|
PR TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS
|
Professional
|
Both
|
$4,533.00
|
|
|
Service Code
|
HCPCS 61624
|
| Min. Negotiated Rate |
$113.06 |
| Max. Negotiated Rate |
$3,173.10 |
| Rate for Payer: Aetna Commercial |
$1,555.97
|
| Rate for Payer: Aetna Medicare |
$1,161.17
|
| Rate for Payer: BCBS Complete |
$777.63
|
| Rate for Payer: BCBS MAPPO |
$1,161.17
|
| Rate for Payer: BCBS Trust/PPO |
$113.06
|
| Rate for Payer: BCN Commercial |
$2,342.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,161.17
|
| Rate for Payer: Cash Price |
$3,626.40
|
| Rate for Payer: Cash Price |
$3,626.40
|
| Rate for Payer: Cofinity Commercial |
$1,672.08
|
| Rate for Payer: Cofinity Commercial |
$1,555.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,161.17
|
| Rate for Payer: Healthscope Commercial |
$1,393.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,393.40
|
| Rate for Payer: Meridian Medicaid |
$777.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,219.23
|
| Rate for Payer: PACE SWMI |
$1,161.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,161.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$740.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,173.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,956.30
|
| Rate for Payer: Priority Health Medicare |
$1,161.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,956.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,196.01
|
|
|
PR TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS
|
Professional
|
Both
|
$1,812.30
|
|
|
Service Code
|
HCPCS 61626
|
| Min. Negotiated Rate |
$73.96 |
| Max. Negotiated Rate |
$1,507.86 |
| Rate for Payer: Aetna Commercial |
$1,197.02
|
| Rate for Payer: Aetna Medicare |
$893.30
|
| Rate for Payer: BCBS Complete |
$602.74
|
| Rate for Payer: BCBS MAPPO |
$893.30
|
| Rate for Payer: BCBS Trust/PPO |
$73.96
|
| Rate for Payer: BCN Commercial |
$1,301.35
|
| Rate for Payer: BCN Medicare Advantage |
$893.30
|
| Rate for Payer: Cash Price |
$1,449.84
|
| Rate for Payer: Cash Price |
$1,449.84
|
| Rate for Payer: Cofinity Commercial |
$1,286.35
|
| Rate for Payer: Cofinity Commercial |
$1,197.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$893.30
|
| Rate for Payer: Healthscope Commercial |
$1,071.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,071.96
|
| Rate for Payer: Meridian Medicaid |
$602.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$937.96
|
| Rate for Payer: PACE SWMI |
$893.30
|
| Rate for Payer: PHP Medicare Advantage |
$893.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,268.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,507.86
|
| Rate for Payer: Priority Health Medicare |
$893.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,507.86
|
| Rate for Payer: UHC Medicare Advantage |
$920.10
|
|
|
PR TCAT PLMT IV STENT ICRA W/BALO ANGIOP IF PFRMD
|
Professional
|
Both
|
$6,660.00
|
|
|
Service Code
|
HCPCS 61635
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$4,662.00 |
| Rate for Payer: Aetna Commercial |
$1,974.21
|
| Rate for Payer: Aetna Medicare |
$1,473.29
|
| Rate for Payer: BCBS Complete |
$2,664.00
|
| Rate for Payer: BCBS MAPPO |
$1,473.29
|
| Rate for Payer: BCBS Trust/PPO |
$63.40
|
| Rate for Payer: BCN Commercial |
$2,155.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,473.29
|
| Rate for Payer: Cash Price |
$5,328.00
|
| Rate for Payer: Cash Price |
$5,328.00
|
| Rate for Payer: Cofinity Commercial |
$2,121.54
|
| Rate for Payer: Cofinity Commercial |
$1,974.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,473.29
|
| Rate for Payer: Healthscope Commercial |
$1,767.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,767.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,546.95
|
| Rate for Payer: PACE SWMI |
$1,473.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,473.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,662.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,497.05
