|
PR DIR/PTCH CLS SINUS VENOSUS W/WO ANOM PUL VEN DRG
|
Professional
|
Both
|
$7,628.00
|
|
|
Service Code
|
HCPCS 33645
|
| Min. Negotiated Rate |
$1,089.50 |
| Max. Negotiated Rate |
$4,958.20 |
| Rate for Payer: Aetna Commercial |
$2,324.74
|
| Rate for Payer: Aetna Medicare |
$3,814.00
|
| Rate for Payer: BCBS Complete |
$1,143.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,139.01
|
| Rate for Payer: BCN Commercial |
$2,482.48
|
| Rate for Payer: Cash Price |
$6,102.40
|
| Rate for Payer: Cash Price |
$6,102.40
|
| Rate for Payer: Meridian Medicaid |
$1,143.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,958.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,712.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,712.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,075.94
|
| Rate for Payer: UHC Exchange |
$2,075.94
|
| Rate for Payer: UHCCP Medicaid |
$1,089.50
|
|
|
PR DIR RPR ANEURYSM ABDOM AORTA W/ILIAC VESSELS
|
Professional
|
Both
|
$3,721.00
|
|
|
Service Code
|
HCPCS 35102
|
| Min. Negotiated Rate |
$1,172.57 |
| Max. Negotiated Rate |
$2,929.82 |
| Rate for Payer: Aetna Commercial |
$2,527.67
|
| Rate for Payer: Aetna Medicare |
$1,860.50
|
| Rate for Payer: BCBS Complete |
$1,231.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,938.33
|
| Rate for Payer: BCN Commercial |
$2,674.05
|
| Rate for Payer: Cash Price |
$2,976.80
|
| Rate for Payer: Cash Price |
$2,976.80
|
| Rate for Payer: Meridian Medicaid |
$1,231.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,172.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,418.65
|
| 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 |
$2,553.70
|
| Rate for Payer: UHC Exchange |
$2,553.70
|
| Rate for Payer: UHCCP Medicaid |
$1,172.57
|
|
|
PR DIR RPR ANEURYSM ABDOM AORTA W/VISCERAL VESSELS
|
Professional
|
Both
|
$3,573.00
|
|
|
Service Code
|
HCPCS 35091
|
| Min. Negotiated Rate |
$1,111.22 |
| Max. Negotiated Rate |
$2,767.61 |
| Rate for Payer: Aetna Commercial |
$2,414.09
|
| Rate for Payer: Aetna Medicare |
$1,786.50
|
| Rate for Payer: BCBS Complete |
$1,166.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.81
|
| Rate for Payer: BCN Commercial |
$2,536.73
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Meridian Medicaid |
$1,166.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,111.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,322.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,767.61
|
| Rate for Payer: Priority Health Narrow Network |
$2,767.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,449.93
|
| Rate for Payer: UHC Exchange |
$2,449.93
|
| Rate for Payer: UHCCP Medicaid |
$1,111.22
|
|
|
PR DIR RPR ANEURYSM ABDOMINAL AORTA
|
Professional
|
Both
|
$5,682.00
|
|
|
Service Code
|
HCPCS 35081
|
| Min. Negotiated Rate |
$1,079.27 |
| Max. Negotiated Rate |
$3,693.30 |
| Rate for Payer: Aetna Commercial |
$2,327.67
|
| Rate for Payer: Aetna Medicare |
$2,841.00
|
| Rate for Payer: BCBS Complete |
$1,133.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,076.67
|
| Rate for Payer: BCN Commercial |
$2,467.34
|
| Rate for Payer: Cash Price |
$4,545.60
|
| Rate for Payer: Cash Price |
$4,545.60
|
| Rate for Payer: Meridian Medicaid |
$1,133.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,079.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,693.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,694.76
|
| Rate for Payer: Priority Health Narrow Network |
$2,694.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,357.21
|
| Rate for Payer: UHC Exchange |
$2,357.21
|
| Rate for Payer: UHCCP Medicaid |
$1,079.27
|
|
|
PR DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION
|
Professional
|
Both
|
$3,720.00
|
|
|
Service Code
|
HCPCS 35011
|
| Min. Negotiated Rate |
$631.55 |
| Max. Negotiated Rate |
$2,418.00 |
| Rate for Payer: Aetna Commercial |
$1,351.29
