|
PR SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT
|
Professional
|
Both
|
$1,251.00
|
|
|
Service Code
|
HCPCS 25118
|
| Min. Negotiated Rate |
$145.28 |
| Max. Negotiated Rate |
$875.70 |
| Rate for Payer: Aetna Commercial |
$505.89
|
| Rate for Payer: Aetna Medicare |
$377.53
|
| Rate for Payer: BCBS Complete |
$263.91
|
| Rate for Payer: BCBS MAPPO |
$377.53
|
| Rate for Payer: BCBS Trust/PPO |
$145.28
|
| Rate for Payer: BCN Commercial |
$568.82
|
| Rate for Payer: BCN Medicare Advantage |
$377.53
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cofinity Commercial |
$505.89
|
| Rate for Payer: Cofinity Commercial |
$543.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$377.53
|
| Rate for Payer: Healthscope Commercial |
$453.04
|
| Rate for Payer: Healthscope Whirlpool |
$453.04
|
| Rate for Payer: Meridian Medicaid |
$263.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$396.41
|
| Rate for Payer: PACE SWMI |
$377.53
|
| Rate for Payer: PHP Medicare Advantage |
$377.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$251.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$875.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$594.40
|
| Rate for Payer: Priority Health Medicare |
$377.53
|
| Rate for Payer: Priority Health Narrow Network |
$594.40
|
| Rate for Payer: UHC Medicare Advantage |
$388.86
|
|
|
PR SYNOVECTOMY METATARSOPHALANGEAL JOINT EACH
|
Professional
|
Both
|
$996.00
|
|
|
Service Code
|
HCPCS 28072
|
| Min. Negotiated Rate |
$210.23 |
| Max. Negotiated Rate |
$712.98 |
| Rate for Payer: Aetna Commercial |
$424.39
|
| Rate for Payer: Aetna Medicare |
$316.71
|
| Rate for Payer: BCBS Complete |
$220.74
|
| Rate for Payer: BCBS MAPPO |
$316.71
|
| Rate for Payer: BCBS Trust/PPO |
$567.39
|
| Rate for Payer: BCN Commercial |
$712.98
|
| Rate for Payer: BCN Medicare Advantage |
$316.71
|
| Rate for Payer: Cash Price |
$796.80
|
| Rate for Payer: Cash Price |
$796.80
|
| Rate for Payer: Cofinity Commercial |
$456.06
|
| Rate for Payer: Cofinity Commercial |
$424.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.71
|
| Rate for Payer: Healthscope Commercial |
$380.05
|
| Rate for Payer: Healthscope Whirlpool |
$380.05
|
| Rate for Payer: Meridian Medicaid |
$220.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$332.55
|
| Rate for Payer: PACE SWMI |
$316.71
|
| Rate for Payer: PHP Medicare Advantage |
$316.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$495.34
|
| Rate for Payer: Priority Health Medicare |
$316.71
|
| Rate for Payer: Priority Health Narrow Network |
$495.34
|
| Rate for Payer: UHC Medicare Advantage |
$326.21
|
|
|
PR SYNVCT MTCARPHLNGL JT W/INTRNSC RLS&XTNSR HOOD
|
Professional
|
Both
|
$1,692.00
|
|
|
Service Code
|
HCPCS 26135
|
| Min. Negotiated Rate |
$295.85 |
| Max. Negotiated Rate |
$1,184.40 |
| Rate for Payer: Aetna Commercial |
$733.68
|
| Rate for Payer: Aetna Medicare |
$547.52
|
| Rate for Payer: BCBS Complete |
$378.86
|
| Rate for Payer: BCBS MAPPO |
$547.52
|
| Rate for Payer: BCBS Trust/PPO |
$295.85
|
| Rate for Payer: BCN Commercial |
$820.97
|
| Rate for Payer: BCN Medicare Advantage |
$547.52
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cofinity Commercial |
$788.43
|
| Rate for Payer: Cofinity Commercial |
$733.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$547.52
|
| Rate for Payer: Healthscope Commercial |
$657.02
|
| Rate for Payer: Healthscope Whirlpool |
$657.02
|
| Rate for Payer: Meridian Medicaid |
$378.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$574.90
|
| Rate for Payer: PACE SWMI |
$547.52
|
| Rate for Payer: PHP Medicare Advantage |
$547.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$360.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,184.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$857.88
