|
PR BYP OTH/THN VEIN COMMON-IPSILATERAL CAROTID
|
Professional
|
Both
|
$2,942.00
|
|
|
Service Code
|
HCPCS 35601
|
| Min. Negotiated Rate |
$879.05 |
| Max. Negotiated Rate |
$2,180.48 |
| Rate for Payer: Aetna Commercial |
$1,879.18
|
| Rate for Payer: Aetna Medicare |
$1,471.00
|
| Rate for Payer: BCBS Complete |
$923.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,268.45
|
| Rate for Payer: BCN Commercial |
$2,000.16
|
| Rate for Payer: Cash Price |
$2,353.60
|
| Rate for Payer: Cash Price |
$2,353.60
|
| Rate for Payer: Meridian Medicaid |
$923.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$879.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,912.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,180.48
|
| Rate for Payer: Priority Health Narrow Network |
$2,180.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,957.43
|
| Rate for Payer: UHC Exchange |
$1,957.43
|
| Rate for Payer: UHCCP Medicaid |
$879.05
|
|
|
PR BYP OTH/THN VEIN FEM-ANT TIBL PST TIBL/PRONEAL
|
Professional
|
Both
|
$4,208.00
|
|
|
Service Code
|
HCPCS 35666
|
| Min. Negotiated Rate |
$802.16 |
| Max. Negotiated Rate |
$2,735.20 |
| Rate for Payer: Aetna Commercial |
$1,724.92
|
| Rate for Payer: Aetna Medicare |
$2,104.00
|
| Rate for Payer: BCBS Complete |
$842.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,310.71
|
| Rate for Payer: BCN Commercial |
$1,839.87
|
| Rate for Payer: Cash Price |
$3,366.40
|
| Rate for Payer: Cash Price |
$3,366.40
|
| Rate for Payer: Meridian Medicaid |
$842.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$802.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,735.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,005.51
|
| Rate for Payer: Priority Health Narrow Network |
$2,005.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,717.18
|
| Rate for Payer: UHC Exchange |
$1,717.18
|
| Rate for Payer: UHCCP Medicaid |
$802.16
|
|
|
PR BYP OTH/THN VEIN FEMORAL-FEMORAL
|
Professional
|
Both
|
$2,253.00
|
|
|
Service Code
|
HCPCS 35661
|
| Min. Negotiated Rate |
$676.49 |
| Max. Negotiated Rate |
$1,686.42 |
| Rate for Payer: Aetna Commercial |
$1,456.02
|
| Rate for Payer: Aetna Medicare |
$1,126.50
|
| Rate for Payer: BCBS Complete |
$710.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,335.54
|
| Rate for Payer: BCN Commercial |
$1,546.17
|
| Rate for Payer: Cash Price |
$1,802.40
|
| Rate for Payer: Cash Price |
$1,802.40
|
| Rate for Payer: Meridian Medicaid |
$710.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$676.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,464.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,686.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,686.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,468.88
|
| Rate for Payer: UHC Exchange |
$1,468.88
|
| Rate for Payer: UHCCP Medicaid |
$676.49
|
|
|
PR BYP OTH/THN VEIN FEMORAL-POPLITEAL
|
Professional
|
Both
|
$2,278.00
|
|
|
Service Code
|
HCPCS 35656
|
| Min. Negotiated Rate |
$668.82 |
| Max. Negotiated Rate |
$1,669.93 |
| Rate for Payer: Aetna Commercial |
$1,449.39
|
| Rate for Payer: Aetna Medicare |
$1,139.00
|
| Rate for Payer: BCBS Complete |
$702.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,054.49
|
| Rate for Payer: BCN Commercial |
$1,532.49
|
| Rate for Payer: Cash Price |
$1,822.40
|
| Rate for Payer: Cash Price |
$1,822.40
|
| Rate for Payer: Meridian Medicaid |
$702.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$668.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,669.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,669.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,462.94
|
| Rate for Payer: UHC Exchange |
$1,462.94
|
| Rate for Payer: UHCCP Medicaid |
$668.82
|
|
|
PR BYP OTH/THN VEIN ILIOFEMORAL
|
Professional
|
Both
|
$4,582.00
|
|
|
Service Code
|
HCPCS 35665
|
| Min. Negotiated Rate |
$732.08 |
| Max. Negotiated Rate |
$2,978.30 |
| Rate for Payer: Aetna Commercial |
$1,576.23
|
| Rate for Payer: Aetna Medicare |
$2,291.00
|
| Rate for Payer: BCBS Complete |
$768.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,269.50
|
| Rate for Payer: BCN Commercial |
$1,673.23
|
| Rate for Payer: Cash Price |
$3,665.60
|
| Rate for Payer: Cash Price |
$3,665.60
