|
PR BYPASS W/VEIN BRACHIAL-ULNAR/-RADIAL
|
Professional
|
Both
|
$2,535.00
|
|
|
Service Code
|
HCPCS 35523
|
| Min. Negotiated Rate |
$769.78 |
| Max. Negotiated Rate |
$1,917.22 |
| Rate for Payer: Aetna Commercial |
$1,713.84
|
| Rate for Payer: Aetna Medicare |
$1,267.50
|
| Rate for Payer: BCBS Complete |
$808.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,439.62
|
| Rate for Payer: BCN Commercial |
$1,807.13
|
| Rate for Payer: Cash Price |
$2,028.00
|
| Rate for Payer: Cash Price |
$2,028.00
|
| Rate for Payer: Meridian Medicaid |
$808.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$769.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,647.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,917.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,917.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,740.78
|
| Rate for Payer: UHC Exchange |
$1,740.78
|
| Rate for Payer: UHCCP Medicaid |
$769.78
|
|
|
PR BYPASS W/VEIN CAROTID-BRACHIAL
|
Professional
|
Both
|
$2,597.00
|
|
|
Service Code
|
HCPCS 35510
|
| Min. Negotiated Rate |
$768.72 |
| Max. Negotiated Rate |
$1,915.64 |
| Rate for Payer: Aetna Commercial |
$1,653.58
|
| Rate for Payer: Aetna Medicare |
$1,298.50
|
| Rate for Payer: BCBS Complete |
$807.16
|
| Rate for Payer: BCBS Trust/PPO |
$971.54
|
| Rate for Payer: BCN Commercial |
$1,751.91
|
| Rate for Payer: Cash Price |
$2,077.60
|
| Rate for Payer: Cash Price |
$2,077.60
|
| Rate for Payer: Meridian Medicaid |
$807.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$768.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,688.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,915.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,915.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,723.84
|
| Rate for Payer: UHC Exchange |
$1,723.84
|
| Rate for Payer: UHCCP Medicaid |
$768.72
|
|
|
PR BYPASS W/VEIN CAROTID-SUBCLV/SUBCLAVIAN CAROTID
|
Professional
|
Both
|
$2,668.00
|
|
|
Service Code
|
HCPCS 35506
|
| Min. Negotiated Rate |
$797.05 |
| Max. Negotiated Rate |
$1,983.70 |
| Rate for Payer: Aetna Commercial |
$1,712.70
|
| Rate for Payer: Aetna Medicare |
$1,334.00
|
| Rate for Payer: BCBS Complete |
$836.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,044.98
|
| Rate for Payer: BCN Commercial |
$1,814.95
|
| Rate for Payer: Cash Price |
$2,134.40
|
| Rate for Payer: Cash Price |
$2,134.40
|
| Rate for Payer: Meridian Medicaid |
$836.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$797.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,734.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,983.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,983.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,808.90
|
| Rate for Payer: UHC Exchange |
$1,808.90
|
| Rate for Payer: UHCCP Medicaid |
$797.05
|
|
|
PR BYPASS W/VEIN COMMON-IPSILATERAL CAROTID
|
Professional
|
Both
|
$3,083.00
|
|
|
Service Code
|
HCPCS 35501
|
| Min. Negotiated Rate |
$844.22 |
| Max. Negotiated Rate |
$2,271.95 |
| Rate for Payer: Aetna Commercial |
$1,963.57
|
| Rate for Payer: Aetna Medicare |
$1,541.50
|
| Rate for Payer: BCBS Complete |
$957.00
|
| Rate for Payer: BCBS Trust/PPO |
$844.22
|
| Rate for Payer: BCN Commercial |
$2,078.35
|
| Rate for Payer: Cash Price |
$2,466.40
|
| Rate for Payer: Cash Price |
$2,466.40
|
| Rate for Payer: Meridian Medicaid |
$957.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$911.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,003.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,271.95
|
| Rate for Payer: Priority Health Narrow Network |
$2,271.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,099.84
|
| Rate for Payer: UHC Exchange |
$2,099.84
|
| Rate for Payer: UHCCP Medicaid |
$911.43
|
|
|
PR BYPASS W/VEIN FEMORAL-FEMORAL
|
Professional
|
Both
|
$2,413.00
|
|
|
Service Code
|
HCPCS 35558
