|
PR ELECTROACOUS EVAL HEARING AID BINAURAL
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 92595
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$338.64 |
| Rate for Payer: Aetna Commercial |
$49.30
|
| Rate for Payer: Aetna Medicare |
$39.50
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCBS Trust/PPO |
$338.64
|
| Rate for Payer: BCN Commercial |
$64.31
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.87
|
| Rate for Payer: Priority Health Narrow Network |
$62.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.69
|
| Rate for Payer: UHC Exchange |
$41.69
|
|
|
PR ELECTROACOUS EVAL HEARING AID MONAURAL
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 92594
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$231.15 |
| Rate for Payer: Aetna Commercial |
$22.43
|
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$231.15
|
| Rate for Payer: BCN Commercial |
$64.31
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.94
|
| Rate for Payer: Priority Health Narrow Network |
$28.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.35
|
| Rate for Payer: UHC Exchange |
$19.35
|
|
|
PR ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS 95824
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$502.89 |
| Rate for Payer: Aetna Commercial |
$106.88
|
| Rate for Payer: Aetna Medicare |
$100.50
|
| Rate for Payer: BCBS Complete |
$25.27
|
| Rate for Payer: BCBS Trust/PPO |
$262.57
|
| Rate for Payer: BCN Commercial |
$502.89
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Meridian Medicaid |
$25.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.57
|
| Rate for Payer: Priority Health Narrow Network |
$51.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.75
|
| Rate for Payer: UHC Exchange |
$73.75
|
| Rate for Payer: UHCCP Medicaid |
$24.07
|
|
|
PR ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN
|
Professional
|
Both
|
$753.00
|
|
|
Service Code
|
HCPCS 95812
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$1,286.41 |
| Rate for Payer: Aetna Commercial |
$364.65
|
| Rate for Payer: Aetna Medicare |
$376.50
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,286.41
|
| Rate for Payer: BCN Commercial |
$504.32
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$489.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.54
|
| Rate for Payer: Priority Health Narrow Network |
$75.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.11
|
| Rate for Payer: UHC Exchange |
$271.11
|
| Rate for Payer: UHCCP Medicaid |
$35.36
|
|
|
PR ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 95822
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$614.41 |
| Rate for Payer: Aetna Commercial |
$435.49
|
| Rate for Payer: Aetna Medicare |
$183.50
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCBS Trust/PPO |
$614.41
|
| Rate for Payer: BCN Commercial |
$607.43
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.54
|
| Rate for Payer: Priority Health Narrow Network |
$75.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.54
|
| Rate for Payer: UHC Exchange |
$262.54
|
| Rate for Payer: UHCCP Medicaid |
$35.36
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 95819
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$648.47 |
| Rate for Payer: Aetna Commercial |
$477.15
|
| Rate for Payer: Aetna Commercial |
$477.15
|
| Rate for Payer: Aetna Medicare |
$103.00
|
| Rate for Payer: Aetna Medicare |
$397.00
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCBS Trust/PPO |
$150.04
|
| Rate for Payer: BCBS Trust/PPO |
$150.04
|
| Rate for Payer: BCN Commercial |
$648.47
|
| Rate for Payer: BCN Commercial |
$648.47
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.54
|
| Rate for Payer: Priority Health Narrow Network |
$75.54
|
| Rate for Payer: Priority Health Narrow Network |
$75.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.22
|
| Rate for Payer: UHC Exchange |
$272.22
|
| Rate for Payer: UHC Exchange |
$272.22
|
| Rate for Payer: UHCCP Medicaid |
$35.36
|
| Rate for Payer: UHCCP Medicaid |
$35.36
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 95816
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$559.05 |
| Rate for Payer: Aetna Commercial |
$398.47
|
| Rate for Payer: Aetna Commercial |
$398.47
|
| Rate for Payer: Aetna Medicare |
$141.00
|
| Rate for Payer: Aetna Medicare |
$346.00
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCBS Trust/PPO |
$231.92
|
| Rate for Payer: BCBS Trust/PPO |
$231.92
|
| Rate for Payer: BCN Commercial |
$559.05
|
| Rate for Payer: BCN Commercial |
$559.05
|
| Rate for Payer: Cash Price |
$553.60
|
| Rate for Payer: Cash Price |
$553.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.54
|
| Rate for Payer: Priority Health Narrow Network |
$75.54
|
| Rate for Payer: Priority Health Narrow Network |
$75.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.18