|
| Rate for Payer: Meridian Medicaid |
$768.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$732.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,978.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,828.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,828.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,592.49
|
| Rate for Payer: UHC Exchange |
$1,592.49
|
| Rate for Payer: UHCCP Medicaid |
$732.08
|
|
|
PR BYP OTH/THN VEIN POPLITEAL-TIBIAL/-PERONEAL ART
|
Professional
|
Both
|
$2,203.00
|
|
|
Service Code
|
HCPCS 35671
|
| Min. Negotiated Rate |
$703.75 |
| Max. Negotiated Rate |
$1,765.67 |
| Rate for Payer: Aetna Commercial |
$1,517.78
|
| Rate for Payer: Aetna Medicare |
$1,101.50
|
| Rate for Payer: BCBS Complete |
$738.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,384.67
|
| Rate for Payer: BCN Commercial |
$1,621.43
|
| Rate for Payer: Cash Price |
$1,762.40
|
| Rate for Payer: Cash Price |
$1,762.40
|
| Rate for Payer: Meridian Medicaid |
$738.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$703.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,431.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,765.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,765.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,513.40
|
| Rate for Payer: UHC Exchange |
$1,513.40
|
| Rate for Payer: UHCCP Medicaid |
$703.75
|
|
|
PR BYP OTH/THN VEIN SUBCLAVIAN-SUBCLAVIAN
|
Professional
|
Both
|
$2,244.00
|
|
|
Service Code
|
HCPCS 35612
|
| Min. Negotiated Rate |
$655.19 |
| Max. Negotiated Rate |
$2,601.35 |
| Rate for Payer: Aetna Commercial |
$1,403.00
|
| Rate for Payer: Aetna Medicare |
$1,122.00
|
| Rate for Payer: BCBS Complete |
$687.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,601.35
|
| Rate for Payer: BCN Commercial |
$1,491.44
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Meridian Medicaid |
$687.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$655.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,458.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,631.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,631.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,231.94
|
| Rate for Payer: UHC Exchange |
$1,231.94
|
| Rate for Payer: UHCCP Medicaid |
$655.19
|
|
|
PR BYP TIBL-TIBL/PRONEAL-TIBL/TIBL/PRONEAL TRK-TIBL
|
Professional
|
Both
|
$2,798.00
|
|
|
Service Code
|
HCPCS 35570
|
| Min. Negotiated Rate |
$921.44 |
| Max. Negotiated Rate |
$2,296.41 |
| Rate for Payer: Aetna Commercial |
$1,981.51
|
| Rate for Payer: Aetna Medicare |
$1,399.00
|
| Rate for Payer: BCBS Complete |
$967.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,043.92
|
| Rate for Payer: BCN Commercial |
$2,098.87
|
| Rate for Payer: Cash Price |
$2,238.40
|
| Rate for Payer: Cash Price |
$2,238.40
|
| Rate for Payer: Meridian Medicaid |
$967.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$921.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,818.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,296.41
|
| Rate for Payer: Priority Health Narrow Network |
$2,296.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,919.14
|
| Rate for Payer: UHC Exchange |
$1,919.14
|
| Rate for Payer: UHCCP Medicaid |
$921.44
|
|
|
PR BYP W/VEIN POP-TIBL-PRONEAL ART/OTH DSTL VSL
|
Professional
|
Both
|
$5,238.00
|
|
|
Service Code
|
HCPCS 35571
|
| Min. Negotiated Rate |
$826.01 |
| Max. Negotiated Rate |
$3,404.70 |
| Rate for Payer: Aetna Commercial |
$1,782.25
|
| Rate for Payer: Aetna Medicare |
$2,619.00
|
| Rate for Payer: BCBS Complete |
$867.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,402.64
|
| Rate for Payer: BCN Commercial |
$1,886.79
|
| Rate for Payer: Cash Price |
$4,190.40
|
| Rate for Payer: Cash Price |
$4,190.40
|
| Rate for Payer: Meridian Medicaid |
$867.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$826.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,404.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,059.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,059.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,810.06
|
| Rate for Payer: UHC Exchange |
$1,810.06
|
| Rate for Payer: UHCCP Medicaid |
$826.01
|
|
|
PR CABG W/ARTERIAL GRAFT FOUR/>ARTERIAL GRAFTS