|
| Min. Negotiated Rate |
$721.66 |
| Max. Negotiated Rate |
$1,930.53 |
| Rate for Payer: Aetna Commercial |
$1,647.15
|
| Rate for Payer: Aetna Medicare |
$1,206.50
|
| Rate for Payer: BCBS Complete |
$802.01
|
| Rate for Payer: BCBS Trust/PPO |
$721.66
|
| Rate for Payer: BCN Commercial |
$1,759.24
|
| Rate for Payer: Cash Price |
$1,930.40
|
| Rate for Payer: Cash Price |
$1,930.40
|
| Rate for Payer: Meridian Medicaid |
$802.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$763.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,568.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,930.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,930.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,657.28
|
| Rate for Payer: UHC Exchange |
$1,657.28
|
| Rate for Payer: UHCCP Medicaid |
$763.82
|
|
|
PR BYPASS W/VEIN FEMORAL-POPLITEAL
|
Professional
|
Both
|
$2,750.00
|
|
|
Service Code
|
HCPCS 35556
|
| Min. Negotiated Rate |
$869.68 |
| Max. Negotiated Rate |
$2,167.72 |
| Rate for Payer: Aetna Commercial |
$1,881.82
|
| Rate for Payer: Aetna Medicare |
$1,375.00
|
| Rate for Payer: BCBS Complete |
$913.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,363.54
|
| Rate for Payer: BCN Commercial |
$1,986.96
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Meridian Medicaid |
$913.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$869.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,787.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,167.72
|
| Rate for Payer: Priority Health Narrow Network |
$2,167.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,887.28
|
| Rate for Payer: UHC Exchange |
$1,887.28
|
| Rate for Payer: UHCCP Medicaid |
$869.68
|
|
|
PR BYPASS W/VEIN HEPATORENAL
|
Professional
|
Both
|
$3,934.00
|
|
|
Service Code
|
HCPCS 35535
|
| Min. Negotiated Rate |
$638.71 |
| Max. Negotiated Rate |
$2,962.26 |
| Rate for Payer: Aetna Commercial |
$2,561.64
|
| Rate for Payer: Aetna Medicare |
$1,967.00
|
| Rate for Payer: BCBS Complete |
$1,247.97
|
| Rate for Payer: BCBS Trust/PPO |
$638.71
|
| Rate for Payer: BCN Commercial |
$2,709.71
|
| Rate for Payer: Cash Price |
$3,147.20
|
| Rate for Payer: Cash Price |
$3,147.20
|
| Rate for Payer: Meridian Medicaid |
$1,247.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,188.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,557.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,962.26
|
| Rate for Payer: Priority Health Narrow Network |
$2,962.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,476.66
|
| Rate for Payer: UHC Exchange |
$2,476.66
|
| Rate for Payer: UHCCP Medicaid |
$1,188.54
|
|
|
PR BYPASS W/VEIN ILIOFEMORAL
|
Professional
|
Both
|
$2,601.00
|
|
|
Service Code
|
HCPCS 35565
|
| Min. Negotiated Rate |
$817.92 |
| Max. Negotiated Rate |
$2,043.28 |
| Rate for Payer: Aetna Commercial |
$1,764.26
|
| Rate for Payer: Aetna Medicare |
$1,300.50
|
| Rate for Payer: BCBS Complete |
$858.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,137.43
|
| Rate for Payer: BCN Commercial |
$1,867.23
|
| Rate for Payer: Cash Price |
$2,080.80
|
| Rate for Payer: Cash Price |
$2,080.80
|
| Rate for Payer: Meridian Medicaid |
$858.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$817.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,690.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,043.28
|
| Rate for Payer: Priority Health Narrow Network |
$2,043.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,785.26
|
| Rate for Payer: UHC Exchange |
$1,785.26
|
| Rate for Payer: UHCCP Medicaid |
$817.92
|
|
|
PR BYPASS W/VEIN ILIOILIAC
|
Professional
|
Both
|
$2,815.00
|
|
|
Service Code
|
HCPCS 35563
|
| Min. Negotiated Rate |
$828.57 |
| Max. Negotiated Rate |
$2,063.49 |
| Rate for Payer: Aetna Commercial |
$1,779.77
|
| Rate for Payer: Aetna Medicare |
$1,407.50
|
| Rate for Payer: BCBS Complete |
