|
PR RHO D IMMUNE GLOBULIN INJ
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS J2790
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$117.84 |
| Rate for Payer: Aetna Commercial |
$109.65
|
| Rate for Payer: Aetna Medicare |
$81.83
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS MAPPO |
$81.83
|
| Rate for Payer: BCBS Trust/PPO |
$64.41
|
| Rate for Payer: BCN Commercial |
$60.97
|
| Rate for Payer: BCN Medicare Advantage |
$81.83
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$117.84
|
| Rate for Payer: Cofinity Commercial |
$109.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.83
|
| Rate for Payer: Healthscope Commercial |
$98.20
|
| Rate for Payer: Healthscope Whirlpool |
$98.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.92
|
| Rate for Payer: PACE SWMI |
$81.83
|
| Rate for Payer: PHP Medicare Advantage |
$81.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health Medicare |
$81.83
|
| Rate for Payer: UHC Medicare Advantage |
$84.29
|
|
|
PR RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 93042
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$2,070.41 |
| Rate for Payer: Aetna Commercial |
$8.95
|
| Rate for Payer: Aetna Medicare |
$6.68
|
| Rate for Payer: BCBS Complete |
$4.47
|
| Rate for Payer: BCBS MAPPO |
$6.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,070.41
|
| Rate for Payer: BCN Commercial |
$7.85
|
| Rate for Payer: BCN Medicare Advantage |
$6.68
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$8.95
|
| Rate for Payer: Cofinity Commercial |
$9.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$8.02
|
| Rate for Payer: Healthscope Whirlpool |
$8.02
|
| Rate for Payer: Meridian Medicaid |
$4.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.01
|
| Rate for Payer: PACE SWMI |
$6.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.46
|
| Rate for Payer: Priority Health Medicare |
$6.68
|
| Rate for Payer: Priority Health Narrow Network |
$9.46
|
| Rate for Payer: UHC Medicare Advantage |
$6.88
|
|
|
PR RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 93041
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$1,926.71 |
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: Aetna Medicare |
$5.61
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS MAPPO |
$5.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,926.71
|
| Rate for Payer: BCN Commercial |
$8.80
|
| Rate for Payer: BCN Medicare Advantage |
$5.61
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$7.52
|
| Rate for Payer: Cofinity Commercial |
$8.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.61
|
| Rate for Payer: Healthscope Commercial |
$6.73
|
| Rate for Payer: Healthscope Whirlpool |
$6.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.89
|
| Rate for Payer: PACE SWMI |
$5.61
|
| Rate for Payer: PHP Medicare Advantage |
$5.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.51
|
| Rate for Payer: Priority Health Medicare |
$5.61
|
| Rate for Payer: Priority Health Narrow Network |
$8.51
|
| Rate for Payer: UHC Medicare Advantage |
$5.78
|
|
|
PR RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 93040
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$2,312.90 |
| Rate for Payer: Aetna Commercial |
$16.48
|
| Rate for Payer: Aetna Medicare |
$12.30
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS MAPPO |
$12.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,312.90
|
| Rate for Payer: BCN Commercial |
$18.57
|
| Rate for Payer: BCN Medicare Advantage |
$12.30
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$17.71
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.30
|
| Rate for Payer: Healthscope Commercial |
$14.76
|
| Rate for Payer: Healthscope Whirlpool |
$14.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.92
|
| Rate for Payer: PACE SWMI |
$12.30
|
| Rate for Payer: PHP Medicare Advantage |
$12.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.97
|
| Rate for Payer: Priority Health Medicare |
$12.30
|
| Rate for Payer: Priority Health Narrow Network |
$17.97
|
| Rate for Payer: UHC Medicare Advantage |
$12.67
|
|
|
PR RHYTIDECTOMY 3 HOURS
|
Professional
|
Both
|
$4,800.00
|
|
|
Service Code
|
HCPCS 00539
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,920.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: BCBS Complete |
$1,920.00
|
| Rate for Payer: Cash Price |
$3,840.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,360.00
|
|
|
PR RHYTIDECTOMY SMAS FLAP
|
Professional
|
Both
|
$4,800.00
|
|
|
Service Code
|
HCPCS 15829
|
| Min. Negotiated Rate |
$129.77 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,885.67