|
| Rate for Payer: Priority Health Medicare |
$547.52
|
| Rate for Payer: Priority Health Narrow Network |
$857.88
|
| Rate for Payer: UHC Medicare Advantage |
$563.95
|
|
|
PR SYNVCT PROX IPHAL JT W/XTNSR RCNSTJ EA IPHAL JT
|
Professional
|
Both
|
$1,447.00
|
|
|
Service Code
|
HCPCS 26140
|
| Min. Negotiated Rate |
$332.07 |
| Max. Negotiated Rate |
$1,012.90 |
| Rate for Payer: Aetna Commercial |
$671.30
|
| Rate for Payer: Aetna Medicare |
$500.97
|
| Rate for Payer: BCBS Complete |
$348.67
|
| Rate for Payer: BCBS MAPPO |
$500.97
|
| Rate for Payer: BCBS Trust/PPO |
$497.66
|
| Rate for Payer: BCN Commercial |
$752.56
|
| Rate for Payer: BCN Medicare Advantage |
$500.97
|
| Rate for Payer: Cash Price |
$1,157.60
|
| Rate for Payer: Cash Price |
$1,157.60
|
| Rate for Payer: Cofinity Commercial |
$721.40
|
| Rate for Payer: Cofinity Commercial |
$671.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$500.97
|
| Rate for Payer: Healthscope Commercial |
$601.16
|
| Rate for Payer: Healthscope Whirlpool |
$601.16
|
| Rate for Payer: Meridian Medicaid |
$348.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$526.02
|
| Rate for Payer: PACE SWMI |
$500.97
|
| Rate for Payer: PHP Medicare Advantage |
$500.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$786.40
|
| Rate for Payer: Priority Health Medicare |
$500.97
|
| Rate for Payer: Priority Health Narrow Network |
$786.40
|
| Rate for Payer: UHC Medicare Advantage |
$516.00
|
|
|
PR SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN
|
Professional
|
Both
|
$1,647.00
|
|
|
Service Code
|
HCPCS 26145
|
| Min. Negotiated Rate |
$273.13 |
| Max. Negotiated Rate |
$1,152.90 |
| Rate for Payer: Aetna Commercial |
$682.62
|
| Rate for Payer: Aetna Medicare |
$509.42
|
| Rate for Payer: BCBS Complete |
$353.82
|
| Rate for Payer: BCBS MAPPO |
$509.42
|
| Rate for Payer: BCBS Trust/PPO |
$273.13
|
| Rate for Payer: BCN Commercial |
$764.78
|
| Rate for Payer: BCN Medicare Advantage |
$509.42
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cofinity Commercial |
$733.56
|
| Rate for Payer: Cofinity Commercial |
$682.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$509.42
|
| Rate for Payer: Healthscope Commercial |
$611.30
|
| Rate for Payer: Healthscope Whirlpool |
$611.30
|
| Rate for Payer: Meridian Medicaid |
$353.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$534.89
|
| Rate for Payer: PACE SWMI |
$509.42
|
| Rate for Payer: PHP Medicare Advantage |
$509.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,152.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$799.16
|
| Rate for Payer: Priority Health Medicare |
$509.42
|
| Rate for Payer: Priority Health Narrow Network |
$799.16
|
| Rate for Payer: UHC Medicare Advantage |
$524.70
|
|
|
PR SYNVCT XTNSR TDN SHTH WRST 1 RESCJ DSTL ULNA
|
Professional
|
Both
|
$1,761.00
|
|
|
Service Code
|
HCPCS 25119
|
| Min. Negotiated Rate |
$39.09 |
| Max. Negotiated Rate |
$1,232.70 |
| Rate for Payer: Aetna Commercial |
$665.31
|
| Rate for Payer: Aetna Medicare |
$496.50
|
| Rate for Payer: BCBS Complete |
$344.64
|
| Rate for Payer: BCBS MAPPO |
$496.50
|
| Rate for Payer: BCBS Trust/PPO |
$39.09
|
| Rate for Payer: BCN Commercial |
$745.24
|
| Rate for Payer: BCN Medicare Advantage |
$496.50
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Cofinity Commercial |
$665.31
|
| Rate for Payer: Cofinity Commercial |
$714.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$496.50
|
| Rate for Payer: Healthscope Commercial |
$595.80
|
| Rate for Payer: Healthscope Whirlpool |
$595.80
|
| Rate for Payer: Meridian Medicaid |
$344.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$521.32