$870.00
|
| Rate for Payer: BCBS Trust/PPO |
$927.69
|
| Rate for Payer: BCN Commercial |
$1,886.79
|
| Rate for Payer: Cash Price |
$2,252.00
|
| Rate for Payer: Cash Price |
$2,252.00
|
| Rate for Payer: Meridian Medicaid |
$870.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$828.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,829.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,063.49
|
| Rate for Payer: Priority Health Narrow Network |
$2,063.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,877.53
|
| Rate for Payer: UHC Exchange |
$1,877.53
|
| Rate for Payer: UHCCP Medicaid |
$828.57
|
|
|
PR BYPASS W/VEIN SPLENORENAL
|
Professional
|
Both
|
$4,905.00
|
|
|
Service Code
|
HCPCS 35536
|
| Min. Negotiated Rate |
$997.96 |
| Max. Negotiated Rate |
$3,188.25 |
| Rate for Payer: Aetna Commercial |
$2,274.13
|
| Rate for Payer: Aetna Medicare |
$2,452.50
|
| Rate for Payer: BCBS Complete |
$1,109.08
|
| Rate for Payer: BCBS Trust/PPO |
$997.96
|
| Rate for Payer: BCN Commercial |
$2,408.20
|
| Rate for Payer: Cash Price |
$3,924.00
|
| Rate for Payer: Cash Price |
$3,924.00
|
| Rate for Payer: Meridian Medicaid |
$1,109.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,056.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,188.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,630.93
|
| Rate for Payer: Priority Health Narrow Network |
$2,630.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,347.49
|
| Rate for Payer: UHC Exchange |
$2,347.49
|
| Rate for Payer: UHCCP Medicaid |
$1,056.27
|
|
|
PR BYPASS W/VEIN SUBCLAVIAN-BRACHIAL
|
Professional
|
Both
|
$2,544.00
|
|
|
Service Code
|
HCPCS 35512
|
| Min. Negotiated Rate |
$754.02 |
| Max. Negotiated Rate |
$1,878.40 |
| Rate for Payer: Aetna Commercial |
$1,621.03
|
| Rate for Payer: Aetna Medicare |
$1,272.00
|
| Rate for Payer: BCBS Complete |
$791.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,303.84
|
| Rate for Payer: BCN Commercial |
$1,716.73
|
| Rate for Payer: Cash Price |
$2,035.20
|
| Rate for Payer: Cash Price |
$2,035.20
|
| Rate for Payer: Meridian Medicaid |
$791.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$754.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,653.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,878.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,878.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,683.05
|
| Rate for Payer: UHC Exchange |
$1,683.05
|
| Rate for Payer: UHCCP Medicaid |
$754.02
|
|
|
PR BYPASS W/VEIN SUBCLAVIAN-SUBCLAVIAN
|
Professional
|
Both
|
$4,185.00
|
|
|
Service Code
|
HCPCS 35511
|
| Min. Negotiated Rate |
$700.77 |
| Max. Negotiated Rate |
$2,720.25 |
| Rate for Payer: Aetna Commercial |
$1,507.56
|
| Rate for Payer: Aetna Medicare |
$2,092.50
|
| Rate for Payer: BCBS Complete |
$735.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,179.69
|
| Rate for Payer: BCN Commercial |
$1,596.02
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Meridian Medicaid |
$735.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$700.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,720.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,745.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,745.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,617.29
|
| Rate for Payer: UHC Exchange |
$1,617.29
|
| Rate for Payer: UHCCP Medicaid |
$700.77
|
|
|
PR BYP AUTOG COMPOSIT 2 SEG VEINS FROM 2 LOCATIONS
|
Professional
|
Both
|
$706.00
|
|
|
Service Code
|
HCPCS 35682
|
| Min. Negotiated Rate |
$218.75 |
| Max. Negotiated Rate |
$1,982.71 |
| Rate for Payer: Aetna Commercial |
$476.87
|
| Rate for Payer: Aetna Medicare |
$353.00
|
| Rate for Payer: BCBS Complete |
$229.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,982.71
|
| Rate for Payer: BCN Commercial |
$500.41
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Meridian Medicaid |