|
| Rate for Payer: Priority Health Medicare |
$1,473.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,497.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,517.49
|
|
|
PR TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL
|
Professional
|
Both
|
$9,679.00
|
|
|
Service Code
|
HCPCS 0075T
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$6,775.30 |
| Rate for Payer: Aetna Commercial |
$1,381.29
|
| Rate for Payer: BCBS Complete |
$3,871.60
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$6,440.29
|
| Rate for Payer: Cash Price |
$7,743.20
|
| Rate for Payer: Cash Price |
$7,743.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,775.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,900.00
|
| Rate for Payer: Priority Health Narrow Network |
$5,900.00
|
|
|
PR TDAP VACCINE 7 YRS/> IM
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 90715
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$55.79 |
| Rate for Payer: Aetna Commercial |
$51.92
|
| Rate for Payer: Aetna Medicare |
$38.74
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: BCBS MAPPO |
$38.74
|
| Rate for Payer: BCBS Trust/PPO |
$40.48
|
| Rate for Payer: BCN Commercial |
$42.12
|
| Rate for Payer: BCN Medicare Advantage |
$38.74
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$55.79
|
| Rate for Payer: Cofinity Commercial |
$51.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.74
|
| Rate for Payer: Healthscope Commercial |
$46.49
|
| Rate for Payer: Healthscope Whirlpool |
$46.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.68
|
| Rate for Payer: PACE SWMI |
$38.74
|
| Rate for Payer: PHP Medicare Advantage |
$38.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
| Rate for Payer: Priority Health Medicare |
$38.74
|
| Rate for Payer: UHC Medicare Advantage |
$39.91
|
|
|
PR TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN
|
Professional
|
Both
|
$2,581.00
|
|
|
Service Code
|
HCPCS 25310
|
| Min. Negotiated Rate |
$404.49 |
| Max. Negotiated Rate |
$1,806.70 |
| Rate for Payer: Aetna Commercial |
$822.01
|
| Rate for Payer: Aetna Medicare |
$613.44
|
| Rate for Payer: BCBS Complete |
$424.71
|
| Rate for Payer: BCBS MAPPO |
$613.44
|
| Rate for Payer: BCBS Trust/PPO |
$791.39
|
| Rate for Payer: BCN Commercial |
$919.20
|
| Rate for Payer: BCN Medicare Advantage |
$613.44
|
| Rate for Payer: Cash Price |
$2,064.80
|
| Rate for Payer: Cash Price |
$2,064.80
|
| Rate for Payer: Cofinity Commercial |
$883.35
|
| Rate for Payer: Cofinity Commercial |
$822.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$613.44
|
| Rate for Payer: Healthscope Commercial |
$736.13
|
| Rate for Payer: Healthscope Whirlpool |
$736.13
|
| Rate for Payer: Meridian Medicaid |
$424.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$644.11
|
| Rate for Payer: PACE SWMI |
$613.44
|
| Rate for Payer: PHP Medicare Advantage |
$613.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$404.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,806.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$960.54
|
| Rate for Payer: Priority Health Medicare |
$613.44
|
| Rate for Payer: Priority Health Narrow Network |
$960.54
|
| Rate for Payer: UHC Medicare Advantage |
$631.84
|
|
|
PR TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1/TDN GR
|
Professional
|
Both
|
$1,552.00
|
|
|
Service Code
|
HCPCS 25312
|
| Min. Negotiated Rate |
$226.11 |
| Max. Negotiated Rate |
$1,106.59 |
| Rate for Payer: Aetna Commercial |
$949.98
|
| Rate for Payer: Aetna Medicare |
$708.94
|
| Rate for Payer: BCBS Complete |
$488.45
|
| Rate for Payer: BCBS MAPPO |
$708.94
|
| Rate for Payer: BCBS Trust/PPO |
$226.11
|
| Rate for Payer: BCN Commercial |
$1,058.97
|
| Rate for Payer: BCN Medicare Advantage |
$708.94
|
| Rate for Payer: Cash Price |
$1,241.60
|
| Rate for Payer: Cash Price |
$1,241.60
|
| Rate for Payer: Cofinity Commercial |
$949.98
