|
PR RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU
|
Professional
|
Both
|
$1,589.00
|
|
|
Service Code
|
HCPCS 25272
|
| Min. Negotiated Rate |
$365.30 |
| Max. Negotiated Rate |
$3,566.55 |
| Rate for Payer: Aetna Commercial |
$742.01
|
| Rate for Payer: Aetna Medicare |
$553.74
|
| Rate for Payer: BCBS Complete |
$383.56
|
| Rate for Payer: BCBS MAPPO |
$553.74
|
| Rate for Payer: BCBS Trust/PPO |
$3,566.55
|
| Rate for Payer: BCN Commercial |
$829.29
|
| Rate for Payer: BCN Medicare Advantage |
$553.74
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cofinity Commercial |
$797.39
|
| Rate for Payer: Cofinity Commercial |
$742.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$553.74
|
| Rate for Payer: Healthscope Commercial |
$664.49
|
| Rate for Payer: Healthscope Whirlpool |
$664.49
|
| Rate for Payer: Meridian Medicaid |
$383.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$581.43
|
| Rate for Payer: PACE SWMI |
$553.74
|
| Rate for Payer: PHP Medicare Advantage |
$553.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$365.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,112.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$866.58
|
| Rate for Payer: Priority Health Medicare |
$553.74
|
| Rate for Payer: Priority Health Narrow Network |
$866.58
|
| Rate for Payer: UHC Medicare Advantage |
$570.35
|
|
|
PR RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT
|
Professional
|
Both
|
$1,985.00
|
|
|
Service Code
|
HCPCS 25275
|
| Min. Negotiated Rate |
$436.86 |
| Max. Negotiated Rate |
$1,389.50 |
| Rate for Payer: Aetna Commercial |
$889.30
|
| Rate for Payer: Aetna Medicare |
$663.66
|
| Rate for Payer: BCBS Complete |
$458.70
|
| Rate for Payer: BCBS MAPPO |
$663.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,102.56
|
| Rate for Payer: BCN Commercial |
$993.00
|
| Rate for Payer: BCN Medicare Advantage |
$663.66
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cofinity Commercial |
$889.30
|
| Rate for Payer: Cofinity Commercial |
$955.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$663.66
|
| Rate for Payer: Healthscope Commercial |
$796.39
|
| Rate for Payer: Healthscope Whirlpool |
$796.39
|
| Rate for Payer: Meridian Medicaid |
$458.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$696.84
|
| Rate for Payer: PACE SWMI |
$663.66
|
| Rate for Payer: PHP Medicare Advantage |
$663.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$436.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,389.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,037.64
|
| Rate for Payer: Priority Health Medicare |
$663.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,037.64
|
| Rate for Payer: UHC Medicare Advantage |
$683.57
|
|
|
PR RPR TENDON XTNSR FOOT SEC W/FREE GRAFT EA TENDON
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 28210
|
| Min. Negotiated Rate |
$273.49 |
| Max. Negotiated Rate |
$912.90 |
| Rate for Payer: Aetna Commercial |
$557.75
|
| Rate for Payer: Aetna Medicare |
$416.23
|
| Rate for Payer: BCBS Complete |
$287.16
|
| Rate for Payer: BCBS MAPPO |
$416.23
|
| Rate for Payer: BCBS Trust/PPO |
$912.90
|
| Rate for Payer: BCN Commercial |
$867.89
|
| Rate for Payer: BCN Medicare Advantage |
$416.23
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cofinity Commercial |
$557.75
|
| Rate for Payer: Cofinity Commercial |
$599.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.23
|
| Rate for Payer: Healthscope Commercial |
$499.48
|
| Rate for Payer: Healthscope Whirlpool |
$499.48
|
| Rate for Payer: Meridian Medicaid |
$287.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$437.04
|
| Rate for Payer: PACE SWMI |
$416.23
|
| Rate for Payer: PHP Medicare Advantage |
$416.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$273.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$649.04
|
| Rate for Payer: Priority Health Medicare |
$416.23
|
| Rate for Payer: Priority Health Narrow Network |
