|
PR INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 33225
|
| Min. Negotiated Rate |
$288.83 |
| Max. Negotiated Rate |
$1,409.50 |
| Rate for Payer: Aetna Commercial |
$629.62
|
| Rate for Payer: Aetna Medicare |
$493.00
|
| Rate for Payer: BCBS Complete |
$303.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,409.50
|
| Rate for Payer: BCN Commercial |
$667.54
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Meridian Medicaid |
$303.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$718.49
|
| Rate for Payer: Priority Health Narrow Network |
$718.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$620.20
|
| Rate for Payer: UHC Exchange |
$620.20
|
| Rate for Payer: UHCCP Medicaid |
$288.83
|
|
|
PR INSJ GRAFT AORTA/GREAT VESSEL W/BYPASS
|
Professional
|
Both
|
$8,205.00
|
|
|
Service Code
|
HCPCS 33335
|
| Min. Negotiated Rate |
$818.87 |
| Max. Negotiated Rate |
$5,333.25 |
| Rate for Payer: Aetna Commercial |
$2,508.48
|
| Rate for Payer: Aetna Medicare |
$4,102.50
|
| Rate for Payer: BCBS Complete |
$1,230.97
|
| Rate for Payer: BCBS Trust/PPO |
$818.87
|
| Rate for Payer: BCN Commercial |
$2,673.07
|
| Rate for Payer: Cash Price |
$6,564.00
|
| Rate for Payer: Cash Price |
$6,564.00
|
| Rate for Payer: Meridian Medicaid |
$1,230.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,172.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,333.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,912.81
|
| Rate for Payer: Priority Health Narrow Network |
$2,912.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,472.63
|
| Rate for Payer: UHC Exchange |
$2,472.63
|
| Rate for Payer: UHCCP Medicaid |
$1,172.35
|
|
|
PR INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
|
Professional
|
Both
|
$3,117.00
|
|
|
Service Code
|
HCPCS 53445
|
| Min. Negotiated Rate |
$485.85 |
| Max. Negotiated Rate |
$3,567.61 |
| Rate for Payer: Aetna Commercial |
$968.30
|
| Rate for Payer: Aetna Medicare |
$1,558.50
|
| Rate for Payer: BCBS Complete |
$510.14
|
| Rate for Payer: BCBS Trust/PPO |
$3,567.61
|
| Rate for Payer: BCN Commercial |
$1,092.68
|
| Rate for Payer: Cash Price |
$2,493.60
|
| Rate for Payer: Cash Price |
$2,493.60
|
| Rate for Payer: Meridian Medicaid |
$510.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$485.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,026.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,206.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,206.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,060.51
|
| Rate for Payer: UHC Exchange |
$1,060.51
|
| Rate for Payer: UHCCP Medicaid |
$485.85
|
|
|
PR INSJ INTRA-AORT BALO ASSIST DEV VIA FEM ART OPEN
|
Professional
|
Both
|
$1,358.00
|
|
|
Service Code
|
HCPCS 33970
|
| Min. Negotiated Rate |
$220.46 |
| Max. Negotiated Rate |
$979.47 |
| Rate for Payer: Aetna Commercial |
$474.61
|
| Rate for Payer: Aetna Medicare |
$679.00
|
| Rate for Payer: BCBS Complete |
$231.48
|
| Rate for Payer: BCBS Trust/PPO |
$979.47
|
| Rate for Payer: BCN Commercial |
$505.29
|
| Rate for Payer: Cash Price |
$1,086.40
|
| Rate for Payer: Cash Price |
$1,086.40
|
| Rate for Payer: Meridian Medicaid |
$231.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$882.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.85
|
| Rate for Payer: Priority Health Narrow Network |
$548.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$481.13
|
| Rate for Payer: UHC Exchange |
$481.13
|
| Rate for Payer: UHCCP Medicaid |
$220.46
|
|
|
PR INSJ MESH/PROSTH PELVIC FLOOR DEFECT EACH SITE
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 57267
|
| Min. Negotiated Rate |
$159.11 |
| Max. Negotiated Rate |
$1,692.14 |
| Rate for Payer: Aetna Commercial |
$302.10
|
| Rate for Payer: Aetna Medicare |
$409.50
|
| Rate for Payer: BCBS Complete |
$167.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,692.14
|
| Rate for Payer: BCN Commercial |
$363.58
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Meridian Medicaid |
$167.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$370.04
|
| Rate for Payer: Priority Health Narrow Network |
$370.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.06
|
| Rate for Payer: UHC Exchange |
$303.06
|
| Rate for Payer: UHCCP Medicaid |
$159.11
|
|
|
PR INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH
|
Professional
|
Both
|
$1,466.00
|
|
|
Service Code
|
HCPCS 54405
|