|
| Rate for Payer: BCBS Complete |
$1,920.00
|
| Rate for Payer: BCBS Trust/PPO |
$129.77
|
| Rate for Payer: BCN Commercial |
$3,009.06
|
| Rate for Payer: Cash Price |
$3,840.00
|
| Rate for Payer: Cash Price |
$3,840.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,360.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,276.80
|
| Rate for Payer: Priority Health Narrow Network |
$3,276.80
|
|
|
PR RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT
|
Professional
|
Both
|
$437.00
|
|
|
Service Code
|
HCPCS 93451
|
| Min. Negotiated Rate |
$174.80 |
| Max. Negotiated Rate |
$1,711.69 |
| Rate for Payer: Aetna Commercial |
$1,089.06
|
| Rate for Payer: Aetna Medicare |
$812.73
|
| Rate for Payer: BCBS Complete |
$174.80
|
| Rate for Payer: BCBS MAPPO |
$812.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,711.69
|
| Rate for Payer: BCN Commercial |
$1,270.56
|
| Rate for Payer: BCN Medicare Advantage |
$812.73
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Cofinity Commercial |
$1,170.33
|
| Rate for Payer: Cofinity Commercial |
$1,089.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.73
|
| Rate for Payer: Healthscope Commercial |
$975.28
|
| Rate for Payer: Healthscope Whirlpool |
$975.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.37
|
| Rate for Payer: PACE SWMI |
$812.73
|
| Rate for Payer: PHP Medicare Advantage |
$812.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,229.46
|
| Rate for Payer: Priority Health Medicare |
$812.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,229.46
|
| Rate for Payer: UHC Medicare Advantage |
$837.11
|
|
|
PR RIMPLTJ VISC ART INFRARNL AORTIC PROSTH EA ART
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 35697
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$1,973.73 |
| Rate for Payer: Aetna Commercial |
$194.15
|
| Rate for Payer: Aetna Medicare |
$144.89
|
| Rate for Payer: BCBS Complete |
$95.50
|
| Rate for Payer: BCBS MAPPO |
$144.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,973.73
|
| Rate for Payer: BCN Commercial |
$208.66
|
| Rate for Payer: BCN Medicare Advantage |
$144.89
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$208.64
|
| Rate for Payer: Cofinity Commercial |
$194.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.89
|
| Rate for Payer: Healthscope Commercial |
$173.87
|
| Rate for Payer: Healthscope Whirlpool |
$173.87
|
| Rate for Payer: Meridian Medicaid |
$95.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$152.13
|
| Rate for Payer: PACE SWMI |
$144.89
|
| Rate for Payer: PHP Medicare Advantage |
$144.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.15
|
| Rate for Payer: Priority Health Medicare |
$144.89
|
| Rate for Payer: Priority Health Narrow Network |
$227.15
|
| Rate for Payer: UHC Medicare Advantage |
$149.24
|
|
|
PR RINGERS LACTATE INFUSION
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS J7120
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: Aetna Medicare |
$2.39
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$2.39
|
| Rate for Payer: BCBS Trust/PPO |
$0.74
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: BCN Medicare Advantage |
$2.39
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.87
|
| Rate for Payer: Healthscope Whirlpool |
$2.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.51
|
| Rate for Payer: PACE SWMI |
$2.39
|
| Rate for Payer: PHP Medicare Advantage |
$2.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health Medicare |
$2.39
|
| Rate for Payer: UHC Medicare Advantage |
$2.46
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Facility
|
IP
|
$2,580.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$1,806.00 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna Commercial |
$2,322.00
|
| Rate for Payer: ASR ASR |
$2,502.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,000.27
|
| Rate for Payer: BCN Commercial |
$2,000.27
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cofinity Commercial |
$2,425.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,064.00
|
| Rate for Payer: Healthscope Commercial |
$2,580.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,502.60
|
| Rate for Payer: Mclaren Commercial |
$2,322.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,193.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,806.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,270.40
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Facility
|
OP
|
$2,580.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$1,806.00 |
| Max. Negotiated Rate |
$7,948.86 |
| Rate for Payer: Aetna Commercial |