|
Professional
|
Both
|
$5,502.00
|
|
|
Service Code
|
HCPCS 33536
|
| Min. Negotiated Rate |
$1,086.18 |
| Max. Negotiated Rate |
$4,118.44 |
| Rate for Payer: Aetna Commercial |
$3,540.72
|
| Rate for Payer: Aetna Medicare |
$2,751.00
|
| Rate for Payer: BCBS Complete |
$1,738.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.18
|
| Rate for Payer: BCN Commercial |
$3,767.70
|
| Rate for Payer: Cash Price |
$4,401.60
|
| Rate for Payer: Cash Price |
$4,401.60
|
| Rate for Payer: Meridian Medicaid |
$1,738.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,655.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,576.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,118.44
|
| Rate for Payer: Priority Health Narrow Network |
$4,118.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,500.83
|
| Rate for Payer: UHC Exchange |
$3,500.83
|
| Rate for Payer: UHCCP Medicaid |
$1,655.86
|
|
|
PR CABG W/ARTERIAL GRAFT SINGLE ARTERIAL GRAFT
|
Professional
|
Both
|
$3,911.00
|
|
|
Service Code
|
HCPCS 33533
|
| Min. Negotiated Rate |
$1,178.10 |
| Max. Negotiated Rate |
$2,929.82 |
| Rate for Payer: Aetna Commercial |
$2,513.12
|
| Rate for Payer: Aetna Medicare |
$1,955.50
|
| Rate for Payer: BCBS Complete |
$1,237.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,225.66
|
| Rate for Payer: BCN Commercial |
$2,682.84
|
| Rate for Payer: Cash Price |
$3,128.80
|
| Rate for Payer: Cash Price |
$3,128.80
|
| Rate for Payer: Meridian Medicaid |
$1,237.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,178.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,542.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,929.82
|
| Rate for Payer: Priority Health Narrow Network |
$2,929.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,491.63
|
| Rate for Payer: UHC Exchange |
$2,491.63
|
| Rate for Payer: UHCCP Medicaid |
$1,178.10
|
|
|
PR CABG W/ARTERIAL GRAFT THREE ARTERIAL GRAFTS
|
Professional
|
Both
|
$5,136.00
|
|
|
Service Code
|
HCPCS 33535
|
| Min. Negotiated Rate |
$1,100.98 |
| Max. Negotiated Rate |
$3,822.22 |
| Rate for Payer: Aetna Commercial |
$3,289.41
|
| Rate for Payer: Aetna Medicare |
$2,568.00
|
| Rate for Payer: BCBS Complete |
$1,614.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,100.98
|
| Rate for Payer: BCN Commercial |
$3,501.37
|
| Rate for Payer: Cash Price |
$4,108.80
|
| Rate for Payer: Cash Price |
$4,108.80
|
| Rate for Payer: Meridian Medicaid |
$1,614.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,537.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,338.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,822.22
|
| Rate for Payer: Priority Health Narrow Network |
$3,822.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,255.93
|
| Rate for Payer: UHC Exchange |
$3,255.93
|
| Rate for Payer: UHCCP Medicaid |
$1,537.22
|
|
|
PR CABG W/ARTERIAL GRAFT TWO ARTERIAL GRAFTS
|
Professional
|
Both
|
$4,602.00
|
|
|
Service Code
|
HCPCS 33534
|
| Min. Negotiated Rate |
$1,126.86 |
| Max. Negotiated Rate |
$3,440.38 |
| Rate for Payer: Aetna Commercial |
$2,950.85
|
| Rate for Payer: Aetna Medicare |
$2,301.00
|
| Rate for Payer: BCBS Complete |
$1,453.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,126.86
|
| Rate for Payer: BCN Commercial |
$3,149.04
|
| Rate for Payer: Cash Price |
$3,681.60
|
| Rate for Payer: Cash Price |
$3,681.60
|
| Rate for Payer: Meridian Medicaid |
$1,453.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,383.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,991.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,440.38
|
| Rate for Payer: Priority Health Narrow Network |
$3,440.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,922.46
|
| Rate for Payer: UHC Exchange |
$2,922.46
|
| Rate for Payer: UHCCP Medicaid |
$1,383.86
|
|
|
PR CALIBRATED MICROCAP TUBE
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS A4651
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCN Commercial |
$1.86
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
|
|
PR CALORIC VESTIBULAR TEST, EACH IRRIGATION, WITH RECORDING
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS 92543
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Aetna Medicare |
$9.50