$229.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$218.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$547.25
|
| Rate for Payer: Priority Health Narrow Network |
$547.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$483.64
|
| Rate for Payer: UHC Exchange |
$483.64
|
| Rate for Payer: UHCCP Medicaid |
$218.75
|
|
|
PR BYP AUTOG COMPOSIT 3/> SEG FROM 2/> LOCATION
|
Professional
|
Both
|
$866.00
|
|
|
Service Code
|
HCPCS 35683
|
| Min. Negotiated Rate |
$254.96 |
| Max. Negotiated Rate |
$1,813.65 |
| Rate for Payer: Aetna Commercial |
$551.97
|
| Rate for Payer: Aetna Medicare |
$433.00
|
| Rate for Payer: BCBS Complete |
$267.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,813.65
|
| Rate for Payer: BCN Commercial |
$581.53
|
| Rate for Payer: Cash Price |
$692.80
|
| Rate for Payer: Cash Price |
$692.80
|
| Rate for Payer: Meridian Medicaid |
$267.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$633.94
|
| Rate for Payer: Priority Health Narrow Network |
$633.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$570.23
|
| Rate for Payer: UHC Exchange |
$570.23
|
| Rate for Payer: UHCCP Medicaid |
$254.96
|
|
|
PR BYP FEM-ANT TIBL PST TIBL PRONEAL ART/OTH DSTL
|
Professional
|
Both
|
$4,830.00
|
|
|
Service Code
|
HCPCS 35566
|
| Min. Negotiated Rate |
$803.02 |
| Max. Negotiated Rate |
$3,139.50 |
| Rate for Payer: Aetna Commercial |
$2,244.41
|
| Rate for Payer: Aetna Medicare |
$2,415.00
|
| Rate for Payer: BCBS Complete |
$1,087.16
|
| Rate for Payer: BCBS Trust/PPO |
$803.02
|
| Rate for Payer: BCN Commercial |
$2,368.62
|
| Rate for Payer: Cash Price |
$3,864.00
|
| Rate for Payer: Cash Price |
$3,864.00
|
| Rate for Payer: Meridian Medicaid |
$1,087.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,035.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,139.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,584.66
|
| Rate for Payer: Priority Health Narrow Network |
$2,584.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,262.69
|
| Rate for Payer: UHC Exchange |
$2,262.69
|
| Rate for Payer: UHCCP Medicaid |
$1,035.39
|
|
|
PR BYP GRF W/DESCENDING THORACIC AORTA RPR NECK INC
|
Professional
|
Both
|
$1,964.00
|
|
|
Service Code
|
HCPCS 33891
|
| Min. Negotiated Rate |
$599.38 |
| Max. Negotiated Rate |
$1,493.36 |
| Rate for Payer: Aetna Commercial |
$1,300.03
|
| Rate for Payer: Aetna Medicare |
$982.00
|
| Rate for Payer: BCBS Complete |
$629.35
|
| Rate for Payer: BCBS Trust/PPO |
$745.96
|
| Rate for Payer: BCN Commercial |
$1,368.30
|
| Rate for Payer: Cash Price |
$1,571.20
|
| Rate for Payer: Cash Price |
$1,571.20
|
| Rate for Payer: Meridian Medicaid |
$629.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$599.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,276.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,493.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,493.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,344.34
|
| Rate for Payer: UHC Exchange |
$1,344.34
|
| Rate for Payer: UHCCP Medicaid |
$599.38
|
|
|
PR BYP OTH/THN VEIN AORTOBIFEMORAL
|
Professional
|
Both
|
$5,782.00
|
|
|
Service Code
|
HCPCS 35646
|
| Min. Negotiated Rate |
$1,061.81 |
| Max. Negotiated Rate |
$3,758.30 |
| Rate for Payer: Aetna Commercial |
$2,302.34
|
| Rate for Payer: Aetna Medicare |
$2,891.00
|
| Rate for Payer: BCBS Complete |
$1,114.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,771.92
|
| Rate for Payer: BCN Commercial |
$2,430.68
|
| Rate for Payer: Cash Price |
$4,625.60
|
| Rate for Payer: Cash Price |
$4,625.60
|
| Rate for Payer: Meridian Medicaid |
$1,114.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,061.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,758.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,652.74
|
| Rate for Payer: Priority Health Narrow Network |
