|
PR ESRD RELATED SVC MONTHLY 20&/> YR OLD 4/> VISITS
|
Professional
|
Both
|
$492.00
|
|
|
Service Code
|
HCPCS 90960
|
| Min. Negotiated Rate |
$225.78 |
| Max. Negotiated Rate |
$508.71 |
| Rate for Payer: Aetna Commercial |
$394.57
|
| Rate for Payer: Aetna Medicare |
$246.00
|
| Rate for Payer: BCBS Complete |
$237.07
|
| Rate for Payer: BCBS Trust/PPO |
$226.11
|
| Rate for Payer: BCN Commercial |
$508.71
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Meridian Medicaid |
$237.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$474.93
|
| Rate for Payer: Priority Health Narrow Network |
$474.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.17
|
| Rate for Payer: UHC Exchange |
$305.17
|
| Rate for Payer: UHCCP Medicaid |
$225.78
|
|
|
PR ESRD SVC HOME DIALYSIS FULL MONTH 20 YR OLD
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 90966
|
| Min. Negotiated Rate |
$187.44 |
| Max. Negotiated Rate |
$422.71 |
| Rate for Payer: Aetna Commercial |
$325.90
|
| Rate for Payer: Aetna Medicare |
$212.50
|
| Rate for Payer: BCBS Complete |
$196.81
|
| Rate for Payer: BCBS Trust/PPO |
$211.32
|
| Rate for Payer: BCN Commercial |
$422.71
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Meridian Medicaid |
$196.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.42
|
| Rate for Payer: Priority Health Narrow Network |
$394.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.79
|
| Rate for Payer: UHC Exchange |
$244.79
|
| Rate for Payer: UHCCP Medicaid |
$187.44
|
|
|
PR ESW BY PHYS W/ANES INVG LAT HUMERL EPICONDYLE
|
Professional
|
Both
|
$2,655.00
|
|
|
Service Code
|
HCPCS 0102T
|
| Min. Negotiated Rate |
$132.14 |
| Max. Negotiated Rate |
$2,753.41 |
| Rate for Payer: Aetna Commercial |
$391.44
|
| Rate for Payer: Aetna Medicare |
$1,327.50
|
| Rate for Payer: BCBS Complete |
$1,062.00
|
| Rate for Payer: BCBS Trust/PPO |
$132.14
|
| Rate for Payer: BCN Commercial |
$2,753.41
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,725.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$331.54
|
| Rate for Payer: UHC Exchange |
$331.54
|
|
|
PR ETHMOIDECTOMY INTRANASAL ANTERIOR
|
Professional
|
Both
|
$2,550.00
|
|
|
Service Code
|
HCPCS 31200
|
| Min. Negotiated Rate |
$398.74 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: Aetna Commercial |
$785.39
|
| Rate for Payer: Aetna Medicare |
$1,275.00
|
| Rate for Payer: BCBS Complete |
$418.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,062.94
|
| Rate for Payer: BCN Commercial |
$920.18
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Meridian Medicaid |
$418.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$875.95
|
| Rate for Payer: Priority Health Narrow Network |
$875.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$581.74
|
| Rate for Payer: UHC Exchange |
$581.74
|
| Rate for Payer: UHCCP Medicaid |
$398.74
|
|
|
PR ETHMOIDECTOMY INTRANASAL TOTAL
|
Professional
|
Both
|
$1,534.00
|
|
|
Service Code
|
HCPCS 31201
|
| Min. Negotiated Rate |
$498.21 |
| Max. Negotiated Rate |
$1,178.69 |
| Rate for Payer: Aetna Commercial |
$1,010.10
|
| Rate for Payer: Aetna Medicare |
$767.00
|
| Rate for Payer: BCBS Complete |
$523.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,073.51
|
| Rate for Payer: BCN Commercial |
$1,178.69
|
| Rate for Payer: Cash Price |
$1,227.20
|
| Rate for Payer: Cash Price |
$1,227.20
|
| Rate for Payer: Meridian Medicaid |
$523.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$498.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,091.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,091.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$793.64
|
| Rate for Payer: UHC Exchange |
$793.64
|
| Rate for Payer: UHCCP Medicaid |
$498.21
|
|
|
PR ETONOGESTREL IMPLANT SYSTEM
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS J7307
|
| Min. Negotiated Rate |
$681.50 |
| Max. Negotiated Rate |
$1,351.89 |
| Rate for Payer: Aetna Commercial |
$1,092.48
|
| Rate for Payer: Aetna Medicare |
$681.50
|
| Rate for Payer: BCBS Complete |
$1,351.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,107.77
|
| Rate for Payer: BCN Commercial |
$1,107.77
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Meridian Medicaid |
$1,351.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,287.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,190.97
|
| Rate for Payer: UHC Exchange |
$1,190.97
|
| Rate for Payer: UHCCP Medicaid |
$1,287.51
|
|
|
PR EUFLEXXA INJ PER DOSE