|
| Rate for Payer: Cofinity Commercial |
$1,020.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$708.94
|
| Rate for Payer: Healthscope Commercial |
$850.73
|
| Rate for Payer: Healthscope Whirlpool |
$850.73
|
| Rate for Payer: Meridian Medicaid |
$488.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$744.39
|
| Rate for Payer: PACE SWMI |
$708.94
|
| Rate for Payer: PHP Medicare Advantage |
$708.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,086.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,106.59
|
| Rate for Payer: Priority Health Medicare |
$708.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,106.59
|
| Rate for Payer: UHC Medicare Advantage |
$730.21
|
|
|
PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 90714
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$44.70 |
| Rate for Payer: Aetna Commercial |
$41.60
|
| Rate for Payer: Aetna Medicare |
$31.04
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$31.04
|
| Rate for Payer: BCBS Trust/PPO |
$35.19
|
| Rate for Payer: BCN Commercial |
$32.99
|
| Rate for Payer: BCN Medicare Advantage |
$31.04
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$44.70
|
| Rate for Payer: Cofinity Commercial |
$41.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.04
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Healthscope Whirlpool |
$37.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.60
|
| Rate for Payer: PACE SWMI |
$31.04
|
| Rate for Payer: PHP Medicare Advantage |
$31.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
| Rate for Payer: Priority Health Medicare |
$31.04
|
| Rate for Payer: UHC Medicare Advantage |
$31.98
|
|
|
PR TEAEC W/GRAFT EA ADDL TIBIAL/PERONEAL ART
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 35306
|
| Min. Negotiated Rate |
$276.26 |
| Max. Negotiated Rate |
$991.62 |
| Rate for Payer: Aetna Commercial |
$590.85
|
| Rate for Payer: Aetna Medicare |
$440.93
|
| Rate for Payer: BCBS Complete |
$290.07
|
| Rate for Payer: BCBS MAPPO |
$440.93
|
| Rate for Payer: BCBS Trust/PPO |
$991.62
|
| Rate for Payer: BCN Commercial |
$633.82
|
| Rate for Payer: BCN Medicare Advantage |
$440.93
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$634.94
|
| Rate for Payer: Cofinity Commercial |
$590.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$440.93
|
| Rate for Payer: Healthscope Commercial |
$529.12
|
| Rate for Payer: Healthscope Whirlpool |
$529.12
|
| Rate for Payer: Meridian Medicaid |
$290.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$462.98
|
| Rate for Payer: PACE SWMI |
$440.93
|
| Rate for Payer: PHP Medicare Advantage |
$440.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$276.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$689.95
|
| Rate for Payer: Priority Health Medicare |
$440.93
|
| Rate for Payer: Priority Health Narrow Network |
$689.95
|
| Rate for Payer: UHC Medicare Advantage |
$454.16
|
|
|
PR TEAEC W/GRAFT POPLITEAL ARTERY
|
Professional
|
Both
|
$2,340.00
|
|
|
Service Code
|
HCPCS 35303
|
| Min. Negotiated Rate |
$764.24 |
| Max. Negotiated Rate |
$1,921.44 |
| Rate for Payer: Aetna Commercial |
$1,632.43
|
| Rate for Payer: Aetna Medicare |
$1,218.23
|
| Rate for Payer: BCBS Complete |
$802.45
|
| Rate for Payer: BCBS MAPPO |
$1,218.23
|
| Rate for Payer: BCBS Trust/PPO |
$903.39
|
| Rate for Payer: BCN Commercial |
$1,765.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,218.23
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Cofinity Commercial |
$1,632.43
|
| Rate for Payer: Cofinity Commercial |
$1,754.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,218.23
|
| Rate for Payer: Healthscope Commercial |
$1,461.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,461.88
|
| Rate for Payer: Meridian Medicaid |
$802.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,279.14
|
| Rate for Payer: PACE SWMI |
