|
PR INSERT TEMP PROSTATIC URETH STENT W/MEASUREMENT
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 53855
|
| Min. Negotiated Rate |
$51.55 |
| Max. Negotiated Rate |
$2,298.11 |
| Rate for Payer: Aetna Commercial |
$107.33
|
| Rate for Payer: Aetna Medicare |
$80.10
|
| Rate for Payer: BCBS Complete |
$54.13
|
| Rate for Payer: BCBS MAPPO |
$80.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,298.11
|
| Rate for Payer: BCN Commercial |
$963.67
|
| Rate for Payer: BCN Medicare Advantage |
$80.10
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cofinity Commercial |
$115.34
|
| Rate for Payer: Cofinity Commercial |
$107.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.10
|
| Rate for Payer: Healthscope Commercial |
$96.12
|
| Rate for Payer: Healthscope Whirlpool |
$96.12
|
| Rate for Payer: Meridian Medicaid |
$54.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.10
|
| Rate for Payer: PACE SWMI |
$80.10
|
| Rate for Payer: PHP Medicare Advantage |
$80.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$801.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.69
|
| Rate for Payer: Priority Health Medicare |
$80.10
|
| Rate for Payer: Priority Health Narrow Network |
$129.69
|
| Rate for Payer: UHC Medicare Advantage |
$82.50
|
|
|
PR INSERT TRAY W/O BAG/CATH
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS A4310
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$8.51 |
| Rate for Payer: Aetna Commercial |
$7.19
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCN Commercial |
$8.51
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
|
|
PR INSERT TUNNELED CVC W/O SUBQ PORT/PMP AGE <5 YR
|
Professional
|
Both
|
$2,105.00
|
|
|
Service Code
|
HCPCS 36557
|
| Min. Negotiated Rate |
$204.48 |
| Max. Negotiated Rate |
$1,711.35 |
| Rate for Payer: Aetna Commercial |
$422.65
|
| Rate for Payer: Aetna Medicare |
$315.41
|
| Rate for Payer: BCBS Complete |
$214.70
|
| Rate for Payer: BCBS MAPPO |
$315.41
|
| Rate for Payer: BCBS Trust/PPO |
$660.90
|
| Rate for Payer: BCN Commercial |
$1,711.35
|
| Rate for Payer: BCN Medicare Advantage |
$315.41
|
| Rate for Payer: Cash Price |
$1,684.00
|
| Rate for Payer: Cash Price |
$1,684.00
|
| Rate for Payer: Cofinity Commercial |
$422.65
|
| Rate for Payer: Cofinity Commercial |
$454.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.41
|
| Rate for Payer: Healthscope Commercial |
$378.49
|
| Rate for Payer: Healthscope Whirlpool |
$378.49
|
| Rate for Payer: Meridian Medicaid |
$214.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$331.18
|
| Rate for Payer: PACE SWMI |
$315.41
|
| Rate for Payer: PHP Medicare Advantage |
$315.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,473.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$506.43
|
| Rate for Payer: Priority Health Medicare |
$315.41
|
| Rate for Payer: Priority Health Narrow Network |
$506.43
|
| Rate for Payer: UHC Medicare Advantage |
$324.87
|
|
|
PR INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I
|
Professional
|
Both
|
$2,720.00
|
|
|
Service Code
|
HCPCS 37191
|
| Min. Negotiated Rate |
$136.75 |
| Max. Negotiated Rate |
$2,999.02 |
| Rate for Payer: Aetna Commercial |
$290.06
|
| Rate for Payer: Aetna Medicare |
$216.46
|
| Rate for Payer: BCBS Complete |
$143.59
|
| Rate for Payer: BCBS MAPPO |
$216.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,200.83
|
| Rate for Payer: BCN Commercial |
$2,999.02
|
| Rate for Payer: BCN Medicare Advantage |
$216.46
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cofinity Commercial |
$290.06
|
| Rate for Payer: Cofinity Commercial |
$311.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.46
|
| Rate for Payer: Healthscope Commercial |
$259.75
|
| Rate for Payer: Healthscope Whirlpool |
$259.75
|
| Rate for Payer: Meridian Medicaid |
$143.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$227.28
|
| Rate for Payer: PACE SWMI |
$216.46
|
| Rate for Payer: PHP Medicare Advantage |
$216.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,904.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.64