$649.04
|
| Rate for Payer: UHC Medicare Advantage |
$428.72
|
|
|
PR RPR THORACOABDOMINAL AORTIC ANEURYS W/WO BYPASS
|
Professional
|
Both
|
$8,520.00
|
|
|
Service Code
|
HCPCS 33877
|
| Min. Negotiated Rate |
$2,114.78 |
| Max. Negotiated Rate |
$5,964.00 |
| Rate for Payer: Aetna Commercial |
$4,758.26
|
| Rate for Payer: Aetna Medicare |
$3,550.94
|
| Rate for Payer: BCBS Complete |
$2,362.42
|
| Rate for Payer: BCBS MAPPO |
$3,550.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,114.78
|
| Rate for Payer: BCN Commercial |
$5,146.27
|
| Rate for Payer: BCN Medicare Advantage |
$3,550.94
|
| Rate for Payer: Cash Price |
$6,816.00
|
| Rate for Payer: Cash Price |
$6,816.00
|
| Rate for Payer: Cofinity Commercial |
$5,113.35
|
| Rate for Payer: Cofinity Commercial |
$4,758.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,550.94
|
| Rate for Payer: Healthscope Commercial |
$4,261.13
|
| Rate for Payer: Healthscope Whirlpool |
$4,261.13
|
| Rate for Payer: Meridian Medicaid |
$2,362.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,728.49
|
| Rate for Payer: PACE SWMI |
$3,550.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,550.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,249.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,964.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,602.04
|
| Rate for Payer: Priority Health Medicare |
$3,550.94
|
| Rate for Payer: Priority Health Narrow Network |
$5,602.04
|
| Rate for Payer: UHC Medicare Advantage |
$3,657.47
|
|
|
PR RPR/TRAUMATIC AV FISTULA EXTREMITIES
|
Professional
|
Both
|
$1,511.00
|
|
|
Service Code
|
HCPCS 35190
|
| Min. Negotiated Rate |
$474.78 |
| Max. Negotiated Rate |
$1,192.11 |
| Rate for Payer: Aetna Commercial |
$1,005.63
|
| Rate for Payer: Aetna Medicare |
$750.47
|
| Rate for Payer: BCBS Complete |
$498.52
|
| Rate for Payer: BCBS MAPPO |
$750.47
|
| Rate for Payer: BCBS Trust/PPO |
$706.87
|
| Rate for Payer: BCN Commercial |
$1,095.13
|
| Rate for Payer: BCN Medicare Advantage |
$750.47
|
| Rate for Payer: Cash Price |
$1,208.80
|
| Rate for Payer: Cash Price |
$1,208.80
|
| Rate for Payer: Cofinity Commercial |
$1,005.63
|
| Rate for Payer: Cofinity Commercial |
$1,080.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$750.47
|
| Rate for Payer: Healthscope Commercial |
$900.56
|
| Rate for Payer: Healthscope Whirlpool |
$900.56
|
| Rate for Payer: Meridian Medicaid |
$498.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$787.99
|
| Rate for Payer: PACE SWMI |
$750.47
|
| Rate for Payer: PHP Medicare Advantage |
$750.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$474.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,057.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,192.11
|
| Rate for Payer: Priority Health Medicare |
$750.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,192.11
|
| Rate for Payer: UHC Medicare Advantage |
$772.98
|
|
|
PR RPR/TRAUMATIC AV FISTULA HEAD & NECK
|
Professional
|
Both
|
$4,157.00
|
|
|
Service Code
|
HCPCS 35188
|
| Min. Negotiated Rate |
$833.26 |
| Max. Negotiated Rate |
$2,909.90 |
| Rate for Payer: Aetna Commercial |
$1,729.86
|
| Rate for Payer: Aetna Medicare |
$1,290.94
|
| Rate for Payer: BCBS Complete |
$874.92
|
| Rate for Payer: BCBS MAPPO |
$1,290.94
|
| Rate for Payer: BCBS Trust/PPO |
$933.51
|
| Rate for Payer: BCN Commercial |
$1,893.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,290.94
|
| Rate for Payer: Cash Price |
$3,325.60
|
| Rate for Payer: Cash Price |
$3,325.60
|
| Rate for Payer: Cofinity Commercial |
$1,729.86
|
| Rate for Payer: Cofinity Commercial |
$1,858.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,290.94
|
| Rate for Payer: Healthscope Commercial |
$1,549.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,549.13
|
| Rate for Payer: Meridian Medicaid |
$874.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,355.49
|