$1,218.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,218.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$764.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,638.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,921.44
|
| Rate for Payer: Priority Health Medicare |
$1,218.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,921.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,254.78
|
|
|
PR TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY
|
Professional
|
Both
|
$2,149.00
|
|
|
Service Code
|
HCPCS 35302
|
| Min. Negotiated Rate |
$655.62 |
| Max. Negotiated Rate |
$1,738.43 |
| Rate for Payer: Aetna Commercial |
$1,476.76
|
| Rate for Payer: Aetna Medicare |
$1,102.06
|
| Rate for Payer: BCBS Complete |
$732.01
|
| Rate for Payer: BCBS MAPPO |
$1,102.06
|
| Rate for Payer: BCBS Trust/PPO |
$655.62
|
| Rate for Payer: BCN Commercial |
$1,596.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,102.06
|
| Rate for Payer: Cash Price |
$1,719.20
|
| Rate for Payer: Cash Price |
$1,719.20
|
| Rate for Payer: Cofinity Commercial |
$1,476.76
|
| Rate for Payer: Cofinity Commercial |
$1,586.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,102.06
|
| Rate for Payer: Healthscope Commercial |
$1,322.47
|
| Rate for Payer: Healthscope Whirlpool |
$1,322.47
|
| Rate for Payer: Meridian Medicaid |
$732.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,157.16
|
| Rate for Payer: PACE SWMI |
$1,102.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,102.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$697.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,504.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,738.43
|
| Rate for Payer: Priority Health Medicare |
$1,102.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,738.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,135.12
|
|
|
PR TEAEC W/GRAFT TIBIAL/PERONEAL ART 1ST VESSEL
|
Professional
|
Both
|
$2,364.00
|
|
|
Service Code
|
HCPCS 35305
|
| Min. Negotiated Rate |
$501.36 |
| Max. Negotiated Rate |
$1,899.08 |
| Rate for Payer: Aetna Commercial |
$1,614.82
|
| Rate for Payer: Aetna Medicare |
$1,205.09
|
| Rate for Payer: BCBS Complete |
$803.58
|
| Rate for Payer: BCBS MAPPO |
$1,205.09
|
| Rate for Payer: BCBS Trust/PPO |
$501.36
|
| Rate for Payer: BCN Commercial |
$1,744.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,205.09
|
| Rate for Payer: Cash Price |
$1,891.20
|
| Rate for Payer: Cash Price |
$1,891.20
|
| Rate for Payer: Cofinity Commercial |
$1,735.33
|
| Rate for Payer: Cofinity Commercial |
$1,614.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,205.09
|
| Rate for Payer: Healthscope Commercial |
$1,446.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,446.11
|
| Rate for Payer: Meridian Medicaid |
$803.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,265.34
|
| Rate for Payer: PACE SWMI |
$1,205.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,205.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$765.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,654.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,899.08
|
| Rate for Payer: Priority Health Medicare |
$1,205.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,899.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,241.24
|
|
|
PR TEAEC W/GRAFT TIBIOPERONEAL TRUNK ARTERY
|
Professional
|
Both
|
$2,460.00
|
|
|
Service Code
|
HCPCS 35304
|
| Min. Negotiated Rate |
$795.56 |
| Max. Negotiated Rate |
$1,973.57 |
| Rate for Payer: Aetna Commercial |
$1,678.81
|
| Rate for Payer: Aetna Medicare |
$1,252.84
|
| Rate for Payer: BCBS Complete |
$835.34
|
| Rate for Payer: BCBS MAPPO |
$1,252.84
|
| Rate for Payer: BCBS Trust/PPO |
$836.83
|
| Rate for Payer: BCN Commercial |
$1,812.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,252.84
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Cofinity Commercial |
$1,804.09
|
| Rate for Payer: Cofinity Commercial |
$1,678.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,252.84