$2,322.00
|
| Rate for Payer: Aetna Medicare |
$6,359.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: ASR ASR |
$2,502.60
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,000.27
|
| Rate for Payer: BCN Commercial |
$2,000.27
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cofinity Commercial |
$2,425.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,064.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Healthscope Commercial |
$2,580.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,502.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,359.09
|
| Rate for Payer: Mclaren Commercial |
$2,322.00
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,193.00
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Commercial |
$6,995.00
|
| Rate for Payer: PHP Medicaid |
$3,478.42
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,806.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,347.80
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,831.80
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,270.40
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,580.00
|
|
|
Service Code
|
HCPCS 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$117.28 |
| Max. Negotiated Rate |
$1,806.00 |
| Rate for Payer: Aetna Commercial |
$1,024.58
|
| Rate for Payer: Aetna Medicare |
$764.61
|
| Rate for Payer: BCBS Complete |
$525.80
|
| Rate for Payer: BCBS MAPPO |
$764.61
|
| Rate for Payer: BCBS Trust/PPO |
$117.28
|
| Rate for Payer: BCN Commercial |
$1,140.08
|
| Rate for Payer: BCN Medicare Advantage |
$764.61
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cofinity Commercial |
$1,024.58
|
| Rate for Payer: Cofinity Commercial |
$1,101.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$764.61
|
| Rate for Payer: Healthscope Commercial |
$917.53
|
| Rate for Payer: Healthscope Whirlpool |
$917.53
|
| Rate for Payer: Meridian Medicaid |
$525.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$802.84
|
| Rate for Payer: PACE SWMI |
$764.61
|
| Rate for Payer: PHP Medicare Advantage |
$764.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,806.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,191.35
|
| Rate for Payer: Priority Health Medicare |
$764.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,191.35
|
| Rate for Payer: UHC Medicare Advantage |
$787.55
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,580.00
|
|
|
Service Code
|
HCPCS 24342
|
| Min. Negotiated Rate |
$117.28 |
| Max. Negotiated Rate |
$1,806.00 |
| Rate for Payer: Aetna Commercial |
$1,024.58
|
| Rate for Payer: Aetna Medicare |
$764.61
|
| Rate for Payer: BCBS Complete |
$525.80
|
| Rate for Payer: BCBS MAPPO |
$764.61
|
| Rate for Payer: BCBS Trust/PPO |
$117.28
|
| Rate for Payer: BCN Commercial |
$1,140.08
|
| Rate for Payer: BCN Medicare Advantage |
$764.61
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cofinity Commercial |
$1,101.04
|
| Rate for Payer: Cofinity Commercial |
$1,024.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$764.61
|
| Rate for Payer: Healthscope Commercial |
$917.53
|
| Rate for Payer: Healthscope Whirlpool |
$917.53
|
| Rate for Payer: Meridian Medicaid |
$525.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$802.84
|
| Rate for Payer: PACE SWMI |
$764.61
|
| Rate for Payer: PHP Medicare Advantage |
$764.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,806.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,191.35
|
| Rate for Payer: Priority Health Medicare |
$764.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,191.35
|
| Rate for Payer: UHC Medicare Advantage |
$787.55
|
|
|
PR RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM
|
Professional
|
Both
|
$91.47
|
|
|
Service Code
|
HCPCS 90682
|
| Min. Negotiated Rate |
$36.59 |
| Max. Negotiated Rate |
$100.72 |
| Rate for Payer: Aetna Commercial |
$93.72
|
| Rate for Payer: Aetna Medicare |
$69.94
|
| Rate for Payer: BCBS Complete |
$36.59
|
| Rate for Payer: BCBS MAPPO |
$69.94
|
| Rate for Payer: BCBS Trust/PPO |
$73.62
|
| Rate for Payer: BCN Commercial |
$73.62
|
| Rate for Payer: BCN Medicare Advantage |
$69.94
|
| Rate for Payer: Cash Price |
$73.18
|
| Rate for Payer: Cash Price |
$73.18
|
| Rate for Payer: Cofinity Commercial |
$100.72
|
| Rate for Payer: Cofinity Commercial |
$93.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.94
|
| Rate for Payer: Healthscope Commercial |
$83.93
|
| Rate for Payer: Healthscope Whirlpool |
$83.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.44
|
| Rate for Payer: PACE SWMI |
$69.94
|
| Rate for Payer: PHP Medicare Advantage |