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.35
|
|
|
PR CANALITH REPOSITIONING PROCEDURE
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 95992
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$189.13 |
| Rate for Payer: Aetna Commercial |
$40.81
|
| Rate for Payer: Aetna Medicare |
$65.50
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS Trust/PPO |
$189.13
|
| Rate for Payer: BCN Commercial |
$63.04
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.94
|
| Rate for Payer: Priority Health Narrow Network |
$47.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.39
|
| Rate for Payer: UHC Exchange |
$40.39
|
|
|
PR CANTHOPLASTY
|
Professional
|
Both
|
$1,146.00
|
|
|
Service Code
|
HCPCS 67950
|
| Min. Negotiated Rate |
$293.09 |
| Max. Negotiated Rate |
$2,419.61 |
| Rate for Payer: Aetna Commercial |
$599.67
|
| Rate for Payer: Aetna Medicare |
$573.00
|
| Rate for Payer: BCBS Complete |
$307.74
|
| Rate for Payer: BCBS Trust/PPO |
$2,419.61
|
| Rate for Payer: BCN Commercial |
$850.79
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Meridian Medicaid |
$307.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$293.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$803.66
|
| Rate for Payer: Priority Health Narrow Network |
$803.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$498.84
|
| Rate for Payer: UHC Exchange |
$498.84
|
| Rate for Payer: UHCCP Medicaid |
$293.09
|
|
|
PR CANTHOTOMY SEPARATE PROCEDURE
|
Professional
|
Both
|
$374.00
|
|
|
Service Code
|
HCPCS 67715
|
| Min. Negotiated Rate |
$69.01 |
| Max. Negotiated Rate |
$523.55 |
| Rate for Payer: Aetna Commercial |
$139.69
|
| Rate for Payer: Aetna Medicare |
$187.00
|
| Rate for Payer: BCBS Complete |
$72.46
|
| Rate for Payer: BCBS Trust/PPO |
$523.55
|
| Rate for Payer: BCN Commercial |
$388.50
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Meridian Medicaid |
$72.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.75
|
| Rate for Payer: Priority Health Narrow Network |
$187.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.61
|
| Rate for Payer: UHC Exchange |
$115.61
|
| Rate for Payer: UHCCP Medicaid |
$69.01
|
|
|
PR CAPSLCTOMY/CAPSUL HIP W/RLS HIP FLXR MUSC
|
Professional
|
Both
|
$4,799.00
|
|
|
Service Code
|
HCPCS 27036
|
| Min. Negotiated Rate |
$197.75 |
| Max. Negotiated Rate |
$3,119.35 |
| Rate for Payer: Aetna Commercial |
$1,355.49
|
| Rate for Payer: Aetna Medicare |
$2,399.50
|
| Rate for Payer: BCBS Complete |
$694.88
|
| Rate for Payer: BCBS Trust/PPO |
$197.75
|
| Rate for Payer: BCN Commercial |
$1,492.42
|
| Rate for Payer: Cash Price |
$3,839.20
|
| Rate for Payer: Cash Price |
$3,839.20
|
| Rate for Payer: Meridian Medicaid |
$694.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$661.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,119.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,568.31
|
| Rate for Payer: Priority Health Narrow Network |
$1,568.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,156.34
|
| Rate for Payer: UHC Exchange |
$1,156.34
|
| Rate for Payer: UHCCP Medicaid |
$661.79
|
|
|
PR CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS
|
Professional
|
Both
|
$1,755.00
|
|
|
Service Code
|
HCPCS 25320
|
| Min. Negotiated Rate |
$400.98 |
| Max. Negotiated Rate |
$1,533.19 |
| Rate for Payer: Aetna Commercial |
$1,305.27
|
| Rate for Payer: Aetna Medicare |
$877.50
|
| Rate for Payer: BCBS Complete |
$681.24
|
| Rate for Payer: BCBS Trust/PPO |
$400.98
|
| Rate for Payer: BCN Commercial |
$1,454.79
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Meridian Medicaid |
$681.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$648.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,140.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,533.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,533.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,110.23
|
| Rate for Payer: UHC Exchange |
$1,110.23
|
| Rate for Payer: UHCCP Medicaid |
$648.80
|
|
|
PR CAPSULAR CONTRACTURE RELEASE
|
Professional
|
Both
|
$2,010.00
|
|
|
Service Code
|
HCPCS 23020
|
| Min. Negotiated Rate |
$282.11 |
| Max. Negotiated Rate |
$1,306.50 |
| Rate for Payer: Aetna Commercial |
$919.64
|
| Rate for Payer: Aetna Medicare |
