCN Commercial |
$543.41
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Meridian Medicaid |
$254.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$241.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$599.71
|
| Rate for Payer: Priority Health Narrow Network |
$599.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$452.73
|
| Rate for Payer: UHC Exchange |
$452.73
|
| Rate for Payer: UHCCP Medicaid |
$241.97
|
|
|
PR BYPASS COMPOSITE GRAFT PROSTHETIC & VEIN
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 35681
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$1,298.03 |
| Rate for Payer: Aetna Commercial |
$108.37
|
| Rate for Payer: Aetna Medicare |
$158.50
|
| Rate for Payer: BCBS Complete |
$51.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,298.03
|
| Rate for Payer: BCN Commercial |
$113.38
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Meridian Medicaid |
$51.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.92
|
| Rate for Payer: Priority Health Narrow Network |
$123.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.51
|
| Rate for Payer: UHC Exchange |
$108.51
|
| Rate for Payer: UHCCP Medicaid |
$49.42
|
|
|
PR BYPASS GRAFT W/OTHER THAN VEIN ILIO-CELIAC
|
Professional
|
Both
|
$3,305.00
|
|
|
Service Code
|
HCPCS 35632
|
| Min. Negotiated Rate |
$1,128.47 |
| Max. Negotiated Rate |
$2,812.28 |
| Rate for Payer: Aetna Commercial |
$2,431.56
|
| Rate for Payer: Aetna Medicare |
$1,652.50
|
| Rate for Payer: BCBS Complete |
$1,184.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,188.68
|
| Rate for Payer: BCN Commercial |
$2,571.91
|
| Rate for Payer: Cash Price |
$2,644.00
|
| Rate for Payer: Cash Price |
$2,644.00
|
| Rate for Payer: Meridian Medicaid |
$1,184.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,128.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,148.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,812.28
|
| Rate for Payer: Priority Health Narrow Network |
$2,812.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,351.55
|
| Rate for Payer: UHC Exchange |
$2,351.55
|
| Rate for Payer: UHCCP Medicaid |
$1,128.47
|
|
|
PR BYPASS GRAFT W/OTHER THAN VEIN ILIO-MESENTERIC
|
Professional
|
Both
|
$3,702.00
|
|
|
Service Code
|
HCPCS 35633
|
| Min. Negotiated Rate |
$1,181.81 |
| Max. Negotiated Rate |
$3,084.59 |
| Rate for Payer: Aetna Commercial |
$2,665.69
|
| Rate for Payer: Aetna Medicare |
$1,851.00
|
| Rate for Payer: BCBS Complete |
$1,295.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,181.81
|
| Rate for Payer: BCN Commercial |
$2,824.07
|
| Rate for Payer: Cash Price |
$2,961.60
|
| Rate for Payer: Cash Price |
$2,961.60
|
| Rate for Payer: Meridian Medicaid |
$1,295.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,233.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,406.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,084.59
|
| Rate for Payer: Priority Health Narrow Network |
$3,084.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,537.63
|
| Rate for Payer: UHC Exchange |
$2,537.63
|
| Rate for Payer: UHCCP Medicaid |
$1,233.48
|
|
|
PR BYPASS GRAFT W/OTHER THAN VEIN ILIORENAL
|
Professional
|
Both
|
$3,232.00
|
|
|
Service Code
|
HCPCS 35634
|
| Min. Negotiated Rate |
$1,104.41 |
| Max. Negotiated Rate |
$2,752.20 |
| Rate for Payer: Aetna Commercial |
$2,379.07
|
| Rate for Payer: Aetna Medicare |
$1,616.00
|
| Rate for Payer: BCBS Complete |
$1,159.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,193.43
|
| Rate for Payer: BCN Commercial |
$2,517.67
|
| Rate for Payer: Cash Price |
$2,585.60
|
| Rate for Payer: Cash Price |
$2,585.60
|
| Rate for Payer: Meridian Medicaid |
$1,159.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,104.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,100.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,752.20
|
| Rate for Payer: Priority Health Narrow Network |
$2,752.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,301.10
|
| Rate for Payer: UHC Exchange |
$2,301.10
|
| Rate for Payer: UHCCP Medicaid |
$1,104.41
|
|
|
PR BYPASS NOT VEIN AORTOSUBCLA/CAROTID/INNOMINATE
|
Professional
|
Both
|
$4,760.00
|
|
|
Service Code
|
HCPCS 35626
|
| Min. Negotiated Rate |
$1,000.25 |
| Max. Negotiated Rate |
$3,094.00 |
| Rate for Payer: Aetna Commercial |
$2,142.20
|
| Rate for Payer: Aetna Medicare |
$2,380.00
|
| Rate for Payer: BCBS Complete |
$1,050.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,555.32
|
| Rate for Payer: BCN Commercial |
$2,274.80
|
| Rate for Payer: Cash Price |
$3,808.00
|
| Rate for Payer: Cash Price |
$3,808.00
|
| Rate for Payer: Meridian Medicaid |
$1,050.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,000.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,094.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,474.58
|
| Rate for Payer: Priority Health Narrow Network |
$2,474.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,101.54
|
| Rate for Payer: UHC Exchange |
$2,101.54
|
| Rate for Payer: UHCCP Medicaid |
$1,000.25
|
|
|
PR BYPASS W/VEIN AORTOBI-ILIAC
|
Professional
|
Both
|
$6,403.00
|
|
|
Service Code
|
HCPCS 35538
|
| Min. Negotiated Rate |
$971.54 |
| Max. Negotiated Rate |
$4,161.95 |
| Rate for Payer: Aetna Commercial |
$3,144.83
|
| Rate for Payer: Aetna Medicare |
$3,201.50
|
| Rate for Payer: BCBS Complete |