|
| Rate for Payer: Priority Health Medicare |
$216.46
|
| Rate for Payer: Priority Health Narrow Network |
$343.64
|
| Rate for Payer: UHC Medicare Advantage |
$222.95
|
|
|
PR IN-SITU FEM-ANT TIBL PST TIBL/PRONEAL ART
|
Professional
|
Both
|
$3,244.00
|
|
|
Service Code
|
HCPCS 35585
|
| Min. Negotiated Rate |
$1,040.29 |
| Max. Negotiated Rate |
$2,589.04 |
| Rate for Payer: Aetna Commercial |
$2,202.76
|
| Rate for Payer: Aetna Medicare |
$1,643.85
|
| Rate for Payer: BCBS Complete |
$1,092.30
|
| Rate for Payer: BCBS MAPPO |
$1,643.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,109.96
|
| Rate for Payer: BCN Commercial |
$2,378.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,643.85
|
| Rate for Payer: Cash Price |
$2,595.20
|
| Rate for Payer: Cash Price |
$2,595.20
|
| Rate for Payer: Cofinity Commercial |
$2,202.76
|
| Rate for Payer: Cofinity Commercial |
$2,367.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,643.85
|
| Rate for Payer: Healthscope Commercial |
$1,972.62
|
| Rate for Payer: Healthscope Whirlpool |
$1,972.62
|
| Rate for Payer: Meridian Medicaid |
$1,092.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,726.04
|
| Rate for Payer: PACE SWMI |
$1,643.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,643.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,040.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,270.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,589.04
|
| Rate for Payer: Priority Health Medicare |
$1,643.85
|
| Rate for Payer: Priority Health Narrow Network |
$2,589.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,693.17
|
|
|
PR IN-SITU VEIN BYPASS FEMORAL-POPLITEAL
|
Professional
|
Both
|
$4,573.00
|
|
|
Service Code
|
HCPCS 35583
|
| Min. Negotiated Rate |
$898.43 |
| Max. Negotiated Rate |
$3,201.10 |
| Rate for Payer: Aetna Commercial |
$1,904.37
|
| Rate for Payer: Aetna Medicare |
$1,421.17
|
| Rate for Payer: BCBS Complete |
$943.35
|
| Rate for Payer: BCBS MAPPO |
$1,421.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,453.35
|
| Rate for Payer: BCN Commercial |
$2,057.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,421.17
|
| Rate for Payer: Cash Price |
$3,658.40
|
| Rate for Payer: Cash Price |
$3,658.40
|
| Rate for Payer: Cofinity Commercial |
$2,046.48
|
| Rate for Payer: Cofinity Commercial |
$1,904.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,421.17
|
| Rate for Payer: Healthscope Commercial |
$1,705.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,705.40
|
| Rate for Payer: Meridian Medicaid |
$943.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,492.23
|
| Rate for Payer: PACE SWMI |
$1,421.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,421.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$898.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,201.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,239.54
|
| Rate for Payer: Priority Health Medicare |
$1,421.17
|
| Rate for Payer: Priority Health Narrow Network |
$2,239.54
|
| Rate for Payer: UHC Medicare Advantage |
$1,463.81
|
|
|
PR IN-SITU VEIN BYP POP-TIBL PRONEAL
|
Professional
|
Both
|
$2,795.00
|
|
|
Service Code
|
HCPCS 35587
|
| Min. Negotiated Rate |
$831.77 |
| Max. Negotiated Rate |
$2,117.72 |
| Rate for Payer: Aetna Commercial |
$1,799.97
|
| Rate for Payer: Aetna Medicare |
$1,343.26
|
| Rate for Payer: BCBS Complete |
$873.36
|
| Rate for Payer: BCBS MAPPO |
$1,343.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,028.60
|
| Rate for Payer: BCN Commercial |
$1,945.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,343.26
|
| Rate for Payer: Cash Price |
$2,236.00
|
| Rate for Payer: Cash Price |
$2,236.00
|
| Rate for Payer: Cofinity Commercial |
$1,934.29
|
| Rate for Payer: Cofinity Commercial |
$1,799.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,343.26
|
| Rate for Payer: Healthscope Commercial |
$1,611.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,611.91
|
| Rate for Payer: Meridian Medicaid |