$2,652.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,327.15
|
| Rate for Payer: UHC Exchange |
$2,327.15
|
| Rate for Payer: UHCCP Medicaid |
$1,061.81
|
|
|
PR BYP OTH/THN VEIN AORTOBI-ILIAC
|
Professional
|
Both
|
$4,943.00
|
|
|
Service Code
|
HCPCS 35638
|
| Min. Negotiated Rate |
$1,090.35 |
| Max. Negotiated Rate |
$3,212.95 |
| Rate for Payer: Aetna Commercial |
$2,341.64
|
| Rate for Payer: Aetna Medicare |
$2,471.50
|
| Rate for Payer: BCBS Complete |
$1,144.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,131.09
|
| Rate for Payer: BCN Commercial |
$2,473.20
|
| Rate for Payer: Cash Price |
$3,954.40
|
| Rate for Payer: Cash Price |
$3,954.40
|
| Rate for Payer: Meridian Medicaid |
$1,144.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,090.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,212.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,699.01
|
| Rate for Payer: Priority Health Narrow Network |
$2,699.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,363.76
|
| Rate for Payer: UHC Exchange |
$2,363.76
|
| Rate for Payer: UHCCP Medicaid |
$1,090.35
|
|
|
PR BYP OTH/THN VEIN AORTOCELIAC AORTOMSN AORTORNL
|
Professional
|
Both
|
$5,066.00
|
|
|
Service Code
|
HCPCS 35631
|
| Min. Negotiated Rate |
$1,152.33 |
| Max. Negotiated Rate |
$3,292.90 |
| Rate for Payer: Aetna Commercial |
$2,492.94
|
| Rate for Payer: Aetna Medicare |
$2,533.00
|
| Rate for Payer: BCBS Complete |
$1,209.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,452.50
|
| Rate for Payer: BCN Commercial |
$2,633.48
|
| Rate for Payer: Cash Price |
$4,052.80
|
| Rate for Payer: Cash Price |
$4,052.80
|
| Rate for Payer: Meridian Medicaid |
$1,209.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,152.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,292.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,883.56
|
| Rate for Payer: Priority Health Narrow Network |
$2,883.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,509.70
|
| Rate for Payer: UHC Exchange |
$2,509.70
|
| Rate for Payer: UHCCP Medicaid |
$1,152.33
|
|
|
PR BYP OTH/THN VEIN AORTOFEMORAL
|
Professional
|
Both
|
$3,067.00
|
|
|
Service Code
|
HCPCS 35647
|
| Min. Negotiated Rate |
$958.29 |
| Max. Negotiated Rate |
$2,412.88 |
| Rate for Payer: Aetna Commercial |
$2,084.62
|
| Rate for Payer: Aetna Medicare |
$1,533.50
|
| Rate for Payer: BCBS Complete |
$1,006.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,996.45
|
| Rate for Payer: BCN Commercial |
$2,211.76
|
| Rate for Payer: Cash Price |
$2,453.60
|
| Rate for Payer: Cash Price |
$2,453.60
|
| Rate for Payer: Meridian Medicaid |
$1,006.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$958.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,993.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,412.88
|
| Rate for Payer: Priority Health Narrow Network |
$2,412.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,105.34
|
| Rate for Payer: UHC Exchange |
$2,105.34
|
| Rate for Payer: UHCCP Medicaid |
$958.29
|
|
|
PR BYP OTH/THN VEIN AORTOILIAC
|
Professional
|
Both
|
$3,635.00
|
|
|
Service Code
|
HCPCS 35637
|
| Min. Negotiated Rate |
$801.58 |
| Max. Negotiated Rate |
$2,582.01 |
| Rate for Payer: Aetna Commercial |
$2,231.68
|
| Rate for Payer: Aetna Medicare |
$1,817.50
|
| Rate for Payer: BCBS Complete |
$1,088.50
|
| Rate for Payer: BCBS Trust/PPO |
$801.58
|
| Rate for Payer: BCN Commercial |
$2,362.27
|
| Rate for Payer: Cash Price |
$2,908.00
|
| Rate for Payer: Cash Price |
$2,908.00
|
| Rate for Payer: Meridian Medicaid |
$1,088.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,036.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,362.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,582.01
|
| Rate for Payer: Priority Health Narrow Network |
$2,582.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,316.85