|
| Rate for Payer: UHC Exchange |
$249.18
|
| Rate for Payer: UHC Exchange |
$249.18
|
| Rate for Payer: UHCCP Medicaid |
$35.36
|
| Rate for Payer: UHCCP Medicaid |
$35.36
|
|
|
PR ELECTROGASTROGRAPHY DX TRANSCUTANEOUS
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 91132
|
| Min. Negotiated Rate |
$34.83 |
| Max. Negotiated Rate |
$652.87 |
| Rate for Payer: Aetna Commercial |
$438.73
|
| Rate for Payer: Aetna Medicare |
$141.00
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: BCBS Trust/PPO |
$538.87
|
| Rate for Payer: BCN Commercial |
$652.87
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.83
|
| Rate for Payer: Priority Health Narrow Network |
$34.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.11
|
| Rate for Payer: UHC Exchange |
$40.11
|
|
|
PR ELECTRONIC ALYS ANTITACHYCARDIA PACEMAKER SYS
|
Professional
|
Both
|
$571.00
|
|
|
Service Code
|
HCPCS 93724
|
| Min. Negotiated Rate |
$99.85 |
| Max. Negotiated Rate |
$409.52 |
| Rate for Payer: Aetna Commercial |
$311.50
|
| Rate for Payer: Aetna Medicare |
$285.50
|
| Rate for Payer: BCBS Complete |
$154.77
|
| Rate for Payer: BCBS Trust/PPO |
$99.85
|
| Rate for Payer: BCN Commercial |
$409.52
|
| Rate for Payer: Cash Price |
$456.80
|
| Rate for Payer: Cash Price |
$456.80
|
| Rate for Payer: Meridian Medicaid |
$154.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$324.40
|
| Rate for Payer: Priority Health Narrow Network |
$324.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.00
|
| Rate for Payer: UHC Exchange |
$330.00
|
| Rate for Payer: UHCCP Medicaid |
$147.40
|
|
|
PR ELEVATION DEPRESSED SKULL FX SIMPLE EXTRADURAL
|
Professional
|
Both
|
$4,144.00
|
|
|
Service Code
|
HCPCS 62000
|
| Min. Negotiated Rate |
$679.04 |
| Max. Negotiated Rate |
$2,693.60 |
| Rate for Payer: Aetna Commercial |
$1,335.49
|
| Rate for Payer: Aetna Medicare |
$2,072.00
|
| Rate for Payer: BCBS Complete |
$712.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,847.99
|
| Rate for Payer: BCN Commercial |
$1,533.47
|
| Rate for Payer: Cash Price |
$3,315.20
|
| Rate for Payer: Cash Price |
$3,315.20
|
| Rate for Payer: Meridian Medicaid |
$712.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$679.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,693.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,802.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,802.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,118.77
|
| Rate for Payer: UHC Exchange |
$1,118.77
|
| Rate for Payer: UHCCP Medicaid |
$679.04
|
|
|
PR ELVTN DEPRS SKL FX COMPOUND/COMMIND XDRL
|
Professional
|
Both
|
$5,239.00
|
|
|
Service Code
|
HCPCS 62005
|
| Min. Negotiated Rate |
$833.04 |
| Max. Negotiated Rate |
$3,405.35 |
| Rate for Payer: Aetna Commercial |
$1,642.59
|
| Rate for Payer: Aetna Medicare |
$2,619.50
|
| Rate for Payer: BCBS Complete |
$874.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,278.49
|
| Rate for Payer: BCN Commercial |
$2,612.76
|
| Rate for Payer: Cash Price |
$4,191.20
|
| Rate for Payer: Cash Price |
$4,191.20
|
| Rate for Payer: Meridian Medicaid |
$874.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$833.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,405.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,213.44
|
| Rate for Payer: Priority Health Narrow Network |
$2,213.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,451.14
|
| Rate for Payer: UHC Exchange |
$1,451.14
|
| Rate for Payer: UHCCP Medicaid |
$833.04
|
|
|
PR ELVTN DEPRS SKL FX W/RPR DURA&/DBRDMT BRN
|
Professional
|
Both
|
$6,878.00
|
|
|
Service Code
|
HCPCS 62010
|
| Min. Negotiated Rate |
$1,004.93 |
| Max. Negotiated Rate |
$4,470.70 |
| Rate for Payer: Aetna Commercial |
$1,985.02
|
| Rate for Payer: Aetna Medicare |
$3,439.00
|
| Rate for Payer: BCBS Complete |
$1,055.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,117.43
|
| Rate for Payer: BCN Commercial |
$3,154.42
|
| Rate for Payer: Cash Price |
$5,502.40
|
| Rate for Payer: Cash Price |
$5,502.40
|
| Rate for Payer: Meridian Medicaid |
$1,055.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,004.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,470.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,671.25
|
| Rate for Payer: Priority Health Narrow Network |
$2,671.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,753.18
|
| Rate for Payer: UHC Exchange |
$1,753.18
|
| Rate for Payer: UHCCP Medicaid |
$1,004.93
|
|
|
PR E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 99318
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$94.25 |
| Rate for Payer: Aetna Medicare |
$72.50
|
| Rate for Payer: BCBS Complete |
$58.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
|
|
PR EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART
|
Professional
|
Both
|
$2,337.00