|
| Rate for Payer: Aetna Medicare |
$1,860.00
|
| Rate for Payer: BCBS Complete |
$663.13
|
| Rate for Payer: BCBS Trust/PPO |
$767.09
|
| Rate for Payer: BCN Commercial |
$1,445.02
|
| Rate for Payer: Cash Price |
$2,976.00
|
| Rate for Payer: Cash Price |
$2,976.00
|
| Rate for Payer: Meridian Medicaid |
$663.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$631.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,418.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,578.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,578.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,333.46
|
| Rate for Payer: UHC Exchange |
$1,333.46
|
| Rate for Payer: UHCCP Medicaid |
$631.55
|
|
|
PR DIR RPR ANEURYSM CAROTID-SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$2,213.00
|
|
|
Service Code
|
HCPCS 35001
|
| Min. Negotiated Rate |
$694.17 |
| Max. Negotiated Rate |
$2,601.88 |
| Rate for Payer: Aetna Commercial |
$1,514.12
|
| Rate for Payer: Aetna Medicare |
$1,106.50
|
| Rate for Payer: BCBS Complete |
$728.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,601.88
|
| Rate for Payer: BCN Commercial |
$1,607.75
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Meridian Medicaid |
$728.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$694.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,438.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,751.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,751.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,520.29
|
| Rate for Payer: UHC Exchange |
$1,520.29
|
| Rate for Payer: UHCCP Medicaid |
$694.17
|
|
|
PR DIR RPR ANEURYSM & GRAFT COMMON FEMORAL ARTERY
|
Professional
|
Both
|
$2,176.00
|
|
|
Service Code
|
HCPCS 35141
|
| Min. Negotiated Rate |
$381.43 |
| Max. Negotiated Rate |
$1,701.84 |
| Rate for Payer: Aetna Commercial |
$1,476.41
|
| Rate for Payer: Aetna Medicare |
$1,088.00
|
| Rate for Payer: BCBS Complete |
$716.57
|
| Rate for Payer: BCBS Trust/PPO |
$381.43
|
| Rate for Payer: BCN Commercial |
$1,560.35
|
| Rate for Payer: Cash Price |
$1,740.80
|
| Rate for Payer: Cash Price |
$1,740.80
|
| Rate for Payer: Meridian Medicaid |
$716.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$682.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,701.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,701.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,493.48
|
| Rate for Payer: UHC Exchange |
$1,493.48
|
| Rate for Payer: UHCCP Medicaid |
$682.45
|
|
|
PR DIR RPR ANEURYSM & GRAFT ILIAC ARTERY
|
Professional
|
Both
|
$4,955.00
|
|
|
Service Code
|
HCPCS 35131
|
| Min. Negotiated Rate |
$866.27 |
| Max. Negotiated Rate |
$3,220.75 |
| Rate for Payer: Aetna Commercial |
$1,850.09
|
| Rate for Payer: Aetna Medicare |
$2,477.50
|
| Rate for Payer: BCBS Complete |
$909.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,490.86
|
| Rate for Payer: BCN Commercial |
$1,965.95
|
| Rate for Payer: Cash Price |
$3,964.00
|
| Rate for Payer: Cash Price |
$3,964.00
|
| Rate for Payer: Meridian Medicaid |
$909.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$866.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,220.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,152.83
|
| Rate for Payer: Priority Health Narrow Network |
$2,152.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,879.84
|
| Rate for Payer: UHC Exchange |
$1,879.84
|
| Rate for Payer: UHCCP Medicaid |
$866.27
|
|
|
PR DIR RPR ANEURYSM & GRAFT POPLITEAL ARTERY
|
Professional
|
Both
|
$2,457.00
|
|
|
Service Code
|
HCPCS 35151
|
| Min. Negotiated Rate |
$773.40 |
| Max. Negotiated Rate |
$1,934.78 |
| Rate for Payer: Aetna Commercial |
$1,658.62
|
| Rate for Payer: Aetna Medicare |
$1,228.50
|
| Rate for Payer: BCBS Complete |
$812.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,760.30
|
| Rate for Payer: BCN Commercial |
$1,767.55
|