| Min. Negotiated Rate |
$156.83 |
| Max. Negotiated Rate |
$1,284.62 |
| Rate for Payer: Aetna Commercial |
$1,038.16
|
| Rate for Payer: Aetna Medicare |
$733.00
|
| Rate for Payer: BCBS Complete |
$543.47
|
| Rate for Payer: BCBS Trust/PPO |
$156.83
|
| Rate for Payer: BCN Commercial |
$1,165.50
|
| Rate for Payer: Cash Price |
$1,172.80
|
| Rate for Payer: Cash Price |
$1,172.80
|
| Rate for Payer: Meridian Medicaid |
$543.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$517.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$952.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,284.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,284.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$977.97
|
| Rate for Payer: UHC Exchange |
$977.97
|
| Rate for Payer: UHCCP Medicaid |
$517.59
|
|
|
PR INSJ NON-NDWELLG BLADDER CATHETER
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 51701
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$661.43 |
| Rate for Payer: Aetna Commercial |
$32.78
|
| Rate for Payer: Aetna Medicare |
$81.00
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS Trust/PPO |
$661.43
|
| Rate for Payer: BCN Commercial |
$52.23
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.48
|
| Rate for Payer: Priority Health Narrow Network |
$40.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.83
|
| Rate for Payer: UHC Exchange |
$32.83
|
| Rate for Payer: UHCCP Medicaid |
$15.98
|
|
|
PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y
|
Professional
|
Both
|
$1,003.00
|
|
|
Service Code
|
HCPCS 36555
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$898.64 |
| Rate for Payer: Aetna Commercial |
$113.71
|
| Rate for Payer: Aetna Medicare |
$501.50
|
| Rate for Payer: BCBS Complete |
$55.69
|
| Rate for Payer: BCBS Trust/PPO |
$898.64
|
| Rate for Payer: BCN Commercial |
$277.56
|
| Rate for Payer: Cash Price |
$802.40
|
| Rate for Payer: Cash Price |
$802.40
|
| Rate for Payer: Meridian Medicaid |
$55.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$651.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.89
|
| Rate for Payer: Priority Health Narrow Network |
$131.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.00
|
| Rate for Payer: UHC Exchange |
$159.00
|
| Rate for Payer: UHCCP Medicaid |
$53.04
|
|
|
PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>
|
Professional
|
Both
|
$859.00
|
|
|
Service Code
|
HCPCS 36556
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$558.35 |
| Rate for Payer: Aetna Commercial |
$113.58
|
| Rate for Payer: Aetna Medicare |
$429.50
|
| Rate for Payer: BCBS Complete |
$55.69
|
| Rate for Payer: BCBS Trust/PPO |
$253.58
|
| Rate for Payer: BCN Commercial |
$313.24
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Meridian Medicaid |
$55.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$558.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.43
|
| Rate for Payer: Priority Health Narrow Network |
$132.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.53
|
| Rate for Payer: UHC Exchange |
$155.53
|
| Rate for Payer: UHCCP Medicaid |
$53.04
|
|
|
PR INSJ PENILE PROSTHESIS NON-INFLATABLE SEMI-RIGID
|
Professional
|
Both
|
$1,596.00
|
|
|
Service Code
|
HCPCS 54400
|
| Min. Negotiated Rate |
$199.17 |
| Max. Negotiated Rate |
$1,037.40 |
| Rate for Payer: Aetna Commercial |
$681.16
|
| Rate for Payer: Aetna Medicare |
$798.00
|
| Rate for Payer: BCBS Complete |
$359.18
|
| Rate for Payer: BCBS Trust/PPO |
$199.17
|
| Rate for Payer: BCN Commercial |
$769.17
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Meridian Medicaid |
$359.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,037.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$850.03
|
| Rate for Payer: Priority Health Narrow Network |
$850.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$639.79
|
| Rate for Payer: UHC Exchange |
$639.79
|
| Rate for Payer: UHCCP Medicaid |
$342.08
|
|
|
PR INSJ PERQ VAD W/RS&I L HRT ARTERIAL ACCESS ONLY
|
Professional
|
Both
|
$897.00
|
|
|
Service Code
|
HCPCS 33990
|
| Min. Negotiated Rate |
$224.93 |
| Max. Negotiated Rate |
$1,090.41 |
| Rate for Payer: Aetna Commercial |
$486.27
|
| Rate for Payer: Aetna Medicare |
$448.50
|
| Rate for Payer: BCBS Complete |
$236.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,090.41
|
| Rate for Payer: BCN Commercial |
$515.07
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Meridian Medicaid |
