|
PR INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 51702
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$1,962.63 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Aetna Medicare |
$87.50
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,962.63
|
| Rate for Payer: BCN Commercial |
$89.92
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.95
|
| Rate for Payer: Priority Health Narrow Network |
$39.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.09
|
| Rate for Payer: UHC Exchange |
$36.09
|
| Rate for Payer: UHCCP Medicaid |
$15.76
|
|
|
PR INSJ TESTICULAR PROSTH SEPARATE PROCEDURE
|
Professional
|
Both
|
$729.00
|
|
|
Service Code
|
HCPCS 54660
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$2,434.41 |
| Rate for Payer: Aetna Commercial |
$457.01
|
| Rate for Payer: Aetna Medicare |
$364.50
|
| Rate for Payer: BCBS Complete |
$244.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,434.41
|
| Rate for Payer: BCN Commercial |
$519.46
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Meridian Medicaid |
$244.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$575.74
|
| Rate for Payer: Priority Health Narrow Network |
$575.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$424.53
|
| Rate for Payer: UHC Exchange |
$424.53
|
| Rate for Payer: UHCCP Medicaid |
$232.38
|
|
|
PR INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Facility
|
OP
|
$3,446.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
36561
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,652.95 |
| Max. Negotiated Rate |
$4,779.98 |
| Rate for Payer: Aetna Commercial |
$3,101.40
|
| 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 |
$3,342.62
|
| Rate for Payer: ASR Commercial |
$3,342.62
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,821.93
|
| Rate for Payer: BCN Commercial |
$2,671.68
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Cofinity Commercial |
$3,239.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,756.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$3,446.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,342.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$3,101.40
|
| 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 |
$2,929.10
|
| Rate for Payer: Nomi Health Commercial |
$2,825.72
|
| 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 |
$2,239.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,019.39
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$2,415.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,032.48
|
| 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 TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Professional
|
Both
|
$3,446.00
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
36561
|
| Min. Negotiated Rate |
$209.59 |
| Max. Negotiated Rate |
$2,239.90 |
| Rate for Payer: Aetna Commercial |
$446.52
|
| Rate for Payer: Aetna Medicare |
$1,723.00
|
| Rate for Payer: BCBS Complete |
$220.07
|
| Rate for Payer: BCBS Trust/PPO |
$486.56
|
| Rate for Payer: BCN Commercial |
$1,449.42
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Meridian Medicaid |
$220.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,239.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$521.72
|
| Rate for Payer: Priority Health Narrow Network |
$521.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$448.74
|
| Rate for Payer: UHC Exchange |
$448.74
|
| Rate for Payer: UHCCP Medicaid |
$209.59
|
|
|
PR INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Facility
|
IP
|
$3,446.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
36561
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,239.90 |
| Max. Negotiated Rate |
$3,446.00 |
| Rate for Payer: Aetna Commercial |
$3,101.40
|
| Rate for Payer: ASR ASR |
$3,342.62
|
| Rate for Payer: ASR Commercial |
$3,342.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,808.15
|
| Rate for Payer: BCN Commercial |
$2,671.68
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Cofinity Commercial |
$3,239.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,756.80
|
| Rate for Payer: Healthscope Commercial |
$3,446.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,342.62
|
| Rate for Payer: Mclaren Commercial |
$3,101.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,929.10
|
| Rate for Payer: Nomi Health Commercial |
$2,825.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,239.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,032.48
|
|
|
PR INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Professional
|
Both
|
$3,446.00
|
|
|
Service Code
|
HCPCS 36561
|
| Min. Negotiated Rate |
$209.59 |
| Max. Negotiated Rate |
$2,239.90 |
| Rate for Payer: Aetna Commercial |
$446.52
|
| Rate for Payer: Aetna Medicare |
$1,723.00
|
| Rate for Payer: BCBS Complete |
$220.07
|
| Rate for Payer: BCBS Trust/PPO |
$486.56
|
| Rate for Payer: BCN Commercial |