|
| Rate for Payer: Healthscope Commercial |
$1,503.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,503.41
|
| Rate for Payer: Meridian Medicaid |
$835.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,315.48
|
| Rate for Payer: PACE SWMI |
$1,252.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,252.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$795.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,722.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,973.57
|
| Rate for Payer: Priority Health Medicare |
$1,252.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,973.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,290.43
|
|
|
PR TEAEC W/PATCH GRF CAROTID VERTB SUBCLAV NECK INC
|
Professional
|
Both
|
$3,625.00
|
|
|
Service Code
|
HCPCS 35301
|
| Min. Negotiated Rate |
$276.83 |
| Max. Negotiated Rate |
$2,537.50 |
| Rate for Payer: Aetna Commercial |
$1,490.09
|
| Rate for Payer: Aetna Medicare |
$1,112.01
|
| Rate for Payer: BCBS Complete |
$740.28
|
| Rate for Payer: BCBS MAPPO |
$1,112.01
|
| Rate for Payer: BCBS Trust/PPO |
$276.83
|
| Rate for Payer: BCN Commercial |
$1,613.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,112.01
|
| Rate for Payer: Cash Price |
$2,900.00
|
| Rate for Payer: Cash Price |
$2,900.00
|
| Rate for Payer: Cofinity Commercial |
$1,601.29
|
| Rate for Payer: Cofinity Commercial |
$1,490.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,112.01
|
| Rate for Payer: Healthscope Commercial |
$1,334.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,334.41
|
| Rate for Payer: Meridian Medicaid |
$740.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,167.61
|
| Rate for Payer: PACE SWMI |
$1,112.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,112.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$705.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,537.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,756.00
|
| Rate for Payer: Priority Health Medicare |
$1,112.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,756.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,145.37
|
|
|
PR TEAEC W/WO PATCH GRAFT ABDOMINAL AORTA
|
Professional
|
Both
|
$4,641.00
|
|
|
Service Code
|
HCPCS 35331
|
| Min. Negotiated Rate |
$763.92 |
| Max. Negotiated Rate |
$3,248.70 |
| Rate for Payer: Aetna Commercial |
$1,926.96
|
| Rate for Payer: Aetna Medicare |
$1,438.03
|
| Rate for Payer: BCBS Complete |
$952.75
|
| Rate for Payer: BCBS MAPPO |
$1,438.03
|
| Rate for Payer: BCBS Trust/PPO |
$763.92
|
| Rate for Payer: BCN Commercial |
$2,084.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,438.03
|
| Rate for Payer: Cash Price |
$3,712.80
|
| Rate for Payer: Cash Price |
$3,712.80
|
| Rate for Payer: Cofinity Commercial |
$2,070.76
|
| Rate for Payer: Cofinity Commercial |
$1,926.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,438.03
|
| Rate for Payer: Healthscope Commercial |
$1,725.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,725.64
|
| Rate for Payer: Meridian Medicaid |
$952.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,509.93
|
| Rate for Payer: PACE SWMI |
$1,438.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,438.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$907.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,248.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,269.33
|
| Rate for Payer: Priority Health Medicare |
$1,438.03
|
| Rate for Payer: Priority Health Narrow Network |
$2,269.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,481.17
|
|
|
PR TEAEC W/WO PATCH GRAFT COMBINED AORTOILIOFEMORAL
|
Professional
|
Both
|
$3,275.00
|
|
|
Service Code
|
HCPCS 35363
|
| Min. Negotiated Rate |
$1,012.60 |
| Max. Negotiated Rate |
$2,517.22 |
| Rate for Payer: Aetna Commercial |
$2,146.91
|
| Rate for Payer: Aetna Medicare |
$1,602.17
|
| Rate for Payer: BCBS Complete |
$1,063.23
|