$69.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.03
|
| Rate for Payer: Priority Health Medicare |
$69.94
|
| Rate for Payer: UHC Medicare Advantage |
$72.04
|
|
|
PR R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I
|
Professional
|
Both
|
$2,862.00
|
|
|
Service Code
|
HCPCS 93461
|
| Min. Negotiated Rate |
$716.90 |
| Max. Negotiated Rate |
$2,006.02 |
| Rate for Payer: Aetna Commercial |
$1,741.17
|
| Rate for Payer: Aetna Medicare |
$1,299.38
|
| Rate for Payer: BCBS Complete |
$1,144.80
|
| Rate for Payer: BCBS MAPPO |
$1,299.38
|
| Rate for Payer: BCBS Trust/PPO |
$716.90
|
| Rate for Payer: BCN Commercial |
$2,006.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,299.38
|
| Rate for Payer: Cash Price |
$2,289.60
|
| Rate for Payer: Cash Price |
$2,289.60
|
| Rate for Payer: Cofinity Commercial |
$1,871.11
|
| Rate for Payer: Cofinity Commercial |
$1,741.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,299.38
|
| Rate for Payer: Healthscope Commercial |
$1,559.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,559.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,364.35
|
| Rate for Payer: PACE SWMI |
$1,299.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,299.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,003.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,941.12
|
| Rate for Payer: Priority Health Medicare |
$1,299.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,941.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,338.36
|
|
|
PR R & L HRT CATH WINJX HRT ART& L VENTR IMG
|
Professional
|
Both
|
$1,205.00
|
|
|
Service Code
|
HCPCS 93460
|
| Min. Negotiated Rate |
$482.00 |
| Max. Negotiated Rate |
$1,818.86 |
| Rate for Payer: Aetna Commercial |
$1,578.51
|
| Rate for Payer: Aetna Medicare |
$1,177.99
|
| Rate for Payer: BCBS Complete |
$482.00
|
| Rate for Payer: BCBS MAPPO |
$1,177.99
|
| Rate for Payer: BCBS Trust/PPO |
$728.00
|
| Rate for Payer: BCN Commercial |
$1,818.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,177.99
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cofinity Commercial |
$1,696.31
|
| Rate for Payer: Cofinity Commercial |
$1,578.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,177.99
|
| Rate for Payer: Healthscope Commercial |
$1,413.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,413.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,236.89
|
| Rate for Payer: PACE SWMI |
$1,177.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,177.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,760.01
|
| Rate for Payer: Priority Health Medicare |
$1,177.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,760.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,213.33
|
|
|
PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
|
Professional
|
Both
|
$659.00
|
|
|
Service Code
|
HCPCS 93453
|
| Min. Negotiated Rate |
$263.60 |
| Max. Negotiated Rate |
$1,678.12 |
| Rate for Payer: Aetna Commercial |
$1,453.38
|
| Rate for Payer: Aetna Medicare |
$1,084.61
|
| Rate for Payer: BCBS Complete |
$263.60
|
| Rate for Payer: BCBS MAPPO |
$1,084.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,507.77
|
| Rate for Payer: BCN Commercial |
$1,678.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,084.61
|
| Rate for Payer: Cash Price |
$527.20
|
| Rate for Payer: Cash Price |
$527.20
|
| Rate for Payer: Cofinity Commercial |
$1,561.84
|
| Rate for Payer: Cofinity Commercial |
$1,453.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,084.61
|
| Rate for Payer: Healthscope Commercial |
$1,301.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,301.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,138.84
|
| Rate for Payer: PACE SWMI |
$1,084.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,084.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,623.83
|
| Rate for Payer: Priority Health Medicare |
$1,084.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,623.83
|
| Rate for Payer: UHC Medicare Advantage |
$1,117.15
|
|
|
PR RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ
|
Professional
|
Both
|
$1,761.00
|
|
|
Service Code
|
HCPCS 33244
|
| Min. Negotiated Rate |
$541.87 |
| Max. Negotiated Rate |
$1,361.27 |
| Rate for Payer: Aetna Commercial |
$1,137.35
|
| Rate for Payer: Aetna Medicare |
$848.77
|
| Rate for Payer: BCBS Complete |
$568.96
|
| Rate for Payer: BCBS MAPPO |
$848.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,160.68
|
| Rate for Payer: BCN Commercial |
$1,250.53
|
| Rate for Payer: BCN Medicare Advantage |
$848.77
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Cofinity Commercial |