$1,005.00
|
| Rate for Payer: BCBS Complete |
$474.59
|
| Rate for Payer: BCBS Trust/PPO |
$282.11
|
| Rate for Payer: BCN Commercial |
$1,017.92
|
| Rate for Payer: Cash Price |
$1,608.00
|
| Rate for Payer: Cash Price |
$1,608.00
|
| Rate for Payer: Meridian Medicaid |
$474.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$451.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,306.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,068.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,068.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$785.59
|
| Rate for Payer: UHC Exchange |
$785.59
|
| Rate for Payer: UHCCP Medicaid |
$451.99
|
|
|
PR CAPSULECTOMY/CAPSULOTOMY IPHAL JOINT EACH
|
Professional
|
Both
|
$1,586.00
|
|
|
Service Code
|
HCPCS 26525
|
| Min. Negotiated Rate |
$440.70 |
| Max. Negotiated Rate |
$1,128.45 |
| Rate for Payer: Aetna Commercial |
$907.21
|
| Rate for Payer: Aetna Medicare |
$793.00
|
| Rate for Payer: BCBS Complete |
$462.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,128.45
|
| Rate for Payer: BCN Commercial |
$1,021.83
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Meridian Medicaid |
$462.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,030.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,060.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,060.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$715.33
|
| Rate for Payer: UHC Exchange |
$715.33
|
| Rate for Payer: UHCCP Medicaid |
$440.70
|
|
|
PR CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH
|
Professional
|
Both
|
$1,586.00
|
|
|
Service Code
|
HCPCS 26520
|
| Min. Negotiated Rate |
$437.50 |
| Max. Negotiated Rate |
$1,062.94 |
| Rate for Payer: Aetna Commercial |
$904.90
|
| Rate for Payer: Aetna Medicare |
$793.00
|
| Rate for Payer: BCBS Complete |
$459.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,062.94
|
| Rate for Payer: BCN Commercial |
$1,017.43
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Meridian Medicaid |
$459.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$437.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,030.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,054.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,054.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$714.17
|
| Rate for Payer: UHC Exchange |
$714.17
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
|
|
PR CAPSUL MTTARPHLNGL JT W/WO TENORRHAPHY EA JT SPX
|
Professional
|
Both
|
$802.00
|
|
|
Service Code
|
HCPCS 28270
|
| Min. Negotiated Rate |
$218.11 |
| Max. Negotiated Rate |
$706.63 |
| Rate for Payer: Aetna Commercial |
$440.61
|
| Rate for Payer: Aetna Medicare |
$401.00
|
| Rate for Payer: BCBS Complete |
$229.02
|
| Rate for Payer: BCBS Trust/PPO |
$265.73
|
| Rate for Payer: BCN Commercial |
$706.63
|
| Rate for Payer: Cash Price |
$641.60
|
| Rate for Payer: Cash Price |
$641.60
|
| Rate for Payer: Meridian Medicaid |
$229.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$218.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$515.47
|
| Rate for Payer: Priority Health Narrow Network |
$515.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.53
|
| Rate for Payer: UHC Exchange |
$389.53
|
| Rate for Payer: UHCCP Medicaid |
$218.11
|
|
|
PR CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT
|
Professional
|
Both
|
$2,003.00
|
|
|
Service Code
|
HCPCS 26516
|
| Min. Negotiated Rate |
$480.95 |
| Max. Negotiated Rate |
$3,178.25 |
| Rate for Payer: Aetna Commercial |
$983.79
|
| Rate for Payer: Aetna Medicare |
$1,001.50
|
| Rate for Payer: BCBS Complete |
$505.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,178.25
|
| Rate for Payer: BCN Commercial |
$1,105.87
|
| Rate for Payer: Cash Price |
$1,602.40
|
| Rate for Payer: Cash Price |
$1,602.40
|
| Rate for Payer: Meridian Medicaid |
$505.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$480.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,301.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,150.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,150.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$775.50
|
| Rate for Payer: UHC Exchange |
$775.50
|
| Rate for Payer: UHCCP Medicaid |
$480.95
|
|