$1,449.42
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Meridian Medicaid |
$220.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,239.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$521.72
|
| Rate for Payer: Priority Health Narrow Network |
$521.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$448.74
|
| Rate for Payer: UHC Exchange |
$448.74
|
| Rate for Payer: UHCCP Medicaid |
$209.59
|
|
|
PR INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR
|
Professional
|
Both
|
$3,579.00
|
|
|
Service Code
|
HCPCS 36560
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$2,326.35 |
| Rate for Payer: Aetna Commercial |
$514.09
|
| Rate for Payer: Aetna Medicare |
$1,789.50
|
| Rate for Payer: BCBS Complete |
$258.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,003.31
|
| Rate for Payer: BCN Commercial |
$1,825.70
|
| Rate for Payer: Cash Price |
$2,863.20
|
| Rate for Payer: Cash Price |
$2,863.20
|
| Rate for Payer: Meridian Medicaid |
$258.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$246.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,326.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$610.01
|
| Rate for Payer: Priority Health Narrow Network |
$610.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$438.19
|
| Rate for Payer: UHC Exchange |
$438.19
|
| Rate for Payer: UHCCP Medicaid |
$246.02
|
|
|
PR INSJ TUNNELED CTR VAD W/SUBQ PUMP
|
Professional
|
Both
|
$3,589.00
|
|
|
Service Code
|
HCPCS 36563
|
| Min. Negotiated Rate |
$230.25 |
| Max. Negotiated Rate |
$2,332.85 |
| Rate for Payer: Aetna Commercial |
$489.50
|
| Rate for Payer: Aetna Medicare |
$1,794.50
|
| Rate for Payer: BCBS Complete |
$241.76
|
| Rate for Payer: BCBS Trust/PPO |
$742.79
|
| Rate for Payer: BCN Commercial |
$1,661.01
|
| Rate for Payer: Cash Price |
$2,871.20
|
| Rate for Payer: Cash Price |
$2,871.20
|
| Rate for Payer: Meridian Medicaid |
$241.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,332.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$570.11
|
| Rate for Payer: Priority Health Narrow Network |
$570.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$466.78
|
| Rate for Payer: UHC Exchange |
$466.78
|
| Rate for Payer: UHCCP Medicaid |
$230.25
|
|
|
PR INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>
|
Professional
|
Both
|
$1,982.00
|
|
|
Service Code
|
HCPCS 36558
|
| Min. Negotiated Rate |
$163.58 |
| Max. Negotiated Rate |
$1,620.82 |
| Rate for Payer: Aetna Commercial |
$346.05
|
| Rate for Payer: Aetna Medicare |
$991.00
|
| Rate for Payer: BCBS Complete |
$171.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,620.82
|
| Rate for Payer: BCN Commercial |
$1,224.63
|
| Rate for Payer: Cash Price |
$1,585.60
|
| Rate for Payer: Cash Price |
$1,585.60
|
| Rate for Payer: Meridian Medicaid |
$171.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$405.78
|
| Rate for Payer: Priority Health Narrow Network |
$405.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.28
|
| Rate for Payer: UHC Exchange |
$361.28
|
| Rate for Payer: UHCCP Medicaid |
$163.58
|
|
|
PR INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$1,738.00
|
|
|
Service Code
|
HCPCS 36565
|
| Min. Negotiated Rate |
$213.64 |
| Max. Negotiated Rate |
$1,210.95 |
| Rate for Payer: Aetna Commercial |
$450.12
|
| Rate for Payer: Aetna Medicare |
$869.00
|
| Rate for Payer: BCBS Complete |
$224.32
|
| Rate for Payer: BCBS Trust/PPO |
$705.81
|
| Rate for Payer: BCN Commercial |
$1,210.95
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Meridian Medicaid |
$224.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$530.76
|
| Rate for Payer: Priority Health Narrow Network |
$530.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.08
|
| Rate for Payer: UHC Exchange |
$449.08
|
| Rate for Payer: UHCCP Medicaid |
$213.64
|
|
|
PR INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT
|
Professional
|
Both
|
$2,907.00
|
|
|
Service Code
|
HCPCS 36566
|
| Min. Negotiated Rate |
$225.57 |
| Max. Negotiated Rate |
$6,274.62 |
| Rate for Payer: Aetna Commercial |
$481.26
|
| Rate for Payer: Aetna Medicare |
$1,453.50
|
| Rate for Payer: BCBS Complete |
$236.85
|
| Rate for Payer: BCBS Trust/PPO |
$907.09
|
| Rate for Payer: BCN Commercial |
$6,274.62
|
| Rate for Payer: Cash Price |
$2,325.60
|
| Rate for Payer: Cash Price |
$2,325.60
|
| Rate for Payer: Meridian Medicaid |
$236.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,889.55
|
| 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 |
$479.10
|
| Rate for Payer: UHC Exchange |
$479.10
|
| Rate for Payer: UHCCP Medicaid |
$225.57
|
|
|
PR INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL
|
Professional
|
Both
|
$1,514.00
|
|
|
Service Code
|
HCPCS 33206
|
| Min. Negotiated Rate |
$286.91 |
| Max. Negotiated Rate |
$1,398.41 |
| Rate for Payer: Aetna Commercial |
$610.49
|
| Rate for Payer: Aetna Medicare |