|
|
|
Service Code
|
HCPCS 34101
|
| Min. Negotiated Rate |
$374.24 |
| Max. Negotiated Rate |
$1,746.03 |
| Rate for Payer: Aetna Commercial |
$800.84
|
| Rate for Payer: Aetna Medicare |
$1,168.50
|
| Rate for Payer: BCBS Complete |
$392.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,746.03
|
| Rate for Payer: BCN Commercial |
$854.70
|
| Rate for Payer: Cash Price |
$1,869.60
|
| Rate for Payer: Cash Price |
$1,869.60
|
| Rate for Payer: Meridian Medicaid |
$392.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$374.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,519.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$930.69
|
| Rate for Payer: Priority Health Narrow Network |
$930.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$808.73
|
| Rate for Payer: UHC Exchange |
$808.73
|
| Rate for Payer: UHCCP Medicaid |
$374.24
|
|
|
PR EMBLC/THRMBC CATH CRTD SUBCLA/INNOMINATE ART
|
Professional
|
Both
|
$2,034.00
|
|
|
Service Code
|
HCPCS 34001
|
| Min. Negotiated Rate |
$573.18 |
| Max. Negotiated Rate |
$1,434.86 |
| Rate for Payer: Aetna Commercial |
$1,229.89
|
| Rate for Payer: Aetna Medicare |
$1,017.00
|
| Rate for Payer: BCBS Complete |
$601.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,434.86
|
| Rate for Payer: BCN Commercial |
$1,305.26
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Meridian Medicaid |
$601.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,426.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,426.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,289.95
|
| Rate for Payer: UHC Exchange |
$1,289.95
|
| Rate for Payer: UHCCP Medicaid |
$573.18
|
|
|
PR EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART
|
Professional
|
Both
|
$1,995.00
|
|
|
Service Code
|
HCPCS 34201
|
| Min. Negotiated Rate |
$637.94 |
| Max. Negotiated Rate |
$2,634.63 |
| Rate for Payer: Aetna Commercial |
$1,375.38
|
| Rate for Payer: Aetna Medicare |
$997.50
|
| Rate for Payer: BCBS Complete |
$669.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,634.63
|
| Rate for Payer: BCN Commercial |
$1,457.73
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: Meridian Medicaid |
$669.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$637.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,296.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,591.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,591.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,368.91
|
| Rate for Payer: UHC Exchange |
$1,368.91
|
| Rate for Payer: UHCCP Medicaid |
$637.94
|
|
|
PR EMBLC/THRMBC INNOMINATE SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$2,010.00
|
|
|
Service Code
|
HCPCS 34051
|
| Min. Negotiated Rate |
$627.50 |
| Max. Negotiated Rate |
$2,053.50 |
| Rate for Payer: Aetna Commercial |
$1,330.19
|
| Rate for Payer: Aetna Medicare |
$1,005.00
|
| Rate for Payer: BCBS Complete |
$658.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,053.50
|
| Rate for Payer: BCN Commercial |
$1,427.42
|
| Rate for Payer: Cash Price |
$1,608.00
|
| Rate for Payer: Cash Price |
$1,608.00
|
| Rate for Payer: Meridian Medicaid |
$658.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$627.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,306.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,558.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,558.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,284.24
|
| Rate for Payer: UHC Exchange |
$1,284.24
|
| Rate for Payer: UHCCP Medicaid |
$627.50
|
|
|
PR EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC
|
Professional
|
Both
|
$1,977.00
|
|
|
Service Code
|
HCPCS 34203
|
| Min. Negotiated Rate |
$593.63 |
| Max. Negotiated Rate |
$3,301.73 |
| Rate for Payer: Aetna Commercial |
$1,273.42
|
| Rate for Payer: Aetna Medicare |
$988.50
|
| Rate for Payer: BCBS Complete |
$623.31
|
| Rate for Payer: BCBS Trust/PPO |
$3,301.73
|
| Rate for Payer: BCN Commercial |
$1,353.15
|
| Rate for Payer: Cash Price |
$1,581.60
|
| Rate for Payer: Cash Price |
$1,581.60
|
| Rate for Payer: Meridian Medicaid |
$623.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$593.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,479.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,479.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,295.40
|
| Rate for Payer: UHC Exchange |
$1,295.40
|
| Rate for Payer: UHCCP Medicaid |
$593.63
|
|
|
PR EMBLC/THRMBC RNL CELIAC MESENTRY AORTO-ILIAC ART
|
Professional
|
Both
|
$2,730.00
|
|
|
Service Code
|
HCPCS 34151
|
| Min. Negotiated Rate |
$870.11 |
| Max. Negotiated Rate |
$2,233.15 |
| Rate for Payer: Aetna Commercial |
$1,868.74
|
| Rate for Payer: Aetna Medicare |
$1,365.00
|
| Rate for Payer: BCBS Complete |
$913.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,233.15
|
| Rate for Payer: BCN Commercial |