| Rate for Payer: BCBS MAPPO |
$1,602.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,218.79
|
| Rate for Payer: BCN Commercial |
$2,312.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.17
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cofinity Commercial |
$2,307.12
|
| Rate for Payer: Cofinity Commercial |
$2,146.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.17
|
| Rate for Payer: Healthscope Commercial |
$1,922.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,922.60
|
| Rate for Payer: Meridian Medicaid |
$1,063.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,682.28
|
| Rate for Payer: PACE SWMI |
$1,602.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,012.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,292.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,517.22
|
| Rate for Payer: Priority Health Medicare |
$1,602.17
|
| Rate for Payer: Priority Health Narrow Network |
$2,517.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,650.24
|
|
|
PR TEAEC W/WO PATCH GRAFT COMMON FEMORAL
|
Professional
|
Both
|
$1,717.00
|
|
|
Service Code
|
HCPCS 35371
|
| Min. Negotiated Rate |
$508.43 |
| Max. Negotiated Rate |
$1,266.58 |
| Rate for Payer: Aetna Commercial |
$1,074.56
|
| Rate for Payer: Aetna Medicare |
$801.91
|
| Rate for Payer: BCBS Complete |
$533.85
|
| Rate for Payer: BCBS MAPPO |
$801.91
|
| Rate for Payer: BCBS Trust/PPO |
$666.19
|
| Rate for Payer: BCN Commercial |
$1,163.54
|
| Rate for Payer: BCN Medicare Advantage |
$801.91
|
| Rate for Payer: Cash Price |
$1,373.60
|
| Rate for Payer: Cash Price |
$1,373.60
|
| Rate for Payer: Cofinity Commercial |
$1,074.56
|
| Rate for Payer: Cofinity Commercial |
$1,154.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$801.91
|
| Rate for Payer: Healthscope Commercial |
$962.29
|
| Rate for Payer: Healthscope Whirlpool |
$962.29
|
| Rate for Payer: Meridian Medicaid |
$533.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$842.01
|
| Rate for Payer: PACE SWMI |
$801.91
|
| Rate for Payer: PHP Medicare Advantage |
$801.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,201.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,266.58
|
| Rate for Payer: Priority Health Medicare |
$801.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,266.58
|
| Rate for Payer: UHC Medicare Advantage |
$825.97
|
|
|
PR TEAEC W/WO PATCH GRAFT DEEP PROFUNDA FEMORAL
|
Professional
|
Both
|
$3,699.00
|
|
|
Service Code
|
HCPCS 35372
|
| Min. Negotiated Rate |
$609.18 |
| Max. Negotiated Rate |
$2,589.30 |
| Rate for Payer: Aetna Commercial |
$1,287.36
|
| Rate for Payer: Aetna Medicare |
$960.72
|
| Rate for Payer: BCBS Complete |
$639.64
|
| Rate for Payer: BCBS MAPPO |
$960.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,194.49
|
| Rate for Payer: BCN Commercial |
$1,392.25
|
| Rate for Payer: BCN Medicare Advantage |
$960.72
|
| Rate for Payer: Cash Price |
$2,959.20
|
| Rate for Payer: Cash Price |
$2,959.20
|
| Rate for Payer: Cofinity Commercial |
$1,383.44
|
| Rate for Payer: Cofinity Commercial |
$1,287.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$960.72
|
| Rate for Payer: Healthscope Commercial |
$1,152.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,152.86
|
| Rate for Payer: Meridian Medicaid |
$639.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,008.76
|
| Rate for Payer: PACE SWMI |
$960.72
|
| Rate for Payer: PHP Medicare Advantage |
$960.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$609.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,589.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,515.55
|
| Rate for Payer: Priority Health Medicare |
$960.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,515.55
|
| Rate for Payer: UHC Medicare Advantage |
$989.54
|
|
|
PR TEAEC W/WO PATCH GRAFT ILIAC
|
Professional
|
Both
|
$2,478.00
|
|
|
Service Code
|
HCPCS 35351
|
| Min. Negotiated Rate |
$801.73 |
| Max. Negotiated Rate |