| Rate for Payer: Cash Price |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,965.60
|
| Rate for Payer: Meridian Medicaid |
$812.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$773.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,597.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,934.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,934.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,686.80
|
| Rate for Payer: UHC Exchange |
$1,686.80
|
| Rate for Payer: UHCCP Medicaid |
$773.40
|
|
|
PR DIR RPR ANEURYSM HEPATIC/CELIAC/RENAL/MESENTERIC
|
Professional
|
Both
|
$3,196.00
|
|
|
Service Code
|
HCPCS 35121
|
| Min. Negotiated Rate |
$283.70 |
| Max. Negotiated Rate |
$2,461.29 |
| Rate for Payer: Aetna Commercial |
$2,126.67
|
| Rate for Payer: Aetna Medicare |
$1,598.00
|
| Rate for Payer: BCBS Complete |
$1,037.74
|
| Rate for Payer: BCBS Trust/PPO |
$283.70
|
| Rate for Payer: BCN Commercial |
$2,251.83
|
| Rate for Payer: Cash Price |
$2,556.80
|
| Rate for Payer: Cash Price |
$2,556.80
|
| Rate for Payer: Meridian Medicaid |
$1,037.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$988.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,077.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,461.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,461.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,213.68
|
| Rate for Payer: UHC Exchange |
$2,213.68
|
| Rate for Payer: UHCCP Medicaid |
$988.32
|
|
|
PR DIR RPR ANEURYSM SPLENIC ARTERY
|
Professional
|
Both
|
$2,774.00
|
|
|
Service Code
|
HCPCS 35111
|
| Min. Negotiated Rate |
$831.55 |
| Max. Negotiated Rate |
$2,070.93 |
| Rate for Payer: Aetna Commercial |
$1,786.57
|
| Rate for Payer: Aetna Medicare |
$1,387.00
|
| Rate for Payer: BCBS Complete |
$873.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.86
|
| Rate for Payer: BCN Commercial |
$1,895.09
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Meridian Medicaid |
$873.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$831.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,070.93
|
| Rate for Payer: Priority Health Narrow Network |
$2,070.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,873.63
|
| Rate for Payer: UHC Exchange |
$1,873.63
|
| Rate for Payer: UHCCP Medicaid |
$831.55
|
|
|
PR DIR RPR RUPTD ANEURSM ABDOM AORTA W/VISCERA VSLS
|
Professional
|
Both
|
$5,498.00
|
|
|
Service Code
|
HCPCS 35092
|
| Min. Negotiated Rate |
$1,619.44 |
| Max. Negotiated Rate |
$4,038.14 |
| Rate for Payer: Aetna Commercial |
$3,485.74
|
| Rate for Payer: Aetna Medicare |
$2,749.00
|
| Rate for Payer: BCBS Complete |
$1,700.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,136.58
|
| Rate for Payer: BCN Commercial |
$3,681.69
|
| Rate for Payer: Cash Price |
$4,398.40
|
| Rate for Payer: Cash Price |
$4,398.40
|
| Rate for Payer: Meridian Medicaid |
$1,700.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,619.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,573.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,038.14
|
| Rate for Payer: Priority Health Narrow Network |
$4,038.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,523.35
|
| Rate for Payer: UHC Exchange |
$3,523.35
|
| Rate for Payer: UHCCP Medicaid |
$1,619.44
|
|
|
PR DIR RPR RUPTD ANEURSM HEPATIC/CELIAC/RENAL/MESEN
|
Professional
|
Both
|
$3,859.00
|
|
|
Service Code
|
HCPCS 35122
|
| Min. Negotiated Rate |
$1,180.87 |
| Max. Negotiated Rate |
$2,943.64 |
| Rate for Payer: Aetna Commercial |
$2,544.07
|
| Rate for Payer: Aetna Medicare |
$1,929.50
|
| Rate for Payer: BCBS Complete |
$1,239.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,197.66
|
| Rate for Payer: BCN Commercial |
$2,691.64
|
| Rate for Payer: Cash Price |
$3,087.20
|
| Rate for Payer: Cash Price |
$3,087.20
|
| Rate for Payer: Meridian Medicaid |