|
| Rate for Payer: PACE SWMI |
$496.50
|
| Rate for Payer: PHP Medicare Advantage |
$496.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$328.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,232.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$778.74
|
| Rate for Payer: Priority Health Medicare |
$496.50
|
| Rate for Payer: Priority Health Narrow Network |
$778.74
|
| Rate for Payer: UHC Medicare Advantage |
$511.40
|
|
|
PR SYNVISC OR SYNVISC-ONE
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS J7325
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial |
$12.89
|
| Rate for Payer: Aetna Medicare |
$9.62
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$9.29
|
| Rate for Payer: BCN Commercial |
$10.87
|
| Rate for Payer: BCN Medicare Advantage |
$9.62
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$12.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.62
|
| Rate for Payer: Healthscope Commercial |
$11.54
|
| Rate for Payer: Healthscope Whirlpool |
$11.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.10
|
| Rate for Payer: PACE SWMI |
$9.62
|
| Rate for Payer: PHP Medicare Advantage |
$9.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health Medicare |
$9.62
|
| Rate for Payer: UHC Medicare Advantage |
$9.91
|
|
|
PR TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 11103
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$28.31
|
| Rate for Payer: Aetna Medicare |
$21.13
|
| Rate for Payer: BCBS Complete |
$14.54
|
| Rate for Payer: BCBS MAPPO |
$21.13
|
| Rate for Payer: BCBS Trust/PPO |
$562.50
|
| Rate for Payer: BCN Commercial |
$59.29
|
| Rate for Payer: BCN Medicare Advantage |
$21.13
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$28.31
|
| Rate for Payer: Cofinity Commercial |
$30.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.13
|
| Rate for Payer: Healthscope Commercial |
$25.36
|
| Rate for Payer: Healthscope Whirlpool |
$25.36
|
| Rate for Payer: Meridian Medicaid |
$14.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.19
|
| Rate for Payer: PACE SWMI |
$21.13
|
| Rate for Payer: PHP Medicare Advantage |
$21.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.31
|
| Rate for Payer: Priority Health Medicare |
$21.13
|
| Rate for Payer: Priority Health Narrow Network |
$26.31
|
| Rate for Payer: UHC Medicare Advantage |
$21.76
|
|
|
PR TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 11102
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$285.54 |
| Rate for Payer: Aetna Commercial |
$49.53
|
| Rate for Payer: Aetna Medicare |
$36.96
|
| Rate for Payer: BCBS Complete |
$25.05
|
| Rate for Payer: BCBS MAPPO |
$36.96
|
| Rate for Payer: BCBS Trust/PPO |
$285.54
|
| Rate for Payer: BCN Commercial |
$119.76
|
| Rate for Payer: BCN Medicare Advantage |
$36.96
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$53.22
|
| Rate for Payer: Cofinity Commercial |
$49.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.96
|
| Rate for Payer: Healthscope Commercial |
$44.35
|
| Rate for Payer: Healthscope Whirlpool |
$44.35
|
| Rate for Payer: Meridian Medicaid |
$25.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.81
|
| Rate for Payer: PACE SWMI |
$36.96
|
| Rate for Payer: PHP Medicare Advantage |
$36.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.03
|
| Rate for Payer: Priority Health Medicare |
$36.96
|
| Rate for Payer: Priority Health Narrow Network |
$46.03
|
| Rate for Payer: UHC Medicare Advantage |
$38.07
|
|
|
PR TAP BLOCK UNILATERAL BY INJECTION(S)
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 64486
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$164.20 |
| Rate for Payer: Aetna Commercial |
$73.39
|