$873.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,410.42
|
| Rate for Payer: PACE SWMI |
$1,343.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,343.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$831.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,956.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,117.72
|
| Rate for Payer: Priority Health Medicare |
$1,343.26
|
| Rate for Payer: Priority Health Narrow Network |
$2,117.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,383.56
|
|
|
PR INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB
|
Professional
|
Both
|
$1,217.00
|
|
|
Service Code
|
HCPCS 33216
|
| Min. Negotiated Rate |
$233.87 |
| Max. Negotiated Rate |
$1,885.50 |
| Rate for Payer: Aetna Commercial |
$488.36
|
| Rate for Payer: Aetna Medicare |
$364.45
|
| Rate for Payer: BCBS Complete |
$245.56
|
| Rate for Payer: BCBS MAPPO |
$364.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,885.50
|
| Rate for Payer: BCN Commercial |
$539.01
|
| Rate for Payer: BCN Medicare Advantage |
$364.45
|
| Rate for Payer: Cash Price |
$973.60
|
| Rate for Payer: Cash Price |
$973.60
|
| Rate for Payer: Cofinity Commercial |
$524.81
|
| Rate for Payer: Cofinity Commercial |
$488.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$364.45
|
| Rate for Payer: Healthscope Commercial |
$437.34
|
| Rate for Payer: Healthscope Whirlpool |
$437.34
|
| Rate for Payer: Meridian Medicaid |
$245.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$382.67
|
| Rate for Payer: PACE SWMI |
$364.45
|
| Rate for Payer: PHP Medicare Advantage |
$364.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$233.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$586.76
|
| Rate for Payer: Priority Health Medicare |
$364.45
|
| Rate for Payer: Priority Health Narrow Network |
$586.76
|
| Rate for Payer: UHC Medicare Advantage |
$375.38
|
|
|
PR INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB
|
Professional
|
Both
|
$1,217.00
|
|
|
Service Code
|
HCPCS 33217
|
| Min. Negotiated Rate |
$232.17 |
| Max. Negotiated Rate |
$1,400.52 |
| Rate for Payer: Aetna Commercial |
$483.62
|
| Rate for Payer: Aetna Medicare |
$360.91
|
| Rate for Payer: BCBS Complete |
$243.78
|
| Rate for Payer: BCBS MAPPO |
$360.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,400.52
|
| Rate for Payer: BCN Commercial |
$533.63
|
| Rate for Payer: BCN Medicare Advantage |
$360.91
|
| Rate for Payer: Cash Price |
$973.60
|
| Rate for Payer: Cash Price |
$973.60
|
| Rate for Payer: Cofinity Commercial |
$519.71
|
| Rate for Payer: Cofinity Commercial |
$483.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$360.91
|
| Rate for Payer: Healthscope Commercial |
$433.09
|
| Rate for Payer: Healthscope Whirlpool |
$433.09
|
| Rate for Payer: Meridian Medicaid |
$243.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$378.96
|
| Rate for Payer: PACE SWMI |
$360.91
|
| Rate for Payer: PHP Medicare Advantage |
$360.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$580.90
|
| Rate for Payer: Priority Health Medicare |
$360.91
|
| Rate for Payer: Priority Health Narrow Network |
$580.90
|
| Rate for Payer: UHC Medicare Advantage |
$371.74
|
|
|
PR INSJ BIOMCHN DEV INTERVERTEBRAL DSC SPC W/ARTHRD
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 22853
|
| Min. Negotiated Rate |
$89.99 |
| Max. Negotiated Rate |
$392.17 |
| Rate for Payer: Aetna Commercial |
$344.69
|
| Rate for Payer: Aetna Medicare |
$257.23
|
| Rate for Payer: BCBS Complete |
$172.21
|
| Rate for Payer: BCBS MAPPO |
$257.23
|
| Rate for Payer: BCBS Trust/PPO |
$89.99
|
| Rate for Payer: BCN Commercial |
$375.30
|
| Rate for Payer: BCN Medicare Advantage |
$257.23
|
| Rate for Payer: Cash Price |
$428.00
|
| Rate for Payer: Cash Price |
$428.00
|
| Rate for Payer: Cofinity Commercial |
$344.69
|
| Rate for Payer: Cofinity Commercial |
$370.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.23
|
| Rate for Payer: Healthscope Commercial |
$308.68
|
| Rate for Payer: Healthscope Whirlpool |
$308.68