$1,222.23
|
| Rate for Payer: Cofinity Commercial |
$1,137.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$848.77
|
| Rate for Payer: Healthscope Commercial |
$1,018.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,018.52
|
| Rate for Payer: Meridian Medicaid |
$568.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$891.21
|
| Rate for Payer: PACE SWMI |
$848.77
|
| Rate for Payer: PHP Medicare Advantage |
$848.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$541.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,232.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,361.27
|
| Rate for Payer: Priority Health Medicare |
$848.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,361.27
|
| Rate for Payer: UHC Medicare Advantage |
$874.23
|
|
|
PR RMVL ASCENDING-AORTA BALO DEV W/RPR ASCEND-AORTA
|
Professional
|
Both
|
$2,431.00
|
|
|
Service Code
|
HCPCS 33974
|
| Min. Negotiated Rate |
$560.40 |
| Max. Negotiated Rate |
$2,513.12 |
| Rate for Payer: Aetna Commercial |
$1,170.38
|
| Rate for Payer: Aetna Medicare |
$873.42
|
| Rate for Payer: BCBS Complete |
$588.42
|
| Rate for Payer: BCBS MAPPO |
$873.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,513.12
|
| Rate for Payer: BCN Commercial |
$1,280.82
|
| Rate for Payer: BCN Medicare Advantage |
$873.42
|
| Rate for Payer: Cash Price |
$1,944.80
|
| Rate for Payer: Cash Price |
$1,944.80
|
| Rate for Payer: Cofinity Commercial |
$1,170.38
|
| Rate for Payer: Cofinity Commercial |
$1,257.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$873.42
|
| Rate for Payer: Healthscope Commercial |
$1,048.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,048.10
|
| Rate for Payer: Meridian Medicaid |
$588.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$917.09
|
| Rate for Payer: PACE SWMI |
$873.42
|
| Rate for Payer: PHP Medicare Advantage |
$873.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$560.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,701.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,394.26
|
| Rate for Payer: Priority Health Medicare |
$873.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,394.26
|
| Rate for Payer: UHC Medicare Advantage |
$899.62
|
|
|
PR RMVL BONE FLAP/PROSTHETIC PLATE SKULL
|
Professional
|
Both
|
$3,305.00
|
|
|
Service Code
|
HCPCS 62142
|
| Min. Negotiated Rate |
$581.92 |
| Max. Negotiated Rate |
$2,313.50 |
| Rate for Payer: Aetna Commercial |
$1,198.86
|
| Rate for Payer: Aetna Medicare |
$894.67
|
| Rate for Payer: BCBS Complete |
$611.02
|
| Rate for Payer: BCBS MAPPO |
$894.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,320.75
|
| Rate for Payer: BCN Commercial |
$1,831.09
|
| Rate for Payer: BCN Medicare Advantage |
$894.67
|
| Rate for Payer: Cash Price |
$2,644.00
|
| Rate for Payer: Cash Price |
$2,644.00
|
| Rate for Payer: Cofinity Commercial |
$1,288.32
|
| Rate for Payer: Cofinity Commercial |
$1,198.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$894.67
|
| Rate for Payer: Healthscope Commercial |
$1,073.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,073.60
|
| Rate for Payer: Meridian Medicaid |
$611.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$939.40
|
| Rate for Payer: PACE SWMI |
$894.67
|
| Rate for Payer: PHP Medicare Advantage |
$894.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$581.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,313.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,529.36
|
| Rate for Payer: Priority Health Medicare |
$894.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,529.36
|
| Rate for Payer: UHC Medicare Advantage |
$921.51
|
|
|
PR RMVL COMPL CSF SHUNT SYSTEM W/O RPLCMT SHUNT
|
Professional
|
Both
|
$2,164.00
|
|
|
Service Code
|
HCPCS 62256
|
| Min. Negotiated Rate |
$87.02 |
| Max. Negotiated Rate |
$1,514.80 |
| Rate for Payer: Aetna Commercial |
$818.39
|
| Rate for Payer: Aetna Medicare |
$610.74
|
| Rate for Payer: BCBS Complete |
$420.91
|
| Rate for Payer: BCBS MAPPO |
$610.74
|
| Rate for Payer: BCBS Trust/PPO |
$87.02
|
| Rate for Payer: BCN Commercial |
$1,256.21
|
| Rate for Payer: BCN Medicare Advantage |
$610.74
|
| Rate for Payer: Cash Price |
$1,731.20
|
| Rate for Payer: Cash Price |
$1,731.20
|
| Rate for Payer: Cofinity Commercial |
$879.47
|
| Rate for Payer: Cofinity Commercial |
$818.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$610.74
|
| Rate for Payer: Healthscope Commercial |
$732.89
|
| Rate for Payer: Healthscope Whirlpool |
$732.89
|
| Rate for Payer: Meridian Medicaid |
$420.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$641.28
|