$1,239.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,180.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,508.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,943.64
|
| Rate for Payer: Priority Health Narrow Network |
$2,943.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,668.09
|
| Rate for Payer: UHC Exchange |
$2,668.09
|
| Rate for Payer: UHCCP Medicaid |
$1,180.87
|
|
|
PR DIR RPR RUPTD ANEURYSM ABDOM AORTA W/ILIAC VSLS
|
Professional
|
Both
|
$3,560.00
|
|
|
Service Code
|
HCPCS 35103
|
| Min. Negotiated Rate |
$621.81 |
| Max. Negotiated Rate |
$3,448.88 |
| Rate for Payer: Aetna Commercial |
$2,999.96
|
| Rate for Payer: Aetna Medicare |
$1,780.00
|
| Rate for Payer: BCBS Complete |
$1,420.40
|
| Rate for Payer: BCBS Trust/PPO |
$621.81
|
| Rate for Payer: BCN Commercial |
$3,166.15
|
| Rate for Payer: Cash Price |
$2,848.00
|
| Rate for Payer: Cash Price |
$2,848.00
|
| Rate for Payer: Meridian Medicaid |
$1,420.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,352.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,314.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,448.88
|
| Rate for Payer: Priority Health Narrow Network |
$3,448.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,030.89
|
| Rate for Payer: UHC Exchange |
$3,030.89
|
| Rate for Payer: UHCCP Medicaid |
$1,352.76
|
|
|
PR DIR RPR RUPTD ANEURYSM ABDOMINAL AORTA
|
Professional
|
Both
|
$4,286.00
|
|
|
Service Code
|
HCPCS 35082
|
| Min. Negotiated Rate |
$750.19 |
| Max. Negotiated Rate |
$3,363.78 |
| Rate for Payer: Aetna Commercial |
$2,925.76
|
| Rate for Payer: Aetna Medicare |
$2,143.00
|
| Rate for Payer: BCBS Complete |
$1,419.96
|
| Rate for Payer: BCBS Trust/PPO |
$750.19
|
| Rate for Payer: BCN Commercial |
$3,083.06
|
| Rate for Payer: Cash Price |
$3,428.80
|
| Rate for Payer: Cash Price |
$3,428.80
|
| Rate for Payer: Meridian Medicaid |
$1,419.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,352.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,785.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,363.78
|
| Rate for Payer: Priority Health Narrow Network |
$3,363.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,941.30
|
| Rate for Payer: UHC Exchange |
$2,941.30
|
| Rate for Payer: UHCCP Medicaid |
$1,352.34
|
|
|
PR DIR RPR RUPTD ANEURYSM AXIL-BRACHIAL ARM INCIS
|
Professional
|
Both
|
$3,927.00
|
|
|
Service Code
|
HCPCS 35013
|
| Min. Negotiated Rate |
$741.88 |
| Max. Negotiated Rate |
$2,552.55 |
| Rate for Payer: Aetna Commercial |
$1,693.49
|
| Rate for Payer: Aetna Medicare |
$1,963.50
|
| Rate for Payer: BCBS Complete |
$778.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,152.22
|
| Rate for Payer: BCN Commercial |
$1,815.92
|
| Rate for Payer: Cash Price |
$3,141.60
|
| Rate for Payer: Cash Price |
$3,141.60
|
| Rate for Payer: Meridian Medicaid |
$778.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$741.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,552.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,981.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,981.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,660.33
|
| Rate for Payer: UHC Exchange |
$1,660.33
|
| Rate for Payer: UHCCP Medicaid |
$741.88
|
|
|
PR DIR RPR RUPTD ANEURYSM CAROTID-SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$2,542.00
|
|
|
Service Code
|
HCPCS 35002
|
| Min. Negotiated Rate |
$712.91 |
| Max. Negotiated Rate |
$2,959.01 |
| Rate for Payer: Aetna Commercial |
$1,529.14
|
| Rate for Payer: Aetna Medicare |
$1,271.00
|
| Rate for Payer: BCBS Complete |
$748.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,959.01
|
| Rate for Payer: BCN Commercial |
$1,623.38
|
| Rate for Payer: Cash Price |
$2,033.60
|
| Rate for Payer: Cash Price |
$2,033.60
|
| Rate for Payer: Meridian Medicaid |