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS J7323
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$191.75 |
| Rate for Payer: Aetna Commercial |
$131.12
|
| Rate for Payer: Aetna Medicare |
$147.50
|
| Rate for Payer: BCBS Complete |
$118.00
|
| Rate for Payer: BCBS Trust/PPO |
$129.70
|
| Rate for Payer: BCN Commercial |
$137.68
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.98
|
| Rate for Payer: UHC Exchange |
$121.98
|
|
|
PR EVACUATION SUBUNGUAL HEMATOMA
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 11740
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$116.11 |
| Rate for Payer: Aetna Commercial |
$31.68
|
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$22.14
|
| Rate for Payer: BCBS Trust/PPO |
$116.11
|
| Rate for Payer: BCN Commercial |
$67.15
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Meridian Medicaid |
$22.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.80
|
| Rate for Payer: Priority Health Narrow Network |
$43.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.27
|
| Rate for Payer: UHC Exchange |
$32.27
|
| Rate for Payer: UHCCP Medicaid |
$21.09
|
|
|
PR EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 92626
|
| Min. Negotiated Rate |
$47.29 |
| Max. Negotiated Rate |
$126.57 |
| Rate for Payer: Aetna Commercial |
$82.97
|
| Rate for Payer: Aetna Medicare |
$92.00
|
| Rate for Payer: BCBS Complete |
$49.65
|
| Rate for Payer: BCN Commercial |
$126.57
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Meridian Medicaid |
$49.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.51
|
| Rate for Payer: Priority Health Narrow Network |
$99.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.74
|
| Rate for Payer: UHC Exchange |
$82.74
|
| Rate for Payer: UHCCP Medicaid |
$47.29
|
|
|
PR EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 92627
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$29.81 |
| Rate for Payer: Aetna Commercial |
$19.69
|
| Rate for Payer: Aetna Medicare |
$22.00
|
| Rate for Payer: BCBS Complete |
$11.63
|
| Rate for Payer: BCN Commercial |
$29.81
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Meridian Medicaid |
$11.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.52
|
| Rate for Payer: Priority Health Narrow Network |
$23.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.90
|
| Rate for Payer: UHC Exchange |
$19.90
|
| Rate for Payer: UHCCP Medicaid |
$11.08
|
|
|
PR EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 92620
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$295.85 |
| Rate for Payer: Aetna Commercial |
$88.66
|
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS Trust/PPO |
$295.85
|
| Rate for Payer: BCN Commercial |
$129.01
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.84
|
| Rate for Payer: Priority Health Narrow Network |
$105.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.54
|
| Rate for Payer: UHC Exchange |
$79.54
|
|
|
PR EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 92621
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$281.58 |
| Rate for Payer: Aetna Commercial |
$20.83
|
| Rate for Payer: Aetna Medicare |
$20.00
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$281.58
|
| Rate for Payer: BCN Commercial |
$31.76
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.88
|
| Rate for Payer: Priority Health Narrow Network |
$24.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.07
|
| Rate for Payer: UHC Exchange |
$18.07
|
|
|
PR EVAL OF ORTHOTIC/PROSTH USE, EA 15 MIN
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 97762
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
|
|
PR EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 92523
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$1,440.15 |
| Rate for Payer: Aetna Commercial |
$210.67
|
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,440.15
|
| Rate for Payer: BCN Commercial |
$331.82
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$309.39
|
| Rate for Payer: Priority Health Narrow Network |
$309.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.12
|
| Rate for Payer: UHC Exchange |
$205.12
|
|
|
PR EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 92521
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$1,170.71 |
| Rate for Payer: Aetna Commercial |
$122.55
|
| Rate for Payer: Aetna Medicare |
$105.50
|
| Rate for Payer: BCBS Complete |
$84.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,170.71