|
| Rate for Payer: Meridian Medicaid |
$172.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$270.09
|
| Rate for Payer: PACE SWMI |
$257.23
|
| Rate for Payer: PHP Medicare Advantage |
$257.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$392.17
|
| Rate for Payer: Priority Health Medicare |
$257.23
|
| Rate for Payer: Priority Health Narrow Network |
$392.17
|
| Rate for Payer: UHC Medicare Advantage |
$264.95
|
|
|
PR INSJ BIOMCHN DEV NTRVRT DISC SPACE W/O ARTHRD
|
Professional
|
Both
|
$2,242.00
|
|
|
Service Code
|
HCPCS 22859
|
| Min. Negotiated Rate |
$133.29 |
| Max. Negotiated Rate |
$1,569.40 |
| Rate for Payer: Aetna Commercial |
$444.69
|
| Rate for Payer: Aetna Medicare |
$331.86
|
| Rate for Payer: BCBS Complete |
$222.76
|
| Rate for Payer: BCBS MAPPO |
$331.86
|
| Rate for Payer: BCBS Trust/PPO |
$133.29
|
| Rate for Payer: BCN Commercial |
$484.28
|
| Rate for Payer: BCN Medicare Advantage |
$331.86
|
| Rate for Payer: Cash Price |
$1,793.60
|
| Rate for Payer: Cash Price |
$1,793.60
|
| Rate for Payer: Cofinity Commercial |
$444.69
|
| Rate for Payer: Cofinity Commercial |
$477.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$331.86
|
| Rate for Payer: Healthscope Commercial |
$398.23
|
| Rate for Payer: Healthscope Whirlpool |
$398.23
|
| Rate for Payer: Meridian Medicaid |
$222.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$348.45
|
| Rate for Payer: PACE SWMI |
$331.86
|
| Rate for Payer: PHP Medicare Advantage |
$331.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$212.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,569.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$506.05
|
| Rate for Payer: Priority Health Medicare |
$331.86
|
| Rate for Payer: Priority Health Narrow Network |
$506.05
|
| Rate for Payer: UHC Medicare Advantage |
$341.82
|
|
|
PR INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD
|
Professional
|
Both
|
$866.00
|
|
|
Service Code
|
HCPCS 22854
|
| Min. Negotiated Rate |
$69.19 |
| Max. Negotiated Rate |
$606.20 |
| Rate for Payer: Aetna Commercial |
$448.75
|
| Rate for Payer: Aetna Medicare |
$334.89
|
| Rate for Payer: BCBS Complete |
$224.32
|
| Rate for Payer: BCBS MAPPO |
$334.89
|
| Rate for Payer: BCBS Trust/PPO |
$69.19
|
| Rate for Payer: BCN Commercial |
$488.19
|
| Rate for Payer: BCN Medicare Advantage |
$334.89
|
| Rate for Payer: Cash Price |
$692.80
|
| Rate for Payer: Cash Price |
$692.80
|
| Rate for Payer: Cofinity Commercial |
$448.75
|
| Rate for Payer: Cofinity Commercial |
$482.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$334.89
|
| Rate for Payer: Healthscope Commercial |
$401.87
|
| Rate for Payer: Healthscope Whirlpool |
$401.87
|
| Rate for Payer: Meridian Medicaid |
$224.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$351.63
|
| Rate for Payer: PACE SWMI |
$334.89
|
| Rate for Payer: PHP Medicare Advantage |
$334.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$606.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$510.13
|
| Rate for Payer: Priority Health Medicare |
$334.89
|
| Rate for Payer: Priority Health Narrow Network |
$510.13
|
| Rate for Payer: UHC Medicare Advantage |
$344.94
|
|
|
PR INSJ CANNULA HEMO OTH PURPOSE SPX ARVEN XTRNL
|
Professional
|
Both
|
$1,454.00
|
|
|
Service Code
|
HCPCS 36810
|
| Min. Negotiated Rate |
$131.85 |
| Max. Negotiated Rate |
$1,017.80 |
| Rate for Payer: Aetna Commercial |
$274.24
|
| Rate for Payer: Aetna Medicare |
$204.66
|
| Rate for Payer: BCBS Complete |
$138.44
|
| Rate for Payer: BCBS MAPPO |
$204.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,011.69
|
| Rate for Payer: BCN Commercial |
$301.51
|
| Rate for Payer: BCN Medicare Advantage |
$204.66
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Cofinity Commercial |
$294.71
|
| Rate for Payer: Cofinity Commercial |
$274.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.66
|
| Rate for Payer: Healthscope Commercial |
$245.59
|
| Rate for Payer: Healthscope Whirlpool |
$245.59
|
| Rate for Payer: Meridian Medicaid |