| Rate for Payer: PACE SWMI |
$610.74
|
| Rate for Payer: PHP Medicare Advantage |
$610.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,514.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,049.21
|
| Rate for Payer: Priority Health Medicare |
$610.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,049.21
|
| Rate for Payer: UHC Medicare Advantage |
$629.06
|
|
|
PR RMVL COMPLETE CSF SHUNT SYSTEM W/RPLCMT SHUNT
|
Professional
|
Both
|
$5,026.00
|
|
|
Service Code
|
HCPCS 62258
|
| Min. Negotiated Rate |
$586.41 |
| Max. Negotiated Rate |
$3,518.20 |
| Rate for Payer: Aetna Commercial |
$1,500.41
|
| Rate for Payer: Aetna Medicare |
$1,119.71
|
| Rate for Payer: BCBS Complete |
$761.08
|
| Rate for Payer: BCBS MAPPO |
$1,119.71
|
| Rate for Payer: BCBS Trust/PPO |
$586.41
|
| Rate for Payer: BCN Commercial |
$2,282.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,119.71
|
| Rate for Payer: Cash Price |
$4,020.80
|
| Rate for Payer: Cash Price |
$4,020.80
|
| Rate for Payer: Cofinity Commercial |
$1,612.38
|
| Rate for Payer: Cofinity Commercial |
$1,500.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,119.71
|
| Rate for Payer: Healthscope Commercial |
$1,343.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,343.65
|
| Rate for Payer: Meridian Medicaid |
$761.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,175.70
|
| Rate for Payer: PACE SWMI |
$1,119.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,119.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$724.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,518.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,906.47
|
| Rate for Payer: Priority Health Medicare |
$1,119.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,906.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,153.30
|
|
|
PR RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 97602
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$917.66 |
| Rate for Payer: Aetna Commercial |
$89.75
|
| Rate for Payer: BCBS Complete |
$58.80
|
| Rate for Payer: BCBS Trust/PPO |
$917.66
|
| Rate for Payer: BCN Commercial |
$167.04
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.57
|
| Rate for Payer: Priority Health Narrow Network |
$109.57
|
|
|
PR RMVL EMBEDDED FB VESTIBULE MOUTH COMP
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 40805
|
| Min. Negotiated Rate |
$126.52 |
| Max. Negotiated Rate |
$526.19 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Medicare |
$191.39
|
| Rate for Payer: BCBS Complete |
$132.85
|
| Rate for Payer: BCBS MAPPO |
$191.39
|
| Rate for Payer: BCBS Trust/PPO |
$526.19
|
| Rate for Payer: BCN Commercial |
$416.35
|
| Rate for Payer: BCN Medicare Advantage |
$191.39
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cofinity Commercial |
$256.46
|
| Rate for Payer: Cofinity Commercial |
$275.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.39
|
| Rate for Payer: Healthscope Commercial |
$229.67
|
| Rate for Payer: Healthscope Whirlpool |
$229.67
|
| Rate for Payer: Meridian Medicaid |
$132.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.96
|
| Rate for Payer: PACE SWMI |
$191.39
|
| Rate for Payer: PHP Medicare Advantage |
$191.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$345.73
|
| Rate for Payer: Priority Health Medicare |
$191.39
|
| Rate for Payer: Priority Health Narrow Network |
$345.73
|
| Rate for Payer: UHC Medicare Advantage |
$197.13
|
|
|
PR RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS 40804
|
| Min. Negotiated Rate |
$73.27 |
| Max. Negotiated Rate |
$1,065.05 |
| Rate for Payer: Aetna Commercial |
$146.35
|
| Rate for Payer: Aetna Medicare |
$109.22
|
| Rate for Payer: BCBS Complete |
$76.93
|
| Rate for Payer: BCBS MAPPO |
$109.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,065.05
|
| Rate for Payer: BCN Commercial |
$275.12
|
| Rate for Payer: BCN Medicare Advantage |
$109.22
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cofinity Commercial |
$146.35
|
| Rate for Payer: Cofinity Commercial |
$157.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.22
|
| Rate for Payer: Healthscope Commercial |
$131.06
|
| Rate for Payer: Healthscope Whirlpool |
$131.06
|
| Rate for Payer: Meridian Medicaid |
$76.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$114.68
|
| Rate for Payer: PACE SWMI |
$109.22
|
| Rate for Payer: PHP Medicare Advantage |
$109.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.74
|
| Rate for Payer: Priority Health Medicare |
$109.22
|
| Rate for Payer: Priority Health Narrow Network |
$198.74
|
| Rate for Payer: UHC Medicare Advantage |
$112.50
|
|