|
| Rate for Payer: BCN Commercial |
$193.52
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.48
|
| Rate for Payer: Priority Health Narrow Network |
$180.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.58
|
| Rate for Payer: UHC Exchange |
$121.58
|
|
|
PR EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 92522
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$1,580.15 |
| Rate for Payer: Aetna Commercial |
$102.73
|
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,580.15
|
| Rate for Payer: BCN Commercial |
$161.75
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.07
|
| Rate for Payer: Priority Health Narrow Network |
$151.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.82
|
| Rate for Payer: UHC Exchange |
$98.82
|
|
|
PR EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART 1ST
|
Professional
|
Both
|
$1,105.00
|
|
|
Service Code
|
HCPCS 61650
|
| Min. Negotiated Rate |
$318.04 |
| Max. Negotiated Rate |
$990.71 |
| Rate for Payer: Aetna Commercial |
$737.29
|
| Rate for Payer: Aetna Medicare |
$552.50
|
| Rate for Payer: BCBS Complete |
$393.84
|
| Rate for Payer: BCBS Trust/PPO |
$318.04
|
| Rate for Payer: BCN Commercial |
$832.21
|
| Rate for Payer: Cash Price |
$884.00
|
| Rate for Payer: Cash Price |
$884.00
|
| Rate for Payer: Meridian Medicaid |
$393.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$718.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$990.71
|
| Rate for Payer: Priority Health Narrow Network |
$990.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$667.98
|
| Rate for Payer: UHC Exchange |
$667.98
|
| Rate for Payer: UHCCP Medicaid |
$375.09
|
|
|
PR EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART ADDL
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 61651
|
| Min. Negotiated Rate |
$160.18 |
| Max. Negotiated Rate |
$423.13 |
| Rate for Payer: Aetna Commercial |
$316.17
|
| Rate for Payer: Aetna Medicare |
$235.00
|
| Rate for Payer: BCBS Complete |
$168.19
|
| Rate for Payer: BCBS Trust/PPO |
$301.13
|
| Rate for Payer: BCN Commercial |
$358.20
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Meridian Medicaid |
$168.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$423.13
|
| Rate for Payer: Priority Health Narrow Network |
$423.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.69
|
| Rate for Payer: UHC Exchange |
$283.69
|
| Rate for Payer: UHCCP Medicaid |
$160.18
|
|
|
PR EVASC PLACEMENT ILIAC ARTERY OCCLUSION DEVICE
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 34808
|
| Min. Negotiated Rate |
$125.88 |
| Max. Negotiated Rate |
$314.31 |
| Rate for Payer: Aetna Commercial |
$268.94
|
| Rate for Payer: Aetna Medicare |
$222.50
|
| Rate for Payer: BCBS Complete |
$132.17
|
| Rate for Payer: BCBS Trust/PPO |
$212.38
|
| Rate for Payer: BCN Commercial |
$287.83
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Meridian Medicaid |
$132.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$314.31
|
| Rate for Payer: Priority Health Narrow Network |
$314.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$276.49
|
| Rate for Payer: UHC Exchange |
$276.49
|
| Rate for Payer: UHCCP Medicaid |
$125.88
|
|
|
PR EVASC RPR DPLMNT AORTO-AORTIC NDGFT
|
Professional
|
Both
|
$2,588.00
|
|
|
Service Code
|
HCPCS 34701
|
| Min. Negotiated Rate |
$772.13 |
| Max. Negotiated Rate |
$1,920.42 |
| Rate for Payer: Aetna Commercial |
$1,668.21
|
| Rate for Payer: Aetna Medicare |
$1,294.00
|
| Rate for Payer: BCBS Complete |
$810.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.71
|
| Rate for Payer: BCN Commercial |
$1,763.15
|
| Rate for Payer: Cash Price |
$2,070.40
|
| Rate for Payer: Cash Price |
$2,070.40
|
| Rate for Payer: Meridian Medicaid |
$810.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$772.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,682.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,920.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,920.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,652.73
|
| Rate for Payer: UHC Exchange |
$1,652.73
|
| Rate for Payer: UHCCP Medicaid |
$772.13
|
|
|
PR EVASC RPR DPLMNT AORTO-AORTIC NDGFT RPT
|
Professional
|
Both
|
$3,913.00
|
|
|
Service Code
|
HCPCS 34702
|
| Min. Negotiated Rate |
$1,119.53 |
| Max. Negotiated Rate |
$2,868.12 |
| Rate for Payer: Aetna Commercial |
$2,491.29
|
| Rate for Payer: Aetna Medicare |
$1,956.50
|
| Rate for Payer: BCBS Complete |
$1,175.51
|