$138.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$214.89
|
| Rate for Payer: PACE SWMI |
$204.66
|
| Rate for Payer: PHP Medicare Advantage |
$204.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,017.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$328.21
|
| Rate for Payer: Priority Health Medicare |
$204.66
|
| Rate for Payer: Priority Health Narrow Network |
$328.21
|
| Rate for Payer: UHC Medicare Advantage |
$210.80
|
|
|
PR INSJ CANNULA HEMO OTH PURPOSE SPX VEIN VEIN
|
Professional
|
Both
|
$652.00
|
|
|
Service Code
|
HCPCS 36800
|
| Min. Negotiated Rate |
$75.83 |
| Max. Negotiated Rate |
$720.07 |
| Rate for Payer: Aetna Commercial |
$158.84
|
| Rate for Payer: Aetna Medicare |
$118.54
|
| Rate for Payer: BCBS Complete |
$79.62
|
| Rate for Payer: BCBS MAPPO |
$118.54
|
| Rate for Payer: BCBS Trust/PPO |
$720.07
|
| Rate for Payer: BCN Commercial |
$173.48
|
| Rate for Payer: BCN Medicare Advantage |
$118.54
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Cofinity Commercial |
$170.70
|
| Rate for Payer: Cofinity Commercial |
$158.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.54
|
| Rate for Payer: Healthscope Commercial |
$142.25
|
| Rate for Payer: Healthscope Whirlpool |
$142.25
|
| Rate for Payer: Meridian Medicaid |
$79.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$124.47
|
| Rate for Payer: PACE SWMI |
$118.54
|
| Rate for Payer: PHP Medicare Advantage |
$118.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.85
|
| Rate for Payer: Priority Health Medicare |
$118.54
|
| Rate for Payer: Priority Health Narrow Network |
$188.85
|
| Rate for Payer: UHC Medicare Advantage |
$122.10
|
|
|
PR INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN
|
Professional
|
Both
|
$1,587.00
|
|
|
Service Code
|
HCPCS 33224
|
| Min. Negotiated Rate |
$319.29 |
| Max. Negotiated Rate |
$1,392.07 |
| Rate for Payer: Aetna Commercial |
$676.66
|
| Rate for Payer: Aetna Medicare |
$504.97
|
| Rate for Payer: BCBS Complete |
$335.25
|
| Rate for Payer: BCBS MAPPO |
$504.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,392.07
|
| Rate for Payer: BCN Commercial |
$738.39
|
| Rate for Payer: BCN Medicare Advantage |
$504.97
|
| Rate for Payer: Cash Price |
$1,269.60
|
| Rate for Payer: Cash Price |
$1,269.60
|
| Rate for Payer: Cofinity Commercial |
$676.66
|
| Rate for Payer: Cofinity Commercial |
$727.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$504.97
|
| Rate for Payer: Healthscope Commercial |
$605.96
|
| Rate for Payer: Healthscope Whirlpool |
$605.96
|
| Rate for Payer: Meridian Medicaid |
$335.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$530.22
|
| Rate for Payer: PACE SWMI |
$504.97
|
| Rate for Payer: PHP Medicare Advantage |
$504.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$803.79
|
| Rate for Payer: Priority Health Medicare |
$504.97
|
| Rate for Payer: Priority Health Narrow Network |
$803.79
|
| Rate for Payer: UHC Medicare Advantage |
$520.12
|
|
|
PR INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN
|
Professional
|
Both
|
$967.00
|
|
|
Service Code
|
HCPCS 33225
|
| Min. Negotiated Rate |
$287.76 |
| Max. Negotiated Rate |
$1,409.50 |
| Rate for Payer: Aetna Commercial |
$612.67
|
| Rate for Payer: Aetna Medicare |
$457.22
|
| Rate for Payer: BCBS Complete |
$302.15
|
| Rate for Payer: BCBS MAPPO |
$457.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,409.50
|
| Rate for Payer: BCN Commercial |
$667.54
|
| Rate for Payer: BCN Medicare Advantage |
$457.22
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Cofinity Commercial |
$658.40
|
| Rate for Payer: Cofinity Commercial |
$612.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$457.22
|
| Rate for Payer: Healthscope Commercial |
$548.66
|
| Rate for Payer: Healthscope Whirlpool |
$548.66
|
| Rate for Payer: Meridian Medicaid |
$302.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$480.08
|
| Rate for Payer: PACE SWMI |
$457.22
|
| Rate for Payer: PHP Medicare Advantage |
$457.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$726.66