$236.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$224.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$561.07
|
| Rate for Payer: Priority Health Narrow Network |
$561.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$597.74
|
| Rate for Payer: UHC Exchange |
$597.74
|
| Rate for Payer: UHCCP Medicaid |
$224.93
|
|
|
PR INSJ PERQ VAD W/RS&I L HRT ARTERIAL&VEN ACCESS
|
Professional
|
Both
|
$3,380.00
|
|
|
Service Code
|
HCPCS 33991
|
| Min. Negotiated Rate |
$282.86 |
| Max. Negotiated Rate |
$2,197.00 |
| Rate for Payer: Aetna Commercial |
$635.02
|
| Rate for Payer: Aetna Medicare |
$1,690.00
|
| Rate for Payer: BCBS Complete |
$297.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,109.43
|
| Rate for Payer: BCN Commercial |
$648.47
|
| Rate for Payer: Cash Price |
$2,704.00
|
| Rate for Payer: Cash Price |
$2,704.00
|
| Rate for Payer: Meridian Medicaid |
$297.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,197.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$704.14
|
| Rate for Payer: Priority Health Narrow Network |
$704.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$870.95
|
| Rate for Payer: UHC Exchange |
$870.95
|
| Rate for Payer: UHCCP Medicaid |
$282.86
|
|
|
PR INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Facility
|
OP
|
$1,733.00
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
36571
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,126.45 |
| Max. Negotiated Rate |
$4,779.98 |
| Rate for Payer: Aetna Commercial |
$1,559.70
|
| Rate for Payer: Aetna Medicare |
$3,083.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: ASR ASR |
$1,681.01
|
| Rate for Payer: ASR Commercial |
$1,681.01
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,419.15
|
| Rate for Payer: BCN Commercial |
$1,343.59
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Cofinity Commercial |
$1,629.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,386.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$1,733.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,681.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$1,559.70
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,473.05
|
| Rate for Payer: Nomi Health Commercial |
$1,421.06
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Commercial |
$3,392.25
|
| Rate for Payer: PHP Medicaid |
$1,652.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,126.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,518.45
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,214.83
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,525.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$4,779.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP DNSP |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
PR INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Facility
|
IP
|
$1,733.00
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
36571
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,126.45 |
| Max. Negotiated Rate |
$1,733.00 |
| Rate for Payer: Aetna Commercial |
$1,559.70
|
| Rate for Payer: ASR ASR |
$1,681.01
|
| Rate for Payer: ASR Commercial |
$1,681.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,412.22
|
| Rate for Payer: BCN Commercial |
$1,343.59
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Cofinity Commercial |
$1,629.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,386.40
|
| Rate for Payer: Healthscope Commercial |
$1,733.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,681.01
|
| Rate for Payer: Mclaren Commercial |
$1,559.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,473.05
|
| Rate for Payer: Nomi Health Commercial |
$1,421.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,126.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,525.04
|
|
|
PR INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Professional
|
Both
|
$1,733.00
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
36571
|
| Min. Negotiated Rate |
$198.52 |
| Max. Negotiated Rate |
$1,860.89 |
| Rate for Payer: Aetna Commercial |
$418.88
|
| Rate for Payer: Aetna Medicare |
$866.50
|
| Rate for Payer: BCBS Complete |
$208.45
|
| Rate for Payer: BCBS Trust/PPO |
$651.39
|
| Rate for Payer: BCN Commercial |
$1,860.89
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Meridian Medicaid |