$1,993.77 |
| Rate for Payer: Aetna Commercial |
$1,694.27
|
| Rate for Payer: Aetna Medicare |
$1,264.38
|
| Rate for Payer: BCBS Complete |
$841.82
|
| Rate for Payer: BCBS MAPPO |
$1,264.38
|
| Rate for Payer: BCBS Trust/PPO |
$942.49
|
| Rate for Payer: BCN Commercial |
$1,831.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,264.38
|
| Rate for Payer: Cash Price |
$1,982.40
|
| Rate for Payer: Cash Price |
$1,982.40
|
| Rate for Payer: Cofinity Commercial |
$1,820.71
|
| Rate for Payer: Cofinity Commercial |
$1,694.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,264.38
|
| Rate for Payer: Healthscope Commercial |
$1,517.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,517.26
|
| Rate for Payer: Meridian Medicaid |
$841.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,327.60
|
| Rate for Payer: PACE SWMI |
$1,264.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,264.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$801.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,734.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,993.77
|
| Rate for Payer: Priority Health Medicare |
$1,264.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,993.77
|
| Rate for Payer: UHC Medicare Advantage |
$1,302.31
|
|
|
PR TEAEC W/WO PATCH GRAFT ILIOFEMORAL
|
Professional
|
Both
|
$2,013.00
|
|
|
Service Code
|
HCPCS 35355
|
| Min. Negotiated Rate |
$641.34 |
| Max. Negotiated Rate |
$1,596.40 |
| Rate for Payer: Aetna Commercial |
$1,357.66
|
| Rate for Payer: Aetna Medicare |
$1,013.18
|
| Rate for Payer: BCBS Complete |
$673.41
|
| Rate for Payer: BCBS MAPPO |
$1,013.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,096.22
|
| Rate for Payer: BCN Commercial |
$1,466.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,013.18
|
| Rate for Payer: Cash Price |
$1,610.40
|
| Rate for Payer: Cash Price |
$1,610.40
|
| Rate for Payer: Cofinity Commercial |
$1,458.98
|
| Rate for Payer: Cofinity Commercial |
$1,357.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,013.18
|
| Rate for Payer: Healthscope Commercial |
$1,215.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,215.82
|
| Rate for Payer: Meridian Medicaid |
$673.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,063.84
|
| Rate for Payer: PACE SWMI |
$1,013.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,013.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$641.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,409.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,596.40
|
| Rate for Payer: Priority Health Medicare |
$1,013.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,596.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,043.58
|
|
|
PR TEAEC W/WO PATCH GRAFT MESENTERIC CELIAC/RENAL
|
Professional
|
Both
|
$4,420.00
|
|
|
Service Code
|
HCPCS 35341
|
| Min. Negotiated Rate |
$865.42 |
| Max. Negotiated Rate |
$3,094.00 |
| Rate for Payer: Aetna Commercial |
$1,823.10
|
| Rate for Payer: Aetna Medicare |
$1,360.52
|
| Rate for Payer: BCBS Complete |
$908.69
|
| Rate for Payer: BCBS MAPPO |
$1,360.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,030.71
|
| Rate for Payer: BCN Commercial |
$1,972.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,360.52
|
| Rate for Payer: Cash Price |
$3,536.00
|
| Rate for Payer: Cash Price |
$3,536.00
|
| Rate for Payer: Cofinity Commercial |
$1,823.10
|
| Rate for Payer: Cofinity Commercial |
$1,959.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,360.52
|
| Rate for Payer: Healthscope Commercial |
$1,632.62
|
| Rate for Payer: Healthscope Whirlpool |
$1,632.62
|
| Rate for Payer: Meridian Medicaid |
$908.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,428.55
|
| Rate for Payer: PACE SWMI |
$1,360.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,360.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$865.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,094.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,146.98