|
| Rate for Payer: Priority Health Medicare |
$457.22
|
| Rate for Payer: Priority Health Narrow Network |
$726.66
|
| Rate for Payer: UHC Medicare Advantage |
$470.94
|
|
|
PR INSJ GRAFT AORTA/GREAT VESSEL W/BYPASS
|
Professional
|
Both
|
$8,044.00
|
|
|
Service Code
|
HCPCS 33335
|
| Min. Negotiated Rate |
$818.87 |
| Max. Negotiated Rate |
$5,630.80 |
| Rate for Payer: Aetna Commercial |
$2,457.09
|
| Rate for Payer: Aetna Medicare |
$1,833.65
|
| Rate for Payer: BCBS Complete |
$1,224.93
|
| Rate for Payer: BCBS MAPPO |
$1,833.65
|
| Rate for Payer: BCBS Trust/PPO |
$818.87
|
| Rate for Payer: BCN Commercial |
$2,673.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,833.65
|
| Rate for Payer: Cash Price |
$6,435.20
|
| Rate for Payer: Cash Price |
$6,435.20
|
| Rate for Payer: Cofinity Commercial |
$2,640.46
|
| Rate for Payer: Cofinity Commercial |
$2,457.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,833.65
|
| Rate for Payer: Healthscope Commercial |
$2,200.38
|
| Rate for Payer: Healthscope Whirlpool |
$2,200.38
|
| Rate for Payer: Meridian Medicaid |
$1,224.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,925.33
|
| Rate for Payer: PACE SWMI |
$1,833.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,833.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,166.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,630.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,909.81
|
| Rate for Payer: Priority Health Medicare |
$1,833.65
|
| Rate for Payer: Priority Health Narrow Network |
$2,909.81
|
| Rate for Payer: UHC Medicare Advantage |
$1,888.66
|
|
|
PR INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
|
Professional
|
Both
|
$3,056.00
|
|
|
Service Code
|
HCPCS 53445
|
| Min. Negotiated Rate |
$482.66 |
| Max. Negotiated Rate |
$3,567.61 |
| Rate for Payer: Aetna Commercial |
$989.13
|
| Rate for Payer: Aetna Medicare |
$738.16
|
| Rate for Payer: BCBS Complete |
$506.79
|
| Rate for Payer: BCBS MAPPO |
$738.16
|
| Rate for Payer: BCBS Trust/PPO |
$3,567.61
|
| Rate for Payer: BCN Commercial |
$1,092.68
|
| Rate for Payer: BCN Medicare Advantage |
$738.16
|
| Rate for Payer: Cash Price |
$2,444.80
|
| Rate for Payer: Cash Price |
$2,444.80
|
| Rate for Payer: Cofinity Commercial |
$1,062.95
|
| Rate for Payer: Cofinity Commercial |
$989.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$738.16
|
| Rate for Payer: Healthscope Commercial |
$885.79
|
| Rate for Payer: Healthscope Whirlpool |
$885.79
|
| Rate for Payer: Meridian Medicaid |
$506.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$775.07
|
| Rate for Payer: PACE SWMI |
$738.16
|
| Rate for Payer: PHP Medicare Advantage |
$738.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$482.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,139.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,208.24
|
| Rate for Payer: Priority Health Medicare |
$738.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,208.24
|
| Rate for Payer: UHC Medicare Advantage |
$760.30
|
|
|
PR INSJ INTRA-AORT BALO ASSIST DEV VIA FEM ART OPEN
|
Professional
|
Both
|
$1,331.00
|
|
|
Service Code
|
HCPCS 33970
|
| Min. Negotiated Rate |
$219.82 |
| Max. Negotiated Rate |
$979.47 |
| Rate for Payer: Aetna Commercial |
$466.37
|
| Rate for Payer: Aetna Medicare |
$348.04
|
| Rate for Payer: BCBS Complete |
$230.81
|
| Rate for Payer: BCBS MAPPO |
$348.04
|
| Rate for Payer: BCBS Trust/PPO |
$979.47
|
| Rate for Payer: BCN Commercial |
$505.29
|
| Rate for Payer: BCN Medicare Advantage |
$348.04
|
| Rate for Payer: Cash Price |
$1,064.80
|
| Rate for Payer: Cash Price |
$1,064.80
|
| Rate for Payer: Cofinity Commercial |
$466.37
|
| Rate for Payer: Cofinity Commercial |
$501.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.04
|
| Rate for Payer: Healthscope Commercial |
$417.65
|
| Rate for Payer: Healthscope Whirlpool |
$417.65
|
| Rate for Payer: Meridian Medicaid |
$230.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$365.44
|
| Rate for Payer: PACE SWMI |
$348.04