$757.00
|
| Rate for Payer: BCBS Complete |
$301.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,398.41
|
| Rate for Payer: BCN Commercial |
$658.25
|
| Rate for Payer: Cash Price |
$1,211.20
|
| Rate for Payer: Cash Price |
$1,211.20
|
| Rate for Payer: Meridian Medicaid |
$301.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$713.18
|
| Rate for Payer: Priority Health Narrow Network |
$713.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$609.30
|
| Rate for Payer: UHC Exchange |
$609.30
|
| Rate for Payer: UHCCP Medicaid |
$286.91
|
|
|
PR INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT
|
Professional
|
Both
|
$1,665.00
|
|
|
Service Code
|
HCPCS 33208
|
| Min. Negotiated Rate |
$325.89 |
| Max. Negotiated Rate |
$1,548.45 |
| Rate for Payer: Aetna Commercial |
$698.84
|
| Rate for Payer: Aetna Medicare |
$832.50
|
| Rate for Payer: BCBS Complete |
$342.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,548.45
|
| Rate for Payer: BCN Commercial |
$748.66
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Meridian Medicaid |
$342.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$811.03
|
| Rate for Payer: Priority Health Narrow Network |
$811.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$703.84
|
| Rate for Payer: UHC Exchange |
$703.84
|
| Rate for Payer: UHCCP Medicaid |
$325.89
|
|
|
PR INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR
|
Professional
|
Both
|
$1,816.00
|
|
|
Service Code
|
HCPCS 33207
|
| Min. Negotiated Rate |
$301.82 |
| Max. Negotiated Rate |
$1,343.47 |
| Rate for Payer: Aetna Commercial |
$643.35
|
| Rate for Payer: Aetna Medicare |
$908.00
|
| Rate for Payer: BCBS Complete |
$316.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,343.47
|
| Rate for Payer: BCN Commercial |
$690.99
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Meridian Medicaid |
$316.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$301.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,180.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$749.34
|
| Rate for Payer: Priority Health Narrow Network |
$749.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$650.53
|
| Rate for Payer: UHC Exchange |
$650.53
|
| Rate for Payer: UHCCP Medicaid |
$301.82
|
|
|
PR INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS
|
Professional
|
Both
|
$1,271.00
|
|
|
Service Code
|
HCPCS 33213
|
| Min. Negotiated Rate |
$213.21 |
| Max. Negotiated Rate |
$1,352.98 |
| Rate for Payer: Aetna Commercial |
$450.33
|
| Rate for Payer: Aetna Medicare |
$635.50
|
| Rate for Payer: BCBS Complete |
$223.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,352.98
|
| Rate for Payer: BCN Commercial |
$486.24
|
| Rate for Payer: Cash Price |
$1,016.80
|
| Rate for Payer: Cash Price |
$1,016.80
|
| Rate for Payer: Meridian Medicaid |
$223.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$531.83
|
| Rate for Payer: Priority Health Narrow Network |
$531.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$517.05
|
| Rate for Payer: UHC Exchange |
$517.05
|
| Rate for Payer: UHCCP Medicaid |
$213.21
|
|
|
PR INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 33221
|
| Min. Negotiated Rate |
$225.35 |
| Max. Negotiated Rate |
$1,089.35 |
| Rate for Payer: Aetna Commercial |
$484.70
|
| Rate for Payer: Aetna Medicare |
$372.00
|
| Rate for Payer: BCBS Complete |
$236.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,089.35
|
| Rate for Payer: BCN Commercial |
$519.95
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Meridian Medicaid |
$236.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$561.61
|
| Rate for Payer: Priority Health Narrow Network |
$561.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$483.80
|
| Rate for Payer: UHC Exchange |
$483.80
|
| Rate for Payer: UHCCP Medicaid |
$225.35
|
|
|
PR INS PM PLS GEN W/EXIST SINGLE LEAD
|
Professional
|
Both
|
$1,120.00
|
|
|
Service Code
|
HCPCS 33212
|
| Min. Negotiated Rate |
$204.91 |
| Max. Negotiated Rate |
$1,488.75 |
| Rate for Payer: Aetna Commercial |
$432.27
|
| Rate for Payer: Aetna Medicare |
$560.00
|
| Rate for Payer: BCBS Complete |
$215.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,488.75
|
| Rate for Payer: BCN Commercial |
$464.73
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Meridian Medicaid |
$215.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$507.90
|
| Rate for Payer: Priority Health Narrow Network |
$507.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$451.83
|
| Rate for Payer: UHC Exchange |
$451.83
|
| Rate for Payer: UHCCP Medicaid |
$204.91
|
|
|
PR INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD
|
Professional
|
Both
|
$1,176.00
|
|
|
Service Code
|
HCPCS 33270
|
| Min. Negotiated Rate |
$352.73 |
| Max. Negotiated Rate |
$1,575.39 |
| Rate for Payer: Aetna Commercial |
$756.49
|
| Rate for Payer: Aetna Medicare |