$208.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,126.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$494.06
|
| Rate for Payer: Priority Health Narrow Network |
$494.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$402.84
|
| Rate for Payer: UHC Exchange |
$402.84
|
| Rate for Payer: UHCCP Medicaid |
$198.52
|
|
|
PR INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Professional
|
Both
|
$1,733.00
|
|
|
Service Code
|
HCPCS 36571
|
| Min. Negotiated Rate |
$198.52 |
| Max. Negotiated Rate |
$1,860.89 |
| Rate for Payer: Aetna Commercial |
$418.88
|
| Rate for Payer: Aetna Medicare |
$866.50
|
| Rate for Payer: BCBS Complete |
$208.45
|
| Rate for Payer: BCBS Trust/PPO |
$651.39
|
| Rate for Payer: BCN Commercial |
$1,860.89
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Meridian Medicaid |
$208.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,126.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$494.06
|
| Rate for Payer: Priority Health Narrow Network |
$494.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$402.84
|
| Rate for Payer: UHC Exchange |
$402.84
|
| Rate for Payer: UHCCP Medicaid |
$198.52
|
|
|
PR INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR
|
Professional
|
Both
|
$3,086.00
|
|
|
Service Code
|
HCPCS 36570
|
| Min. Negotiated Rate |
$213.43 |
| Max. Negotiated Rate |
$2,152.62 |
| Rate for Payer: Aetna Commercial |
$445.12
|
| Rate for Payer: Aetna Medicare |
$1,543.00
|
| Rate for Payer: BCBS Complete |
$224.10
|
| Rate for Payer: BCN Commercial |
$2,152.62
|
| Rate for Payer: Cash Price |
$2,468.80
|
| Rate for Payer: Cash Price |
$2,468.80
|
| Rate for Payer: Meridian Medicaid |
$224.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,005.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$529.69
|
| Rate for Payer: Priority Health Narrow Network |
$529.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$387.84
|
| Rate for Payer: UHC Exchange |
$387.84
|
| Rate for Payer: UHCCP Medicaid |
$213.43
|
|
|
PR INSJ/RPLCMT BREAST IMPLANT SEP DAY MASTECTOMY
|
Professional
|
Both
|
$1,677.00
|
|
|
Service Code
|
HCPCS 19342
|
| Min. Negotiated Rate |
$493.10 |
| Max. Negotiated Rate |
$1,594.65 |
| Rate for Payer: Aetna Commercial |
$822.56
|
| Rate for Payer: Aetna Medicare |
$838.50
|
| Rate for Payer: BCBS Complete |
$517.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,594.65
|
| Rate for Payer: BCN Commercial |
$1,114.67
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Meridian Medicaid |
$517.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$493.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,035.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,035.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$969.00
|
| Rate for Payer: UHC Exchange |
$969.00
|
| Rate for Payer: UHCCP Medicaid |
$493.10
|
|
|
PR INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS
|
Professional
|
Both
|
$1,890.00
|
|
|
Service Code
|
HCPCS 61886
|
| Min. Negotiated Rate |
$579.36 |
| Max. Negotiated Rate |
$1,804.66 |
| Rate for Payer: Aetna Commercial |
$1,112.99
|
| Rate for Payer: Aetna Medicare |
$945.00
|
| Rate for Payer: BCBS Complete |
$608.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,034.41
|
| Rate for Payer: BCN Commercial |
$1,804.66
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Meridian Medicaid |
$608.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$579.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,228.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,537.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,537.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$935.52
|
| Rate for Payer: UHC Exchange |
$935.52
|
| Rate for Payer: UHCCP Medicaid |
$579.36
|
|
|
PR INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR
|
Professional
|
Both
|
$1,654.00
|
|
|
Service Code
|
HCPCS 61885
|
| Min. Negotiated Rate |
$347.40 |
| Max. Negotiated Rate |
$1,084.02 |
| Rate for Payer: Aetna Commercial |
$671.13
|
| Rate for Payer: Aetna Medicare |
$827.00
|
| Rate for Payer: BCBS Complete |
$364.77
|
| Rate for Payer: BCBS Trust/PPO |
$810.94
|
| Rate for Payer: BCN Commercial |
$1,084.02
|
| Rate for Payer: Cash Price |
$1,323.20
|
| Rate for Payer: Cash Price |
$1,323.20
|
| Rate for Payer: Meridian Medicaid |
$364.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$921.32
|
| Rate for Payer: Priority Health Narrow Network |