| Rate for Payer: Aetna Medicare |
$54.77
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS MAPPO |
$54.77
|
| Rate for Payer: BCBS Trust/PPO |
$92.98
|
| Rate for Payer: BCN Commercial |
$164.20
|
| Rate for Payer: BCN Medicare Advantage |
$54.77
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$73.39
|
| Rate for Payer: Cofinity Commercial |
$78.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.77
|
| Rate for Payer: Healthscope Commercial |
$65.72
|
| Rate for Payer: Healthscope Whirlpool |
$65.72
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.51
|
| Rate for Payer: PACE SWMI |
$54.77
|
| Rate for Payer: PHP Medicare Advantage |
$54.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.30
|
| Rate for Payer: Priority Health Medicare |
$54.77
|
| Rate for Payer: Priority Health Narrow Network |
$92.30
|
| Rate for Payer: UHC Medicare Advantage |
$56.41
|
|
|
PR TATTOOING INCL MICROPIGMENTATION 6.0 CM/<
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 11920
|
| Min. Negotiated Rate |
$72.63 |
| Max. Negotiated Rate |
$630.49 |
| Rate for Payer: Aetna Commercial |
$142.48
|
| Rate for Payer: Aetna Medicare |
$106.33
|
| Rate for Payer: BCBS Complete |
$76.26
|
| Rate for Payer: BCBS MAPPO |
$106.33
|
| Rate for Payer: BCBS Trust/PPO |
$630.49
|
| Rate for Payer: BCN Commercial |
$281.97
|
| Rate for Payer: BCN Medicare Advantage |
$106.33
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$153.12
|
| Rate for Payer: Cofinity Commercial |
$142.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.33
|
| Rate for Payer: Healthscope Commercial |
$127.60
|
| Rate for Payer: Healthscope Whirlpool |
$127.60
|
| Rate for Payer: Meridian Medicaid |
$76.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$111.65
|
| Rate for Payer: PACE SWMI |
$106.33
|
| Rate for Payer: PHP Medicare Advantage |
$106.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.17
|
| Rate for Payer: Priority Health Medicare |
$106.33
|
| Rate for Payer: Priority Health Narrow Network |
$133.17
|
| Rate for Payer: UHC Medicare Advantage |
$109.52
|
|
|
PR TATTOOING INCL MICROPIGMENTATION 6.1-20.0 CM
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 11921
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$2,064.94 |
| Rate for Payer: Aetna Commercial |
$171.76
|
| Rate for Payer: Aetna Medicare |
$128.18
|
| Rate for Payer: BCBS Complete |
$87.44
|
| Rate for Payer: BCBS MAPPO |
$128.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,064.94
|
| Rate for Payer: BCN Commercial |
$327.90
|
| Rate for Payer: BCN Medicare Advantage |
$128.18
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cofinity Commercial |
$171.76
|
| Rate for Payer: Cofinity Commercial |
$184.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.18
|
| Rate for Payer: Healthscope Commercial |
$153.82
|
| Rate for Payer: Healthscope Whirlpool |
$153.82
|
| Rate for Payer: Meridian Medicaid |
$87.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$134.59
|
| Rate for Payer: PACE SWMI |
$128.18
|
| Rate for Payer: PHP Medicare Advantage |
$128.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.31
|
| Rate for Payer: Priority Health Medicare |
$128.18
|
| Rate for Payer: Priority Health Narrow Network |
$160.31
|
| Rate for Payer: UHC Medicare Advantage |
$132.03
|
|
|
PR TATTOOING INCL MICROPIGMENTATION EA 20.0 CM
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 11922
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$89.43 |
| Rate for Payer: Aetna Commercial |
$38.71
|
| Rate for Payer: Aetna Medicare |
$28.89
|
| Rate for Payer: BCBS Complete |
$19.24
|
| Rate for Payer: BCBS MAPPO |
$28.89
|
| Rate for Payer: BCBS Trust/PPO |
$62.82
|
| Rate for Payer: BCN Commercial |
$89.43
|