| Rate for Payer: PACE SWMI |
$1,290.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,290.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$833.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,909.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,060.80
|
| Rate for Payer: Priority Health Medicare |
$1,290.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,060.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,329.67
|
|
|
PR RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE
|
Professional
|
Both
|
$618.00
|
|
|
Service Code
|
HCPCS 55060
|
| Min. Negotiated Rate |
$243.67 |
| Max. Negotiated Rate |
$1,220.90 |
| Rate for Payer: Aetna Commercial |
$497.10
|
| Rate for Payer: Aetna Medicare |
$370.97
|
| Rate for Payer: BCBS Complete |
$255.85
|
| Rate for Payer: BCBS MAPPO |
$370.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,220.90
|
| Rate for Payer: BCN Commercial |
$551.23
|
| Rate for Payer: BCN Medicare Advantage |
$370.97
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cofinity Commercial |
$534.20
|
| Rate for Payer: Cofinity Commercial |
$497.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$370.97
|
| Rate for Payer: Healthscope Commercial |
$445.16
|
| Rate for Payer: Healthscope Whirlpool |
$445.16
|
| Rate for Payer: Meridian Medicaid |
$255.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$389.52
|
| Rate for Payer: PACE SWMI |
$370.97
|
| Rate for Payer: PHP Medicare Advantage |
$370.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$243.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$609.53
|
| Rate for Payer: Priority Health Medicare |
$370.97
|
| Rate for Payer: Priority Health Narrow Network |
$609.53
|
| Rate for Payer: UHC Medicare Advantage |
$382.10
|
|
|
PR RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$439.00
|
|
|
Service Code
|
HCPCS 36575
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$1,177.58 |
| Rate for Payer: Aetna Commercial |
$43.78
|
| Rate for Payer: Aetna Medicare |
$32.67
|
| Rate for Payer: BCBS Complete |
$21.91
|
| Rate for Payer: BCBS MAPPO |
$32.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,177.58
|
| Rate for Payer: BCN Commercial |
$212.57
|
| Rate for Payer: BCN Medicare Advantage |
$32.67
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cofinity Commercial |
$47.04
|
| Rate for Payer: Cofinity Commercial |
$43.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.67
|
| Rate for Payer: Healthscope Commercial |
$39.20
|
| Rate for Payer: Healthscope Whirlpool |
$39.20
|
| Rate for Payer: Meridian Medicaid |
$21.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34.30
|
| Rate for Payer: PACE SWMI |
$32.67
|
| Rate for Payer: PHP Medicare Advantage |
$32.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.13
|
| Rate for Payer: Priority Health Medicare |
$32.67
|
| Rate for Payer: Priority Health Narrow Network |
$52.13
|
| Rate for Payer: UHC Medicare Advantage |
$33.65
|
|
|
PR RPR UMBILICAL HERNIA < 5 YRS INCARCERATED
|
Professional
|
Both
|
$1,434.00
|
|
|
Service Code
|
HCPCS 49582
|
| Min. Negotiated Rate |
$573.60 |
| Max. Negotiated Rate |
$1,003.80 |
| Rate for Payer: BCBS Complete |
$573.60
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,003.80
|
|
|
PR RPR UMBILICAL HERNIA < 5 YRS REDUCIBLE
|
Professional
|
Both
|
$1,243.00
|
|
|
Service Code
|
HCPCS 49580
|
| Min. Negotiated Rate |
$497.20 |
| Max. Negotiated Rate |
$870.10 |
| Rate for Payer: BCBS Complete |
$497.20
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$870.10
|
|
|
PR RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$1,652.00
|
|
|
Service Code
|
HCPCS 49587
|
| Min. Negotiated Rate |
$660.80 |
| Max. Negotiated Rate |
$1,156.40 |
| Rate for Payer: BCBS Complete |
$660.80
|
| Rate for Payer: Cash Price |
$1,321.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,156.40
|
|
|
PR RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$1,434.00