|
| Rate for Payer: UHC Exchange |
$2,316.85
|
| Rate for Payer: UHCCP Medicaid |
$1,036.67
|
|
|
PR BYP OTH/THN VEIN AXILLARY-AXILLARY
|
Professional
|
Both
|
$2,215.00
|
|
|
Service Code
|
HCPCS 35650
|
| Min. Negotiated Rate |
$639.43 |
| Max. Negotiated Rate |
$1,592.29 |
| Rate for Payer: Aetna Commercial |
$1,374.21
|
| Rate for Payer: Aetna Medicare |
$1,107.50
|
| Rate for Payer: BCBS Complete |
$671.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.34
|
| Rate for Payer: BCN Commercial |
$1,456.75
|
| Rate for Payer: Cash Price |
$1,772.00
|
| Rate for Payer: Cash Price |
$1,772.00
|
| Rate for Payer: Meridian Medicaid |
$671.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$639.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,439.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,592.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,592.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,438.45
|
| Rate for Payer: UHC Exchange |
$1,438.45
|
| Rate for Payer: UHCCP Medicaid |
$639.43
|
|
|
PR BYP OTH/THN VEIN AXILLARY-FEMORAL
|
Professional
|
Both
|
$4,190.00
|
|
|
Service Code
|
HCPCS 35621
|
| Min. Negotiated Rate |
$683.73 |
| Max. Negotiated Rate |
$2,723.50 |
| Rate for Payer: Aetna Commercial |
$1,473.74
|
| Rate for Payer: Aetna Medicare |
$2,095.00
|
| Rate for Payer: BCBS Complete |
$717.92
|
| Rate for Payer: BCBS Trust/PPO |
$2,170.78
|
| Rate for Payer: BCN Commercial |
$1,565.23
|
| Rate for Payer: Cash Price |
$3,352.00
|
| Rate for Payer: Cash Price |
$3,352.00
|
| Rate for Payer: Meridian Medicaid |
$717.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$683.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,723.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,707.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,707.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,493.40
|
| Rate for Payer: UHC Exchange |
$1,493.40
|
| Rate for Payer: UHCCP Medicaid |
$683.73
|
|
|
PR BYP OTH/THN VEIN AXILLARY-FEMORAL-FEMORAL
|
Professional
|
Both
|
$4,922.00
|
|
|
Service Code
|
HCPCS 35654
|
| Min. Negotiated Rate |
$853.07 |
| Max. Negotiated Rate |
$3,199.30 |
| Rate for Payer: Aetna Commercial |
$1,837.45
|
| Rate for Payer: Aetna Medicare |
$2,461.00
|
| Rate for Payer: BCBS Complete |
$895.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,290.11
|
| Rate for Payer: BCN Commercial |
$1,943.47
|
| Rate for Payer: Cash Price |
$3,937.60
|
| Rate for Payer: Cash Price |
$3,937.60
|
| Rate for Payer: Meridian Medicaid |
$895.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$853.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,199.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,122.51
|
| Rate for Payer: Priority Health Narrow Network |
$2,122.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,860.45
|
| Rate for Payer: UHC Exchange |
$1,860.45
|
| Rate for Payer: UHCCP Medicaid |
$853.07
|
|
|
PR BYP OTH/THN VEIN CAROTID-SUBCLAVIAN
|
Professional
|
Both
|
$2,324.00
|
|
|
Service Code
|
HCPCS 35606
|
| Min. Negotiated Rate |
$733.57 |
| Max. Negotiated Rate |
$1,832.13 |
| Rate for Payer: Aetna Commercial |
$1,574.58
|
| Rate for Payer: Aetna Medicare |
$1,162.00
|
| Rate for Payer: BCBS Complete |
$770.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,535.77
|
| Rate for Payer: BCN Commercial |
$1,673.72
|
| Rate for Payer: Cash Price |
$1,859.20
|
| Rate for Payer: Cash Price |
$1,859.20
|
| Rate for Payer: Meridian Medicaid |
$770.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$733.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,510.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,832.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,832.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,595.01
|
| Rate for Payer: UHC Exchange |
$1,595.01
|
| Rate for Payer: UHCCP Medicaid |
$733.57
|
|