$748.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$712.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,652.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,775.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,775.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,612.50
|
| Rate for Payer: UHC Exchange |
$1,612.50
|
| Rate for Payer: UHCCP Medicaid |
$712.91
|
|
|
PR DIR RPR RUPTD ANEURYSM & GRAFT ILIAC ARTERY
|
Professional
|
Both
|
$3,452.00
|
|
|
Service Code
|
HCPCS 35132
|
| Min. Negotiated Rate |
$1,021.55 |
| Max. Negotiated Rate |
$2,544.79 |
| Rate for Payer: Aetna Commercial |
$2,198.85
|
| Rate for Payer: Aetna Medicare |
$1,726.00
|
| Rate for Payer: BCBS Complete |
$1,072.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,010.18
|
| Rate for Payer: BCN Commercial |
$2,328.55
|
| Rate for Payer: Cash Price |
$2,761.60
|
| Rate for Payer: Cash Price |
$2,761.60
|
| Rate for Payer: Meridian Medicaid |
$1,072.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,021.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,243.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,544.79
|
| Rate for Payer: Priority Health Narrow Network |
$2,544.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,284.59
|
| Rate for Payer: UHC Exchange |
$2,284.59
|
| Rate for Payer: UHCCP Medicaid |
$1,021.55
|
|
|
PR DIR RPR RUPTD ANEURYSM & GRF COMMON FEMORAL ART
|
Professional
|
Both
|
$2,610.00
|
|
|
Service Code
|
HCPCS 35142
|
| Min. Negotiated Rate |
$571.62 |
| Max. Negotiated Rate |
$2,055.50 |
| Rate for Payer: Aetna Commercial |
$1,780.33
|
| Rate for Payer: Aetna Medicare |
$1,305.00
|
| Rate for Payer: BCBS Complete |
$865.53
|
| Rate for Payer: BCBS Trust/PPO |
$571.62
|
| Rate for Payer: BCN Commercial |
$1,884.34
|
| Rate for Payer: Cash Price |
$2,088.00
|
| Rate for Payer: Cash Price |
$2,088.00
|
| Rate for Payer: Meridian Medicaid |
$865.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$824.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,696.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,055.50
|
| Rate for Payer: Priority Health Narrow Network |
$2,055.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,790.81
|
| Rate for Payer: UHC Exchange |
$1,790.81
|
| Rate for Payer: UHCCP Medicaid |
$824.31
|
|
|
PR DIR RPR RUPTD ANEURYSM & GRF POPLITEAL ARTERY
|
Professional
|
Both
|
$2,737.00
|
|
|
Service Code
|
HCPCS 35152
|
| Min. Negotiated Rate |
$874.58 |
| Max. Negotiated Rate |
$2,435.46 |
| Rate for Payer: Aetna Commercial |
$1,879.21
|
| Rate for Payer: Aetna Medicare |
$1,368.50
|
| Rate for Payer: BCBS Complete |
$918.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,435.46
|
| Rate for Payer: BCN Commercial |
$1,992.34
|
| Rate for Payer: Cash Price |
$2,189.60
|
| Rate for Payer: Cash Price |
$2,189.60
|
| Rate for Payer: Meridian Medicaid |
$918.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$874.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,779.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,177.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,177.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,954.94
|
| Rate for Payer: UHC Exchange |
$1,954.94
|
| Rate for Payer: UHCCP Medicaid |
$874.58
|
|
|
PR DIR RPR RUPTD ANEURYSM INNOMINATE/SUBCLAVIAN
|
Professional
|
Both
|
$2,934.00
|
|
|
Service Code
|
HCPCS 35022
|
| Min. Negotiated Rate |
$906.74 |
| Max. Negotiated Rate |
$2,253.34 |
| Rate for Payer: Aetna Commercial |
$1,935.64
|
| Rate for Payer: Aetna Medicare |
$1,467.00
|
| Rate for Payer: BCBS Complete |
$952.08
|
| Rate for Payer: BCN Commercial |
$2,065.64
|
| Rate for Payer: Cash Price |
$2,347.20
|
| Rate for Payer: Cash Price |
$2,347.20
|
| Rate for Payer: Meridian Medicaid |
$952.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$906.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,907.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,253.34
|
| Rate for Payer: Priority Health Narrow Network |