|
|
|
Service Code
|
HCPCS 49585
|
| Min. Negotiated Rate |
$573.60 |
| Max. Negotiated Rate |
$1,003.80 |
| Rate for Payer: BCBS Complete |
$573.60
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,003.80
|
|
|
PR RPR VENTR O/F TRC OBSTRCJ PATCH ENLGMENT O/F TRC
|
Professional
|
Both
|
$7,883.00
|
|
|
Service Code
|
HCPCS 33414
|
| Min. Negotiated Rate |
$509.28 |
| Max. Negotiated Rate |
$5,518.10 |
| Rate for Payer: Aetna Commercial |
$2,834.07
|
| Rate for Payer: Aetna Medicare |
$2,114.98
|
| Rate for Payer: BCBS Complete |
$1,413.69
|
| Rate for Payer: BCBS MAPPO |
$2,114.98
|
| Rate for Payer: BCBS Trust/PPO |
$509.28
|
| Rate for Payer: BCN Commercial |
$3,076.23
|
| Rate for Payer: BCN Medicare Advantage |
$2,114.98
|
| Rate for Payer: Cash Price |
$6,306.40
|
| Rate for Payer: Cash Price |
$6,306.40
|
| Rate for Payer: Cofinity Commercial |
$3,045.57
|
| Rate for Payer: Cofinity Commercial |
$2,834.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,114.98
|
| Rate for Payer: Healthscope Commercial |
$2,537.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,537.98
|
| Rate for Payer: Meridian Medicaid |
$1,413.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,220.73
|
| Rate for Payer: PACE SWMI |
$2,114.98
|
| Rate for Payer: PHP Medicare Advantage |
$2,114.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,346.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,518.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,348.67
|
| Rate for Payer: Priority Health Medicare |
$2,114.98
|
| Rate for Payer: Priority Health Narrow Network |
$3,348.67
|
| Rate for Payer: UHC Medicare Advantage |
$2,178.43
|
|
|
PR RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER
|
Professional
|
Both
|
$2,768.00
|
|
|
Service Code
|
HCPCS 26428
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,937.60 |
| Rate for Payer: Aetna Commercial |
$1,045.13
|
| Rate for Payer: Aetna Medicare |
$779.95
|
| Rate for Payer: BCBS Complete |
$541.68
|
| Rate for Payer: BCBS MAPPO |
$779.95
|
| Rate for Payer: BCBS Trust/PPO |
$98.26
|
| Rate for Payer: BCN Commercial |
$1,186.02
|
| Rate for Payer: BCN Medicare Advantage |
$779.95
|
| Rate for Payer: Cash Price |
$2,214.40
|
| Rate for Payer: Cash Price |
$2,214.40
|
| Rate for Payer: Cofinity Commercial |
$1,123.13
|
| Rate for Payer: Cofinity Commercial |
$1,045.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$779.95
|
| Rate for Payer: Healthscope Commercial |
$935.94
|
| Rate for Payer: Healthscope Whirlpool |
$935.94
|
| Rate for Payer: Meridian Medicaid |
$541.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$818.95
|
| Rate for Payer: PACE SWMI |
$779.95
|
| Rate for Payer: PHP Medicare Advantage |
$779.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$515.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,937.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,239.34
|
| Rate for Payer: Priority Health Medicare |
$779.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,239.34
|
| Rate for Payer: UHC Medicare Advantage |
$803.35
|
|
|
PR RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR
|
Professional
|
Both
|
$1,944.00
|
|
|
Service Code
|
HCPCS 26426
|
| Min. Negotiated Rate |
$195.47 |
| Max. Negotiated Rate |
$1,360.80 |
| Rate for Payer: Aetna Commercial |
$666.89
|
| Rate for Payer: Aetna Medicare |
$497.68
|
| Rate for Payer: BCBS Complete |
$345.54
|
| Rate for Payer: BCBS MAPPO |
$497.68
|
| Rate for Payer: BCBS Trust/PPO |
$195.47
|
| Rate for Payer: BCN Commercial |
$747.19
|
| Rate for Payer: BCN Medicare Advantage |
$497.68
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cofinity Commercial |
$716.66
|
| Rate for Payer: Cofinity Commercial |
$666.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$497.68
|
| Rate for Payer: Healthscope Commercial |
$597.22
|
| Rate for Payer: Healthscope Whirlpool |
$597.22
|
| Rate for Payer: Meridian Medicaid |