$1,987.94
|
| Rate for Payer: Cash Price |
$2,184.00
|
| Rate for Payer: Cash Price |
$2,184.00
|
| Rate for Payer: Meridian Medicaid |
$913.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$870.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,774.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,168.25
|
| Rate for Payer: Priority Health Narrow Network |
$2,168.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,873.34
|
| Rate for Payer: UHC Exchange |
$1,873.34
|
| Rate for Payer: UHCCP Medicaid |
$870.11
|
|
|
PR EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC
|
Professional
|
Both
|
$1,258.00
|
|
|
Service Code
|
HCPCS 34111
|
| Min. Negotiated Rate |
$373.39 |
| Max. Negotiated Rate |
$1,789.88 |
| Rate for Payer: Aetna Commercial |
$804.67
|
| Rate for Payer: Aetna Medicare |
$629.00
|
| Rate for Payer: BCBS Complete |
$392.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.88
|
| Rate for Payer: BCN Commercial |
$857.63
|
| Rate for Payer: Cash Price |
$1,006.40
|
| Rate for Payer: Cash Price |
$1,006.40
|
| Rate for Payer: Meridian Medicaid |
$392.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$373.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$929.64
|
| Rate for Payer: Priority Health Narrow Network |
$929.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$808.18
|
| Rate for Payer: UHC Exchange |
$808.18
|
| Rate for Payer: UHCCP Medicaid |
$373.39
|
|
|
PR EMERGENCY DEPARTMENT VISIT HIGH MDM
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
HCPCS 99285
|
| Min. Negotiated Rate |
$77.24 |
| Max. Negotiated Rate |
$932.45 |
| Rate for Payer: Aetna Commercial |
$179.88
|
| Rate for Payer: Aetna Medicare |
$185.50
|
| Rate for Payer: BCBS Complete |
$81.10
|
| Rate for Payer: BCBS Trust/PPO |
$932.45
|
| Rate for Payer: BCN Commercial |
$254.60
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Meridian Medicaid |
$81.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$299.15
|
| Rate for Payer: Priority Health Narrow Network |
$299.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.88
|
| Rate for Payer: UHC Exchange |
$191.88
|
| Rate for Payer: UHCCP Medicaid |
$77.24
|
|
|
PR EMERGENCY DEPARTMENT VISIT LOW MDM
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 99283
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$72.50
|
| Rate for Payer: Aetna Medicare |
$86.50
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS Trust/PPO |
$75.14
|
| Rate for Payer: BCN Commercial |
$104.09
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.00
|
| Rate for Payer: Priority Health Narrow Network |
$114.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.74
|
| Rate for Payer: UHC Exchange |
$68.74
|
| Rate for Payer: UHCCP Medicaid |
$44.94
|
|
|
PR EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 99281
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$171.07 |
| Rate for Payer: Aetna Commercial |
$22.17
|
| Rate for Payer: Aetna Medicare |
$46.50
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: BCBS Trust/PPO |
$171.07
|
| Rate for Payer: BCN Commercial |
$17.10
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Meridian Medicaid |
$7.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.89
|
| Rate for Payer: Priority Health Narrow Network |
$36.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.03
|
| Rate for Payer: UHC Exchange |
$23.03
|
| Rate for Payer: UHCCP Medicaid |
$7.24
|
|
|
PR EMERGENCY DEPARTMENT VISIT MODERATE MDM
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 99284
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$203.10 |
| Rate for Payer: Aetna Commercial |
$123.22
|
| Rate for Payer: Aetna Medicare |
$124.50
|
| Rate for Payer: BCBS Complete |
$80.51
|
| Rate for Payer: BCBS Trust/PPO |
$46.49
|
| Rate for Payer: BCN Commercial |
$174.95
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Meridian Medicaid |
$80.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$203.10
|
| Rate for Payer: Priority Health Narrow Network |
$203.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.37
|
| Rate for Payer: UHC Exchange |
$130.37
|
| Rate for Payer: UHCCP Medicaid |
$76.68
|
|
|
PR EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 99282
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$338.11 |
| Rate for Payer: Aetna Commercial |
$42.97
|
| Rate for Payer: Aetna Medicare |
$59.00
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS Trust/PPO |
$338.11
|
| Rate for Payer: BCN Commercial |
$60.60
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Meridian Medicaid |
$27.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.81
|
| Rate for Payer: Priority Health Narrow Network |
$71.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.30
|
| Rate for Payer: UHC Exchange |
$45.30
|
| Rate for Payer: UHCCP Medicaid |
$26.63
|
|