$2,253.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,851.23
|
| Rate for Payer: UHC Exchange |
$1,851.23
|
| Rate for Payer: UHCCP Medicaid |
$906.74
|
|
|
PR DIR RPR RUPTD ANEURYSM RADIAL/ULNAR ARTERY
|
Professional
|
Both
|
$3,424.00
|
|
|
Service Code
|
HCPCS 35045
|
| Min. Negotiated Rate |
$606.84 |
| Max. Negotiated Rate |
$2,225.60 |
| Rate for Payer: Aetna Commercial |
$1,308.16
|
| Rate for Payer: Aetna Medicare |
$1,712.00
|
| Rate for Payer: BCBS Complete |
$637.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,582.22
|
| Rate for Payer: BCN Commercial |
$1,389.31
|
| Rate for Payer: Cash Price |
$2,739.20
|
| Rate for Payer: Cash Price |
$2,739.20
|
| Rate for Payer: Meridian Medicaid |
$637.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$606.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,225.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,515.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,515.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,298.33
|
| Rate for Payer: UHC Exchange |
$1,298.33
|
| Rate for Payer: UHCCP Medicaid |
$606.84
|
|
|
PR DISARTICULATION HIP
|
Professional
|
Both
|
$5,432.00
|
|
|
Service Code
|
HCPCS 27295
|
| Min. Negotiated Rate |
$809.19 |
| Max. Negotiated Rate |
$3,530.80 |
| Rate for Payer: Aetna Commercial |
$1,675.17
|
| Rate for Payer: Aetna Medicare |
$2,716.00
|
| Rate for Payer: BCBS Complete |
$849.65
|
| Rate for Payer: BCBS Trust/PPO |
$3,334.10
|
| Rate for Payer: BCN Commercial |
$1,837.92
|
| Rate for Payer: Cash Price |
$4,345.60
|
| Rate for Payer: Cash Price |
$4,345.60
|
| Rate for Payer: Meridian Medicaid |
$849.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$809.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,530.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,930.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,930.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,479.07
|
| Rate for Payer: UHC Exchange |
$1,479.07
|
| Rate for Payer: UHCCP Medicaid |
$809.19
|
|
|
PR DISARTICULATION KNEE
|
Professional
|
Both
|
$2,933.00
|
|
|
Service Code
|
HCPCS 27598
|
| Min. Negotiated Rate |
$446.87 |
| Max. Negotiated Rate |
$1,906.45 |
| Rate for Payer: Aetna Commercial |
$947.37
|
| Rate for Payer: Aetna Medicare |
$1,466.50
|
| Rate for Payer: BCBS Complete |
$469.21
|
| Rate for Payer: BCBS Trust/PPO |
$797.73
|
| Rate for Payer: BCN Commercial |
$1,014.00
|
| Rate for Payer: Cash Price |
$2,346.40
|
| Rate for Payer: Cash Price |
$2,346.40
|
| Rate for Payer: Meridian Medicaid |
$469.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$446.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,906.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,057.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,057.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$875.51
|
| Rate for Payer: UHC Exchange |
$875.51
|
| Rate for Payer: UHCCP Medicaid |
$446.87
|
|
|
PR DISARTICULATION SHOULDER
|
Professional
|
Both
|
$1,996.00
|
|
|
Service Code
|
HCPCS 23920
|
| Min. Negotiated Rate |
$491.15 |
| Max. Negotiated Rate |
$1,727.08 |
| Rate for Payer: Aetna Commercial |
$1,500.60
|
| Rate for Payer: Aetna Medicare |
$998.00
|
| Rate for Payer: BCBS Complete |
$765.33
|
| Rate for Payer: BCBS Trust/PPO |
$491.15
|
| Rate for Payer: BCN Commercial |
$1,644.89
|
| Rate for Payer: Cash Price |
$1,596.80
|
| Rate for Payer: Cash Price |
$1,596.80
|
| Rate for Payer: Meridian Medicaid |
$765.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$728.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,297.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,727.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,727.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,261.09
|
| Rate for Payer: UHC Exchange |
$1,261.09
|
| Rate for Payer: UHCCP Medicaid |
$728.89
|
|