|
| Rate for Payer: PHP Medicare Advantage |
$348.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$219.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$931.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$550.04
|
| Rate for Payer: Priority Health Medicare |
$348.04
|
| Rate for Payer: Priority Health Narrow Network |
$550.04
|
| Rate for Payer: UHC Medicare Advantage |
$358.48
|
|
|
PR INSJ MESH/PROSTH PELVIC FLOOR DEFECT EACH SITE
|
Professional
|
Both
|
$803.00
|
|
|
Service Code
|
HCPCS 57267
|
| Min. Negotiated Rate |
$158.90 |
| Max. Negotiated Rate |
$1,692.14 |
| Rate for Payer: Aetna Commercial |
$333.04
|
| Rate for Payer: Aetna Medicare |
$248.54
|
| Rate for Payer: BCBS Complete |
$166.84
|
| Rate for Payer: BCBS MAPPO |
$248.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,692.14
|
| Rate for Payer: BCN Commercial |
$363.58
|
| Rate for Payer: BCN Medicare Advantage |
$248.54
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cofinity Commercial |
$357.90
|
| Rate for Payer: Cofinity Commercial |
$333.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.54
|
| Rate for Payer: Healthscope Commercial |
$298.25
|
| Rate for Payer: Healthscope Whirlpool |
$298.25
|
| Rate for Payer: Meridian Medicaid |
$166.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$260.97
|
| Rate for Payer: PACE SWMI |
$248.54
|
| Rate for Payer: PHP Medicare Advantage |
$248.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$352.23
|
| Rate for Payer: Priority Health Medicare |
$248.54
|
| Rate for Payer: Priority Health Narrow Network |
$352.23
|
| Rate for Payer: UHC Medicare Advantage |
$256.00
|
|
|
PR INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH
|
Professional
|
Both
|
$1,437.00
|
|
|
Service Code
|
HCPCS 54405
|
| Min. Negotiated Rate |
$156.83 |
| Max. Negotiated Rate |
$1,288.75 |
| Rate for Payer: Aetna Commercial |
$1,058.25
|
| Rate for Payer: Aetna Medicare |
$789.74
|
| Rate for Payer: BCBS Complete |
$539.45
|
| Rate for Payer: BCBS MAPPO |
$789.74
|
| Rate for Payer: BCBS Trust/PPO |
$156.83
|
| Rate for Payer: BCN Commercial |
$1,165.50
|
| Rate for Payer: BCN Medicare Advantage |
$789.74
|
| Rate for Payer: Cash Price |
$1,149.60
|
| Rate for Payer: Cash Price |
$1,149.60
|
| Rate for Payer: Cofinity Commercial |
$1,058.25
|
| Rate for Payer: Cofinity Commercial |
$1,137.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$789.74
|
| Rate for Payer: Healthscope Commercial |
$947.69
|
| Rate for Payer: Healthscope Whirlpool |
$947.69
|
| Rate for Payer: Meridian Medicaid |
$539.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$829.23
|
| Rate for Payer: PACE SWMI |
$789.74
|
| Rate for Payer: PHP Medicare Advantage |
$789.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$513.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,288.75
|
| Rate for Payer: Priority Health Medicare |
$789.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,288.75
|
| Rate for Payer: UHC Medicare Advantage |
$813.43
|
|
|
PR INSJ NON-NDWELLG BLADDER CATHETER
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS 51701
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$661.43 |
| Rate for Payer: Aetna Commercial |
$33.57
|
| Rate for Payer: Aetna Medicare |
$25.05
|
| Rate for Payer: BCBS Complete |
$17.00
|
| Rate for Payer: BCBS MAPPO |
$25.05
|
| Rate for Payer: BCBS Trust/PPO |
$661.43
|
| Rate for Payer: BCN Commercial |
$52.23
|
| Rate for Payer: BCN Medicare Advantage |
$25.05
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cofinity Commercial |
$36.07
|
| Rate for Payer: Cofinity Commercial |
$33.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.05
|
| Rate for Payer: Healthscope Commercial |
$30.06
|
| Rate for Payer: Healthscope Whirlpool |
$30.06
|
| Rate for Payer: Meridian Medicaid |
$17.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.30
|
| Rate for Payer: PACE SWMI |
$25.05
|
| Rate for Payer: PHP Medicare Advantage |
$25.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.53
|
| Rate for Payer: Priority Health Medicare |