|
| Rate for Payer: Priority Health Medicare |
$1,360.52
|
| Rate for Payer: Priority Health Narrow Network |
$2,146.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,401.34
|
|
|
PR TEAEC W/WO PATCH GRF AXILLARY-BRACHIAL
|
Professional
|
Both
|
$3,779.00
|
|
|
Service Code
|
HCPCS 35321
|
| Min. Negotiated Rate |
$561.89 |
| Max. Negotiated Rate |
$2,645.30 |
| Rate for Payer: Aetna Commercial |
$1,180.85
|
| Rate for Payer: Aetna Medicare |
$881.23
|
| Rate for Payer: BCBS Complete |
$589.98
|
| Rate for Payer: BCBS MAPPO |
$881.23
|
| Rate for Payer: BCBS Trust/PPO |
$677.28
|
| Rate for Payer: BCN Commercial |
$1,280.34
|
| Rate for Payer: BCN Medicare Advantage |
$881.23
|
| Rate for Payer: Cash Price |
$3,023.20
|
| Rate for Payer: Cash Price |
$3,023.20
|
| Rate for Payer: Cofinity Commercial |
$1,268.97
|
| Rate for Payer: Cofinity Commercial |
$1,180.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.23
|
| Rate for Payer: Healthscope Commercial |
$1,057.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,057.48
|
| Rate for Payer: Meridian Medicaid |
$589.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$925.29
|
| Rate for Payer: PACE SWMI |
$881.23
|
| Rate for Payer: PHP Medicare Advantage |
$881.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$561.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,645.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,393.72
|
| Rate for Payer: Priority Health Medicare |
$881.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,393.72
|
| Rate for Payer: UHC Medicare Advantage |
$907.67
|
|
|
PR TEAEC W/WO PATCH GRF SUBCLAV INNOM THORACIC INC
|
Professional
|
Both
|
$2,790.00
|
|
|
Service Code
|
HCPCS 35311
|
| Min. Negotiated Rate |
$970.00 |
| Max. Negotiated Rate |
$2,421.48 |
| Rate for Payer: Aetna Commercial |
$2,046.96
|
| Rate for Payer: Aetna Medicare |
$1,527.58
|
| Rate for Payer: BCBS Complete |
$1,018.50
|
| Rate for Payer: BCBS MAPPO |
$1,527.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,646.71
|
| Rate for Payer: BCN Commercial |
$2,224.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,527.58
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Cofinity Commercial |
$2,199.72
|
| Rate for Payer: Cofinity Commercial |
$2,046.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,527.58
|
| Rate for Payer: Healthscope Commercial |
$1,833.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,833.10
|
| Rate for Payer: Meridian Medicaid |
$1,018.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,603.96
|
| Rate for Payer: PACE SWMI |
$1,527.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,527.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$970.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,953.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,421.48
|
| Rate for Payer: Priority Health Medicare |
$1,527.58
|
| Rate for Payer: Priority Health Narrow Network |
$2,421.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,573.41
|
|
|
PR TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 99368
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$852.68 |
| Rate for Payer: Aetna Commercial |
$36.09
|
| Rate for Payer: BCBS Complete |
$23.20
|
| Rate for Payer: BCBS Trust/PPO |
$852.68
|
| Rate for Payer: BCN Commercial |
$50.82
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.54
|
| Rate for Payer: Priority Health Narrow Network |
$44.54
|
|
|
PR TEAM CONFERENCE NON-FACE-TO-FACE PHYSICIAN
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 99367
|
| Min. Negotiated Rate |
$55.68 |
| Max. Negotiated Rate |
$232.98 |
| Rate for Payer: Aetna Commercial |
$55.68
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS Trust/PPO |
$232.98
|
| Rate for Payer: BCN Commercial |
$145.07
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.53
|
| Rate for Payer: Priority Health Narrow Network |
$68.53
|
|