$1,530.89
|
| Rate for Payer: BCBS Trust/PPO |
$971.54
|
| Rate for Payer: BCN Commercial |
$3,324.47
|
| Rate for Payer: Cash Price |
$5,122.40
|
| Rate for Payer: Cash Price |
$5,122.40
|
| Rate for Payer: Meridian Medicaid |
$1,530.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,457.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,161.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,632.90
|
| Rate for Payer: Priority Health Narrow Network |
$3,632.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,264.25
|
| Rate for Payer: UHC Exchange |
$3,264.25
|
| Rate for Payer: UHCCP Medicaid |
$1,457.99
|
|
|
PR BYPASS W/VEIN AORTOCELIAC/AORTOMESENTERIC
|
Professional
|
Both
|
$4,277.00
|
|
|
Service Code
|
HCPCS 35531
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$3,035.13 |
| Rate for Payer: Aetna Commercial |
$2,623.52
|
| Rate for Payer: Aetna Medicare |
$2,138.50
|
| Rate for Payer: BCBS Complete |
$1,278.61
|
| Rate for Payer: BCBS Trust/PPO |
$63.40
|
| Rate for Payer: BCN Commercial |
$2,776.67
|
| Rate for Payer: Cash Price |
$3,421.60
|
| Rate for Payer: Cash Price |
$3,421.60
|
| Rate for Payer: Meridian Medicaid |
$1,278.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,217.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,780.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,035.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,035.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,731.26
|
| Rate for Payer: UHC Exchange |
$2,731.26
|
| Rate for Payer: UHCCP Medicaid |
$1,217.72
|
|
|
PR BYPASS W/VEIN AORTOILIAC
|
Professional
|
Both
|
$4,403.00
|
|
|
Service Code
|
HCPCS 35537
|
| Min. Negotiated Rate |
$1,301.22 |
| Max. Negotiated Rate |
$3,244.13 |
| Rate for Payer: Aetna Commercial |
$2,806.89
|
| Rate for Payer: Aetna Medicare |
$2,201.50
|
| Rate for Payer: BCBS Complete |
$1,366.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,308.07
|
| Rate for Payer: BCN Commercial |
$2,966.27
|
| Rate for Payer: Cash Price |
$3,522.40
|
| Rate for Payer: Cash Price |
$3,522.40
|
| Rate for Payer: Meridian Medicaid |
$1,366.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,301.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,861.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,244.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,244.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,907.03
|
| Rate for Payer: UHC Exchange |
$2,907.03
|
| Rate for Payer: UHCCP Medicaid |
$1,301.22
|
|
|
PR BYPASS W/VEIN AORTOSUBCLAV/CAROTID/INNOMINATE
|
Professional
|
Both
|
$3,677.00
|
|
|
Service Code
|
HCPCS 35526
|
| Min. Negotiated Rate |
$1,084.60 |
| Max. Negotiated Rate |
$3,230.55 |
| Rate for Payer: Aetna Commercial |
$2,325.27
|
| Rate for Payer: Aetna Medicare |
$1,838.50
|
| Rate for Payer: BCBS Complete |
$1,138.83
|
| Rate for Payer: BCBS Trust/PPO |
$3,230.55
|
| Rate for Payer: BCN Commercial |
$2,474.66
|
| Rate for Payer: Cash Price |
$2,941.60
|
| Rate for Payer: Cash Price |
$2,941.60
|
| Rate for Payer: Meridian Medicaid |
$1,138.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,084.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,390.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,697.41
|
| Rate for Payer: Priority Health Narrow Network |
$2,697.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,274.44
|
| Rate for Payer: UHC Exchange |
$2,274.44
|
| Rate for Payer: UHCCP Medicaid |
$1,084.60
|
|
|
PR BYPASS W/VEIN AXILLARY-BRACHIAL
|
Professional
|
Both
|
$2,410.00
|
|
|
Service Code
|
HCPCS 35522
|
| Min. Negotiated Rate |
$430.04 |
| Max. Negotiated Rate |
$1,822.03 |
| Rate for Payer: Aetna Commercial |
$1,641.02
|
| Rate for Payer: Aetna Medicare |
$1,205.00
|
| Rate for Payer: BCBS Complete |
$768.24
|
| Rate for Payer: BCBS Trust/PPO |
$430.04
|
| Rate for Payer: BCN Commercial |
$1,666.39
|
| Rate for Payer: Cash Price |
$1,928.00
|
| Rate for Payer: Cash Price |
$1,928.00
|
| Rate for Payer: Meridian Medicaid |
$768.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$731.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,566.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,822.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,822.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,654.38
|
| Rate for Payer: UHC Exchange |
$1,654.38
|
| Rate for Payer: UHCCP Medicaid |
$731.66
|
|
|
PR BYPASS W/VEIN BRACHIAL-BRACHIAL
|
Professional
|
Both
|
$4,190.00
|
|
|
Service Code
|
HCPCS 35525
|
| Min. Negotiated Rate |
$688.42 |
| Max. Negotiated Rate |
$2,723.50 |
| Rate for Payer: Aetna Commercial |
$1,525.84
|
| Rate for Payer: Aetna Medicare |
$2,095.00
|
| Rate for Payer: BCBS Complete |
$722.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,468.75
|
| Rate for Payer: BCN Commercial |
$1,616.06
|
| Rate for Payer: Cash Price |
$3,352.00
|
| Rate for Payer: Cash Price |
$3,352.00
|
| Rate for Payer: Meridian Medicaid |
$722.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$688.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,723.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,764.60
|
| Rate for Payer: Priority Health Narrow Network |
$1,764.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,537.85
|
| Rate for Payer: UHC Exchange |
$1,537.85
|
| Rate for Payer: UHCCP Medicaid |
$688.42
|
|