$25.05
|
| Rate for Payer: Priority Health Narrow Network |
$40.53
|
| Rate for Payer: UHC Medicare Advantage |
$25.80
|
|
|
PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y
|
Professional
|
Both
|
$983.00
|
|
|
Service Code
|
HCPCS 36555
|
| Min. Negotiated Rate |
$52.82 |
| Max. Negotiated Rate |
$898.64 |
| Rate for Payer: Aetna Commercial |
$112.08
|
| Rate for Payer: Aetna Medicare |
$83.64
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCBS MAPPO |
$83.64
|
| Rate for Payer: BCBS Trust/PPO |
$898.64
|
| Rate for Payer: BCN Commercial |
$277.56
|
| Rate for Payer: BCN Medicare Advantage |
$83.64
|
| Rate for Payer: Cash Price |
$786.40
|
| Rate for Payer: Cash Price |
$786.40
|
| Rate for Payer: Cofinity Commercial |
$112.08
|
| Rate for Payer: Cofinity Commercial |
$120.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.64
|
| Rate for Payer: Healthscope Commercial |
$100.37
|
| Rate for Payer: Healthscope Whirlpool |
$100.37
|
| Rate for Payer: Meridian Medicaid |
$55.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.82
|
| Rate for Payer: PACE SWMI |
$83.64
|
| Rate for Payer: PHP Medicare Advantage |
$83.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$688.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.46
|
| Rate for Payer: Priority Health Medicare |
$83.64
|
| Rate for Payer: Priority Health Narrow Network |
$132.46
|
| Rate for Payer: UHC Medicare Advantage |
$86.15
|
|
|
PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 36556
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$589.40 |
| Rate for Payer: Aetna Commercial |
$111.31
|
| Rate for Payer: Aetna Medicare |
$83.07
|
| Rate for Payer: BCBS Complete |
$55.69
|
| Rate for Payer: BCBS MAPPO |
$83.07
|
| Rate for Payer: BCBS Trust/PPO |
$253.58
|
| Rate for Payer: BCN Commercial |
$313.24
|
| Rate for Payer: BCN Medicare Advantage |
$83.07
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$119.62
|
| Rate for Payer: Cofinity Commercial |
$111.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.07
|
| Rate for Payer: Healthscope Commercial |
$99.68
|
| Rate for Payer: Healthscope Whirlpool |
$99.68
|
| Rate for Payer: Meridian Medicaid |
$55.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.22
|
| Rate for Payer: PACE SWMI |
$83.07
|
| Rate for Payer: PHP Medicare Advantage |
$83.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$589.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.93
|
| Rate for Payer: Priority Health Medicare |
$83.07
|
| Rate for Payer: Priority Health Narrow Network |
$131.93
|
| Rate for Payer: UHC Medicare Advantage |
$85.56
|
|
|
PR INSJ PENILE PROSTHESIS NON-INFLATABLE SEMI-RIGID
|
Professional
|
Both
|
$1,565.00
|
|
|
Service Code
|
HCPCS 54400
|
| Min. Negotiated Rate |
$199.17 |
| Max. Negotiated Rate |
$1,095.50 |
| Rate for Payer: Aetna Commercial |
$696.42
|
| Rate for Payer: Aetna Medicare |
$519.72
|
| Rate for Payer: BCBS Complete |
$356.95
|
| Rate for Payer: BCBS MAPPO |
$519.72
|
| Rate for Payer: BCBS Trust/PPO |
$199.17
|
| Rate for Payer: BCN Commercial |
$769.17
|
| Rate for Payer: BCN Medicare Advantage |
$519.72
|
| Rate for Payer: Cash Price |
$1,252.00
|
| Rate for Payer: Cash Price |
$1,252.00
|
| Rate for Payer: Cofinity Commercial |
$748.40
|
| Rate for Payer: Cofinity Commercial |
$696.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.72
|
| Rate for Payer: Healthscope Commercial |
$623.66
|
| Rate for Payer: Healthscope Whirlpool |
$623.66
|
| Rate for Payer: Meridian Medicaid |
$356.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$545.71
|
| Rate for Payer: PACE SWMI |
$519.72
|
| Rate for Payer: PHP Medicare Advantage |
$519.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$339.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,095.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$850.52
|
| Rate for Payer: Priority Health Medicare |
$519.72
|
| Rate for Payer: Priority Health Narrow Network |
$850.52
|
| Rate for Payer: UHC Medicare Advantage |
$535.31
|
|