$345.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$522.56
|
| Rate for Payer: PACE SWMI |
$497.68
|
| Rate for Payer: PHP Medicare Advantage |
$497.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$329.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,360.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$780.79
|
| Rate for Payer: Priority Health Medicare |
$497.68
|
| Rate for Payer: Priority Health Narrow Network |
$780.79
|
| Rate for Payer: UHC Medicare Advantage |
$512.61
|
|
|
PR RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD
|
Professional
|
Both
|
$1,272.00
|
|
|
Service Code
|
HCPCS 33226
|
| Min. Negotiated Rate |
$305.66 |
| Max. Negotiated Rate |
$1,099.92 |
| Rate for Payer: Aetna Commercial |
$644.33
|
| Rate for Payer: Aetna Medicare |
$480.84
|
| Rate for Payer: BCBS Complete |
$320.94
|
| Rate for Payer: BCBS MAPPO |
$480.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.92
|
| Rate for Payer: BCN Commercial |
$702.72
|
| Rate for Payer: BCN Medicare Advantage |
$480.84
|
| Rate for Payer: Cash Price |
$1,017.60
|
| Rate for Payer: Cash Price |
$1,017.60
|
| Rate for Payer: Cofinity Commercial |
$644.33
|
| Rate for Payer: Cofinity Commercial |
$692.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.84
|
| Rate for Payer: Healthscope Commercial |
$577.01
|
| Rate for Payer: Healthscope Whirlpool |
$577.01
|
| Rate for Payer: Meridian Medicaid |
$320.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$504.88
|
| Rate for Payer: PACE SWMI |
$480.84
|
| Rate for Payer: PHP Medicare Advantage |
$480.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$764.96
|
| Rate for Payer: Priority Health Medicare |
$480.84
|
| Rate for Payer: Priority Health Narrow Network |
$764.96
|
| Rate for Payer: UHC Medicare Advantage |
$495.27
|
|
|
PR RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE
|
Professional
|
Both
|
$1,009.00
|
|
|
Service Code
|
HCPCS 33215
|
| Min. Negotiated Rate |
$195.32 |
| Max. Negotiated Rate |
$1,453.88 |
| Rate for Payer: Aetna Commercial |
$407.95
|
| Rate for Payer: Aetna Medicare |
$304.44
|
| Rate for Payer: BCBS Complete |
$205.09
|
| Rate for Payer: BCBS MAPPO |
$304.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,453.88
|
| Rate for Payer: BCN Commercial |
$448.61
|
| Rate for Payer: BCN Medicare Advantage |
$304.44
|
| Rate for Payer: Cash Price |
$807.20
|
| Rate for Payer: Cash Price |
$807.20
|
| Rate for Payer: Cofinity Commercial |
$407.95
|
| Rate for Payer: Cofinity Commercial |
$438.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$304.44
|
| Rate for Payer: Healthscope Commercial |
$365.33
|
| Rate for Payer: Healthscope Whirlpool |
$365.33
|
| Rate for Payer: Meridian Medicaid |
$205.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$319.66
|
| Rate for Payer: PACE SWMI |
$304.44
|
| Rate for Payer: PHP Medicare Advantage |
$304.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$706.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$488.33
|
| Rate for Payer: Priority Health Medicare |
$304.44
|
| Rate for Payer: Priority Health Narrow Network |
$488.33
|
| Rate for Payer: UHC Medicare Advantage |
$313.57
|
|
|
PR RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDNCE
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 36597
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$578.49 |
| Rate for Payer: Aetna Commercial |
$80.21
|
| Rate for Payer: Aetna Medicare |
$59.86
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS MAPPO |
$59.86
|
| Rate for Payer: BCBS Trust/PPO |
$578.49
|
| Rate for Payer: BCN Commercial |
$163.71
|
| Rate for Payer: BCN Medicare Advantage |
$59.86
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$86.20
|
| Rate for Payer: Cofinity Commercial |
$80.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.86
|
| Rate for Payer: Healthscope Commercial |
$71.83
|
| Rate for Payer: Healthscope Whirlpool |
$71.83