| Rate for Payer: BCN Medicare Advantage |
$28.89
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cofinity Commercial |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$38.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.89
|
| Rate for Payer: Healthscope Commercial |
$34.67
|
| Rate for Payer: Healthscope Whirlpool |
$34.67
|
| Rate for Payer: Meridian Medicaid |
$19.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.33
|
| Rate for Payer: PACE SWMI |
$28.89
|
| Rate for Payer: PHP Medicare Advantage |
$28.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.76
|
| Rate for Payer: Priority Health Medicare |
$28.89
|
| Rate for Payer: Priority Health Narrow Network |
$35.76
|
| Rate for Payer: UHC Medicare Advantage |
$29.76
|
|
|
PR TC99M DISOFENIN
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS A9510
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$1,959.99 |
| Rate for Payer: Aetna Commercial |
$67.20
|
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,959.99
|
| Rate for Payer: BCN Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
|
|
PR TC99M MEBROFENIN
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS A9537
|
| Min. Negotiated Rate |
$53.10 |
| Max. Negotiated Rate |
$2,874.48 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: BCBS Complete |
$95.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,874.48
|
| Rate for Payer: BCN Commercial |
$69.79
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.60
|
|
|
PR TC99M MEDRONATE
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS A9503
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$1,603.92 |
| Rate for Payer: Aetna Commercial |
$12.48
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,603.92
|
| Rate for Payer: BCN Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
|
|
PR TC99M PERTECHNETATE
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS A9512
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1,517.81 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.81
|
| Rate for Payer: BCN Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
|
|
PR TC99M SESTAMIBI
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS A9500
|
| Min. Negotiated Rate |
$102.48 |
| Max. Negotiated Rate |
$1,830.03 |
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: BCBS Complete |
$125.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,830.03
|
| Rate for Payer: BCN Commercial |
$128.10
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.80
|
|
|
PR TCATH STENT PLACEMT ANTEGRADE CAROTID/INNOMINATE
|
Professional
|
Both
|
$1,778.00
|
|
|
Service Code
|
HCPCS 37218
|
| Min. Negotiated Rate |
$517.59 |
| Max. Negotiated Rate |
$1,283.62 |
| Rate for Payer: Aetna Commercial |
$1,083.58
|
| Rate for Payer: Aetna Medicare |
$808.64
|
| Rate for Payer: BCBS Complete |
$543.47
|
| Rate for Payer: BCBS MAPPO |
$808.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,155.92
|
| Rate for Payer: BCN Commercial |
$1,179.18
|
| Rate for Payer: BCN Medicare Advantage |
$808.64
|
| Rate for Payer: Cash Price |
$1,422.40
|
| Rate for Payer: Cash Price |
$1,422.40
|
| Rate for Payer: Cofinity Commercial |
$1,164.44
|
| Rate for Payer: Cofinity Commercial |
$1,083.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$808.64
|
| Rate for Payer: Healthscope Commercial |
$970.37
|
| Rate for Payer: Healthscope Whirlpool |
$970.37
|
| Rate for Payer: Meridian Medicaid |
$543.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$849.07
|
| Rate for Payer: PACE SWMI |
$808.64
|
| Rate for Payer: PHP Medicare Advantage |
$808.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$517.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,244.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,283.62