| Rate for Payer: BCBS Trust/PPO |
$2,005.96
|
| Rate for Payer: BCN Commercial |
$2,630.55
|
| Rate for Payer: Cash Price |
$3,130.40
|
| Rate for Payer: Cash Price |
$3,130.40
|
| Rate for Payer: Meridian Medicaid |
$1,175.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,119.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,543.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,868.12
|
| Rate for Payer: Priority Health Narrow Network |
$2,868.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,469.45
|
| Rate for Payer: UHC Exchange |
$2,469.45
|
| Rate for Payer: UHCCP Medicaid |
$1,119.53
|
|
|
PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT
|
Professional
|
Both
|
$3,166.00
|
|
|
Service Code
|
HCPCS 34705
|
| Min. Negotiated Rate |
$950.83 |
| Max. Negotiated Rate |
$2,747.37 |
| Rate for Payer: Aetna Commercial |
$2,056.06
|
| Rate for Payer: Aetna Medicare |
$1,583.00
|
| Rate for Payer: BCBS Complete |
$998.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,747.37
|
| Rate for Payer: BCN Commercial |
$2,174.62
|
| Rate for Payer: Cash Price |
$2,532.80
|
| Rate for Payer: Cash Price |
$2,532.80
|
| Rate for Payer: Meridian Medicaid |
$998.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$950.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,057.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,371.93
|
| Rate for Payer: Priority Health Narrow Network |
$2,371.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,052.41
|
| Rate for Payer: UHC Exchange |
$2,052.41
|
| Rate for Payer: UHCCP Medicaid |
$950.83
|
|
|
PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT
|
Professional
|
Both
|
$4,840.00
|
|
|
Service Code
|
HCPCS 34706
|
| Min. Negotiated Rate |
$1,419.65 |
| Max. Negotiated Rate |
$3,535.04 |
| Rate for Payer: Aetna Commercial |
$3,096.26
|
| Rate for Payer: Aetna Medicare |
$2,420.00
|
| Rate for Payer: BCBS Complete |
$1,490.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,686.93
|
| Rate for Payer: BCN Commercial |
$3,239.93
|
| Rate for Payer: Cash Price |
$3,872.00
|
| Rate for Payer: Cash Price |
$3,872.00
|
| Rate for Payer: Meridian Medicaid |
$1,490.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,419.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,146.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,535.04
|
| Rate for Payer: Priority Health Narrow Network |
$3,535.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,090.48
|
| Rate for Payer: UHC Exchange |
$3,090.48
|
| Rate for Payer: UHCCP Medicaid |
$1,419.65
|
|
|
PR EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT
|
Professional
|
Both
|
$2,917.00
|
|
|
Service Code
|
HCPCS 34703
|
| Min. Negotiated Rate |
$855.62 |
| Max. Negotiated Rate |
$2,308.14 |
| Rate for Payer: Aetna Commercial |
$1,848.30
|
| Rate for Payer: Aetna Medicare |
$1,458.50
|
| Rate for Payer: BCBS Complete |
$898.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,308.14
|
| Rate for Payer: BCN Commercial |
$1,960.57
|
| Rate for Payer: Cash Price |
$2,333.60
|
| Rate for Payer: Cash Price |
$2,333.60
|
| Rate for Payer: Meridian Medicaid |
$898.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$855.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,896.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,133.15
|
| Rate for Payer: Priority Health Narrow Network |
$2,133.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,864.30
|
| Rate for Payer: UHC Exchange |
$1,864.30
|
| Rate for Payer: UHCCP Medicaid |
$855.62
|
|
|
PR EVASC RPR DPLMNT ILIO-ILIAC NDGFT
|
Professional
|
Both
|
$2,414.00
|
|
|
Service Code
|
HCPCS 34707
|
| Min. Negotiated Rate |
$725.48 |
| Max. Negotiated Rate |
$2,209.35 |
| Rate for Payer: Aetna Commercial |
$1,567.17
|
| Rate for Payer: Aetna Medicare |
$1,207.00
|
| Rate for Payer: BCBS Complete |
$761.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,209.35
|
| Rate for Payer: BCN Commercial |
$1,662.48
|
| Rate for Payer: Cash Price |
$1,931.20
|
| Rate for Payer: Cash Price |
$1,931.20
|
| Rate for Payer: Meridian Medicaid |
$761.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$725.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,569.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,803.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,803.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,541.69
|
| Rate for Payer: UHC Exchange |
$1,541.69
|
| Rate for Payer: UHCCP Medicaid |
$725.48
|
|