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$62.85
|
| Rate for Payer: PACE SWMI |
$59.86
|
| Rate for Payer: PHP Medicare Advantage |
$59.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.22
|
| Rate for Payer: Priority Health Medicare |
$59.86
|
| Rate for Payer: Priority Health Narrow Network |
$95.22
|
| Rate for Payer: UHC Medicare Advantage |
$61.66
|
|
|
PR RSV MONOC ANTB SEASN 1 ML IM
|
Professional
|
Both
|
$1,277.00
|
|
|
Service Code
|
HCPCS 90381
|
| Min. Negotiated Rate |
$504.90 |
| Max. Negotiated Rate |
$893.90 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: BCBS Complete |
$510.80
|
| Rate for Payer: BCBS Trust/PPO |
$504.90
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$893.90
|
|
|
PR RSV MONOC ANTB SEASN .5ML IM
|
Professional
|
Both
|
$1,277.00
|
|
|
Service Code
|
HCPCS 90380
|
| Min. Negotiated Rate |
$504.90 |
| Max. Negotiated Rate |
$893.90 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: BCBS Complete |
$510.80
|
| Rate for Payer: BCBS Trust/PPO |
$504.90
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$893.90
|
|
|
PR RSV VACCINE PREF RECOMB SUBUNIT ADJUVANTED FOR IM USE
|
Professional
|
Both
|
$781.20
|
|
|
Service Code
|
HCPCS 90679
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$546.84 |
| Rate for Payer: Aetna Commercial |
$285.60
|
| Rate for Payer: BCBS Complete |
$312.48
|
| Rate for Payer: BCBS Trust/PPO |
$285.60
|
| Rate for Payer: Cash Price |
$624.96
|
| Rate for Payer: Cash Price |
$624.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.84
|
|
|
PR RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE
|
Professional
|
Both
|
$823.05
|
|
|
Service Code
|
HCPCS 90678
|
| Min. Negotiated Rate |
$300.90 |
| Max. Negotiated Rate |
$576.14 |
| Rate for Payer: Aetna Commercial |
$300.90
|
| Rate for Payer: BCBS Complete |
$329.22
|
| Rate for Payer: BCBS Trust/PPO |
$347.00
|
| Rate for Payer: Cash Price |
$658.44
|
| Rate for Payer: Cash Price |
$658.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.14
|
|
|
PR RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I
|
Professional
|
Both
|
$2,888.00
|
|
|
Service Code
|
HCPCS 37193
|
| Min. Negotiated Rate |
$214.92 |
| Max. Negotiated Rate |
$2,206.87 |
| Rate for Payer: Aetna Commercial |
$453.59
|
| Rate for Payer: Aetna Medicare |
$338.50
|
| Rate for Payer: BCBS Complete |
$225.67
|
| Rate for Payer: BCBS MAPPO |
$338.50
|
| Rate for Payer: BCBS Trust/PPO |
$524.07
|
| Rate for Payer: BCN Commercial |
$2,206.87
|
| Rate for Payer: BCN Medicare Advantage |
$338.50
|
| Rate for Payer: Cash Price |
$2,310.40
|
| Rate for Payer: Cash Price |
$2,310.40
|
| Rate for Payer: Cofinity Commercial |
$487.44
|
| Rate for Payer: Cofinity Commercial |
$453.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.50
|
| Rate for Payer: Healthscope Commercial |
$406.20
|
| Rate for Payer: Healthscope Whirlpool |
$406.20
|
| Rate for Payer: Meridian Medicaid |
$225.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$355.42
|
| Rate for Payer: PACE SWMI |
$338.50
|
| Rate for Payer: PHP Medicare Advantage |
$338.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$214.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,021.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.74
|
| Rate for Payer: Priority Health Medicare |
$338.50
|
| Rate for Payer: Priority Health Narrow Network |
$536.74
|
| Rate for Payer: UHC Medicare Advantage |
$348.66
|
|
|
PR RUBELLA IMMUNIZATION, SUBCUT
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 90706
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
|
|
PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 90681
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$137.29 |
| Rate for Payer: Aetna Commercial |
$137.29
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS Trust/PPO |
$129.14
|
| Rate for Payer: BCN Commercial |
$129.14
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
|