|
| Rate for Payer: Priority Health Medicare |
$808.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,283.62
|
| Rate for Payer: UHC Medicare Advantage |
$832.90
|
|
|
PR TCATH STENT PLACEMT RETROGRAD CAROTID/INNOMINATE
|
Professional
|
Both
|
$1,721.00
|
|
|
Service Code
|
HCPCS 37217
|
| Min. Negotiated Rate |
$672.65 |
| Max. Negotiated Rate |
$1,682.04 |
| Rate for Payer: Aetna Commercial |
$1,427.49
|
| Rate for Payer: Aetna Medicare |
$1,065.29
|
| Rate for Payer: BCBS Complete |
$706.28
|
| Rate for Payer: BCBS MAPPO |
$1,065.29
|
| Rate for Payer: BCBS Trust/PPO |
$721.66
|
| Rate for Payer: BCN Commercial |
$1,545.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,065.29
|
| Rate for Payer: Cash Price |
$1,376.80
|
| Rate for Payer: Cash Price |
$1,376.80
|
| Rate for Payer: Cofinity Commercial |
$1,427.49
|
| Rate for Payer: Cofinity Commercial |
$1,534.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,065.29
|
| Rate for Payer: Healthscope Commercial |
$1,278.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,278.35
|
| Rate for Payer: Meridian Medicaid |
$706.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,118.55
|
| Rate for Payer: PACE SWMI |
$1,065.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,065.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$672.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,682.04
|
| Rate for Payer: Priority Health Medicare |
$1,065.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,682.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,097.25
|
|
|
PR TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
HCPCS 33289
|
| Min. Negotiated Rate |
$208.53 |
| Max. Negotiated Rate |
$1,657.81 |
| Rate for Payer: Aetna Commercial |
$437.89
|
| Rate for Payer: Aetna Medicare |
$326.78
|
| Rate for Payer: BCBS Complete |
$218.96
|
| Rate for Payer: BCBS MAPPO |
$326.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,657.81
|
| Rate for Payer: BCN Commercial |
$476.95
|
| Rate for Payer: BCN Medicare Advantage |
$326.78
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cofinity Commercial |
$470.56
|
| Rate for Payer: Cofinity Commercial |
$437.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.78
|
| Rate for Payer: Healthscope Commercial |
$392.14
|
| Rate for Payer: Healthscope Whirlpool |
$392.14
|
| Rate for Payer: Meridian Medicaid |
$218.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$343.12
|
| Rate for Payer: PACE SWMI |
$326.78
|
| Rate for Payer: PHP Medicare Advantage |
$326.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$519.19
|
| Rate for Payer: Priority Health Medicare |
$326.78
|
| Rate for Payer: Priority Health Narrow Network |
$519.19
|
| Rate for Payer: UHC Medicare Advantage |
$336.58
|
|
|
PR TCAT INSJ/RPL PERM LEADLESS PACEMAKER RV W/IMG
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33274
|
| Min. Negotiated Rate |
$299.90 |
| Max. Negotiated Rate |
$1,157.51 |
| Rate for Payer: Aetna Commercial |
$631.07
|
| Rate for Payer: Aetna Medicare |
$470.95
|
| Rate for Payer: BCBS Complete |
$314.90
|
| Rate for Payer: BCBS MAPPO |
$470.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,157.51
|
| Rate for Payer: BCN Commercial |
$692.95
|
| Rate for Payer: BCN Medicare Advantage |
$470.95
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cofinity Commercial |
$631.07
|
| Rate for Payer: Cofinity Commercial |
$678.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$470.95
|
| Rate for Payer: Healthscope Commercial |
$565.14
|
| Rate for Payer: Healthscope Whirlpool |
$565.14
|
| Rate for Payer: Meridian Medicaid |
$314.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$494.50
|
| Rate for Payer: PACE SWMI |
$470.95
|