$921.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$737.16
|
| Rate for Payer: UHC Exchange |
$737.16
|
| Rate for Payer: UHCCP Medicaid |
$347.40
|
|
|
PR INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR
|
Professional
|
Both
|
$1,897.00
|
|
|
Service Code
|
HCPCS 33249
|
| Min. Negotiated Rate |
$573.40 |
| Max. Negotiated Rate |
$1,427.95 |
| Rate for Payer: Aetna Commercial |
$1,231.48
|
| Rate for Payer: Aetna Medicare |
$948.50
|
| Rate for Payer: BCBS Complete |
$602.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,179.17
|
| Rate for Payer: BCN Commercial |
$1,319.43
|
| Rate for Payer: Cash Price |
$1,517.60
|
| Rate for Payer: Cash Price |
$1,517.60
|
| Rate for Payer: Meridian Medicaid |
$602.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,233.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,427.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,427.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,222.71
|
| Rate for Payer: UHC Exchange |
$1,222.71
|
| Rate for Payer: UHCCP Medicaid |
$573.40
|
|
|
PR INSJ/RPLCMT SPINAL NPG/RCVR POCKET CRTJ&CONNJ
|
Professional
|
Both
|
$2,287.00
|
|
|
Service Code
|
HCPCS 63685
|
| Min. Negotiated Rate |
$218.96 |
| Max. Negotiated Rate |
$1,486.55 |
| Rate for Payer: Aetna Commercial |
$465.59
|
| Rate for Payer: Aetna Medicare |
$1,143.50
|
| Rate for Payer: BCBS Complete |
$229.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,113.66
|
| Rate for Payer: BCN Commercial |
$529.73
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Meridian Medicaid |
$229.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$218.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,486.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$584.65
|
| Rate for Payer: Priority Health Narrow Network |
$584.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$455.50
|
| Rate for Payer: UHC Exchange |
$455.50
|
| Rate for Payer: UHCCP Medicaid |
$218.96
|
|
|
PR INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH
|
Professional
|
Both
|
$1,036.00
|
|
|
Service Code
|
HCPCS 33210
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$1,347.69 |
| Rate for Payer: Aetna Commercial |
$218.64
|
| Rate for Payer: Aetna Medicare |
$518.00
|
| Rate for Payer: BCBS Complete |
$106.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,347.69
|
| Rate for Payer: BCN Commercial |
$231.63
|
| Rate for Payer: Cash Price |
$828.80
|
| Rate for Payer: Cash Price |
$828.80
|
| Rate for Payer: Meridian Medicaid |
$106.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$673.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.03
|
| Rate for Payer: Priority Health Narrow Network |
$251.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.68
|
| Rate for Payer: UHC Exchange |
$243.68
|
| Rate for Payer: UHCCP Medicaid |
$100.96
|
|
|
PR INSJ SUBQ RSVR PUMP/CONT INFUSION SYS VENTR CATH
|
Professional
|
Both
|
$2,725.00
|
|
|
Service Code
|
HCPCS 61215
|
| Min. Negotiated Rate |
$341.44 |
| Max. Negotiated Rate |
$1,771.25 |
| Rate for Payer: Aetna Commercial |
$652.56
|
| Rate for Payer: Aetna Medicare |
$1,362.50
|
| Rate for Payer: BCBS Complete |
$358.51
|
| Rate for Payer: BCBS Trust/PPO |
$682.56
|
| Rate for Payer: BCN Commercial |
$1,063.68
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Meridian Medicaid |
$358.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$341.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,771.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$904.26
|
| Rate for Payer: Priority Health Narrow Network |
$904.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$558.98
|
| Rate for Payer: UHC Exchange |
$558.98
|
| Rate for Payer: UHCCP Medicaid |
$341.44
|
|
|
PR INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 51703
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$2,051.39 |
| Rate for Payer: Aetna Commercial |
$98.20
|
| Rate for Payer: Aetna Medicare |
$149.50
|
| Rate for Payer: BCBS Complete |
$50.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,051.39
|
| Rate for Payer: BCN Commercial |
$218.93
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Meridian Medicaid |
$50.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.37
|
| Rate for Payer: Priority Health Narrow Network |
$120.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.93
|
| Rate for Payer: UHC Exchange |
$97.93
|
| Rate for Payer: UHCCP Medicaid |
$48.35
|
|