$588.00
|
| Rate for Payer: BCBS Complete |
$370.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,575.39
|
| Rate for Payer: BCN Commercial |
$812.18
|
| Rate for Payer: Cash Price |
$940.80
|
| Rate for Payer: Cash Price |
$940.80
|
| Rate for Payer: Meridian Medicaid |
$370.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$352.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$877.50
|
| Rate for Payer: Priority Health Narrow Network |
$877.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$783.98
|
| Rate for Payer: UHC Exchange |
$783.98
|
| Rate for Payer: UHCCP Medicaid |
$352.73
|
|
|
PR INS/RPLC PERPH SAC/GSTRC NPG/RCVR PCKT CRTJ&CONN
|
Professional
|
Both
|
$995.00
|
|
|
Service Code
|
HCPCS 64590
|
| Min. Negotiated Rate |
$188.93 |
| Max. Negotiated Rate |
$1,604.98 |
| Rate for Payer: Aetna Commercial |
$205.58
|
| Rate for Payer: Aetna Medicare |
$497.50
|
| Rate for Payer: BCBS Complete |
$198.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,604.98
|
| Rate for Payer: BCN Commercial |
$384.59
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Meridian Medicaid |
$198.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$502.18
|
| Rate for Payer: Priority Health Narrow Network |
$502.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.90
|
| Rate for Payer: UHC Exchange |
$201.90
|
| Rate for Payer: UHCCP Medicaid |
$188.93
|
|
|
PR INSRT CH WALL RESPIR ELTRD/RA & CONJ PULSE GEN
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 0466T
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$315.25 |
| Rate for Payer: Aetna Medicare |
$242.50
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
|
|
PR INSTLJ CH TUBE/CATH AGENT FBRNLYSIS SBSQ DAY
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
HCPCS 32562
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$724.30 |
| Rate for Payer: Aetna Commercial |
$78.58
|
| Rate for Payer: Aetna Medicare |
$106.50
|
| Rate for Payer: BCBS Complete |
$39.58
|
| Rate for Payer: BCBS Trust/PPO |
$724.30
|
| Rate for Payer: BCN Commercial |
$122.17
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Meridian Medicaid |
$39.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.04
|
| Rate for Payer: Priority Health Narrow Network |
$82.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.30
|
| Rate for Payer: UHC Exchange |
$76.30
|
| Rate for Payer: UHCCP Medicaid |
$37.70
|
|
|
PR INSTLJ VIA CHEST TUBE/CATH AGENT FOR PLEURODESIS
|
Professional
|
Both
|
$455.00
|
|
|
Service Code
|
HCPCS 32560
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$722.19 |
| Rate for Payer: Aetna Commercial |
$99.91
|
| Rate for Payer: Aetna Medicare |
$227.50
|
| Rate for Payer: BCBS Complete |
$50.10
|
| Rate for Payer: BCBS Trust/PPO |
$722.19
|
| Rate for Payer: BCN Commercial |
$373.84
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Meridian Medicaid |
$50.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.81
|
| Rate for Payer: Priority Health Narrow Network |
$103.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.77
|
| Rate for Payer: UHC Exchange |
$99.77
|
| Rate for Payer: UHCCP Medicaid |
$47.71
|
|
|
PR INSTLJ VIA CH TUBE/CATH AGENT FBRNLYSIS 1ST DAY
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 32561
|
| Min. Negotiated Rate |
$42.39 |
| Max. Negotiated Rate |
$892.83 |
| Rate for Payer: Aetna Commercial |
$87.90
|
| Rate for Payer: Aetna Medicare |
$115.00
|
| Rate for Payer: BCBS Complete |
$44.51
|
| Rate for Payer: BCBS Trust/PPO |
$892.83
|
| Rate for Payer: BCN Commercial |
$136.83
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Meridian Medicaid |
$44.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.77
|
| Rate for Payer: Priority Health Narrow Network |
$91.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.74
|
| Rate for Payer: UHC Exchange |
$84.74
|
| Rate for Payer: UHCCP Medicaid |
$42.39
|
|
|
PR INSTRUMENT BASED OCULAR SCR BI W/ONSITE ANALYSIS
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS 99177
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$7.15 |
| Rate for Payer: Aetna Commercial |
$4.57
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: BCN Commercial |
$6.85
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.78
|
| Rate for Payer: Priority Health Narrow Network |
$6.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.51
|
| Rate for Payer: UHC Exchange |
$5.51
|
|
|
PR INSTRUMENT BASED OCULAR SCR BI W/RMT ANAL & RPT
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 99174
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$544.15 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$544.15
|
| Rate for Payer: BCN Commercial |
$8.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.59
|
| Rate for Payer: Priority Health Narrow Network |
$8.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.36
|
| Rate for Payer: UHC Exchange |
$27.36
|
|