| Rate for Payer: PHP Medicare Advantage |
$470.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$299.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$754.32
|
| Rate for Payer: Priority Health Medicare |
$470.95
|
| Rate for Payer: Priority Health Narrow Network |
$754.32
|
| Rate for Payer: UHC Medicare Advantage |
$485.08
|
|
|
PR TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ
|
Professional
|
Both
|
$2,068.90
|
|
|
Service Code
|
HCPCS 37215
|
| Min. Negotiated Rate |
$618.55 |
| Max. Negotiated Rate |
$1,543.21 |
| Rate for Payer: Aetna Commercial |
$1,305.00
|
| Rate for Payer: Aetna Medicare |
$973.88
|
| Rate for Payer: BCBS Complete |
$649.48
|
| Rate for Payer: BCBS MAPPO |
$973.88
|
| Rate for Payer: BCBS Trust/PPO |
$967.85
|
| Rate for Payer: BCN Commercial |
$1,417.66
|
| Rate for Payer: BCN Medicare Advantage |
$973.88
|
| Rate for Payer: Cash Price |
$1,655.12
|
| Rate for Payer: Cash Price |
$1,655.12
|
| Rate for Payer: Cofinity Commercial |
$1,402.39
|
| Rate for Payer: Cofinity Commercial |
$1,305.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$973.88
|
| Rate for Payer: Healthscope Commercial |
$1,168.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,168.66
|
| Rate for Payer: Meridian Medicaid |
$649.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,022.57
|
| Rate for Payer: PACE SWMI |
$973.88
|
| Rate for Payer: PHP Medicare Advantage |
$973.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$618.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,543.21
|
| Rate for Payer: Priority Health Medicare |
$973.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,543.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,003.10
|
|
|
PR TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ
|
Professional
|
Both
|
$4,102.00
|
|
|
Service Code
|
HCPCS 37216
|
| Min. Negotiated Rate |
$471.24 |
| Max. Negotiated Rate |
$2,871.40 |
| Rate for Payer: Aetna Commercial |
$1,302.62
|
| Rate for Payer: BCBS Complete |
$1,640.80
|
| Rate for Payer: BCBS Trust/PPO |
$471.24
|
| Rate for Payer: BCN Commercial |
$1,417.16
|
| Rate for Payer: Cash Price |
$3,281.60
|
| Rate for Payer: Cash Price |
$3,281.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,871.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,542.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,542.68
|
|
|
PR TCAT MITRAL VALVE REPAIR INITIAL PROSTHESIS
|
Professional
|
Both
|
$3,685.00
|
|
|
Service Code
|
HCPCS 33418
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$2,794.37 |
| Rate for Payer: Aetna Commercial |
$2,357.17
|
| Rate for Payer: Aetna Medicare |
$1,759.08
|
| Rate for Payer: BCBS Complete |
$1,181.76
|
| Rate for Payer: BCBS MAPPO |
$1,759.08
|
| Rate for Payer: BCBS Trust/PPO |
$308.00
|
| Rate for Payer: BCN Commercial |
$2,567.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,759.08
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Cofinity Commercial |
$2,533.08
|
| Rate for Payer: Cofinity Commercial |
$2,357.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,759.08
|
| Rate for Payer: Healthscope Commercial |
$2,110.90
|
| Rate for Payer: Healthscope Whirlpool |
$2,110.90
|
| Rate for Payer: Meridian Medicaid |
$1,181.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,847.03
|
| Rate for Payer: PACE SWMI |
$1,759.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,759.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,125.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,579.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,794.37
|
| Rate for Payer: Priority Health Medicare |
$1,759.08
|
| Rate for Payer: Priority Health Narrow Network |
$2,794.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,811.85
|
|
