|
PR INTRACRANIAL ARVEN MALFRMJ INFRATENTRL CMPL
|
Professional
|
Both
|
$12,123.00
|
|
|
Service Code
|
HCPCS 61686
|
| Min. Negotiated Rate |
$191.24 |
| Max. Negotiated Rate |
$9,146.67 |
| Rate for Payer: Aetna Commercial |
$5,806.18
|
| Rate for Payer: Aetna Medicare |
$6,061.50
|
| Rate for Payer: BCBS Complete |
$3,050.59
|
| Rate for Payer: BCBS Trust/PPO |
$191.24
|
| Rate for Payer: BCN Commercial |
$9,146.67
|
| Rate for Payer: Cash Price |
$9,698.40
|
| Rate for Payer: Cash Price |
$9,698.40
|
| Rate for Payer: Meridian Medicaid |
$3,050.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,905.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,879.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,727.71
|
| Rate for Payer: Priority Health Narrow Network |
$7,727.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,286.13
|
| Rate for Payer: UHC Exchange |
$5,286.13
|
| Rate for Payer: UHCCP Medicaid |
$2,905.32
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ INFRATENTRL SMPL
|
Professional
|
Both
|
$5,987.00
|
|
|
Service Code
|
HCPCS 61684
|
| Min. Negotiated Rate |
$195.47 |
| Max. Negotiated Rate |
$5,805.13 |
| Rate for Payer: Aetna Commercial |
$3,673.33
|
| Rate for Payer: Aetna Medicare |
$2,993.50
|
| Rate for Payer: BCBS Complete |
$1,938.37
|
| Rate for Payer: BCBS Trust/PPO |
$195.47
|
| Rate for Payer: BCN Commercial |
$5,805.13
|
| Rate for Payer: Cash Price |
$4,789.60
|
| Rate for Payer: Cash Price |
$4,789.60
|
| Rate for Payer: Meridian Medicaid |
$1,938.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,846.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,891.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,908.58
|
| Rate for Payer: Priority Health Narrow Network |
$4,908.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,296.57
|
| Rate for Payer: UHC Exchange |
$3,296.57
|
| Rate for Payer: UHCCP Medicaid |
$1,846.07
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL CMPL
|
Professional
|
Both
|
$8,916.00
|
|
|
Service Code
|
HCPCS 61682
|
| Min. Negotiated Rate |
$275.77 |
| Max. Negotiated Rate |
$8,459.92 |
| Rate for Payer: Aetna Commercial |
$5,378.16
|
| Rate for Payer: Aetna Medicare |
$4,458.00
|
| Rate for Payer: BCBS Complete |
$2,811.73
|
| Rate for Payer: BCBS Trust/PPO |
$275.77
|
| Rate for Payer: BCN Commercial |
$8,459.92
|
| Rate for Payer: Cash Price |
$7,132.80
|
| Rate for Payer: Cash Price |
$7,132.80
|
| Rate for Payer: Meridian Medicaid |
$2,811.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,677.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,795.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,176.62
|
| Rate for Payer: Priority Health Narrow Network |
$7,176.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,926.08
|
| Rate for Payer: UHC Exchange |
$4,926.08
|
| Rate for Payer: UHCCP Medicaid |
$2,677.84
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL SMPL
|
Professional
|
Both
|
$4,754.00
|
|
|
Service Code
|
HCPCS 61680
|
| Min. Negotiated Rate |
$373.51 |
| Max. Negotiated Rate |
$4,568.58 |
| Rate for Payer: Aetna Commercial |
$2,931.17
|
| Rate for Payer: Aetna Medicare |
$2,377.00
|
| Rate for Payer: BCBS Complete |
$1,541.62
|
| Rate for Payer: BCBS Trust/PPO |
$373.51
|
| Rate for Payer: BCN Commercial |
$4,568.58
|
| Rate for Payer: Cash Price |
$3,803.20
|
| Rate for Payer: Cash Price |
$3,803.20
|
| Rate for Payer: Meridian Medicaid |
$1,541.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,468.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,090.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,928.68
|
| Rate for Payer: Priority Health Narrow Network |
$3,928.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,629.94
|
| Rate for Payer: UHC Exchange |
$2,629.94
|
| Rate for Payer: UHCCP Medicaid |
$1,468.21
|
|
|
PR INTRAFRACTION TRACK MOTION
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS G6017
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$1,256.83 |
| Rate for Payer: Aetna Commercial |
$94.22
|
| Rate for Payer: Aetna Medicare |
$88.00
|
| Rate for Payer: BCBS Complete |
$70.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,256.83
|
| Rate for Payer: BCN Commercial |
$104.62
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.52
|
| Rate for Payer: Priority Health Narrow Network |
$136.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.38
|
| Rate for Payer: UHC Exchange |
$96.38
|
|
|
PR INTRAOPERATIVE COLONIC LAVAGE
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 44701
|
| Min. Negotiated Rate |
$107.99 |
| Max. Negotiated Rate |
$300.09 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: Aetna Medicare |
$206.00
|
| Rate for Payer: BCBS Complete |
$113.39
|
| Rate for Payer: BCBS Trust/PPO |
$226.64
|
| Rate for Payer: BCN Commercial |
$245.32
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Meridian Medicaid |
$113.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$300.09
|
| Rate for Payer: Priority Health Narrow Network |
$300.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.91
|
| Rate for Payer: UHC Exchange |
$206.91
|
| Rate for Payer: UHCCP Medicaid |
$107.99
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 38900
|
| Min. Negotiated Rate |
$87.54 |
| Max. Negotiated Rate |
$438.49 |
| Rate for Payer: Aetna Commercial |
$172.38
|
| Rate for Payer: Aetna Medicare |
$152.50
|
| Rate for Payer: BCBS Complete |
$91.92
|
| Rate for Payer: BCBS Trust/PPO |
$438.49
|
| Rate for Payer: BCN Commercial |
$198.40
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Meridian Medicaid |
$91.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.30
|
| Rate for Payer: Priority Health Narrow Network |
$272.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.55
|
| Rate for Payer: UHC Exchange |
$171.55
|
| Rate for Payer: UHCCP Medicaid |
$87.54
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 38900
|
| Hospital Charge Code |
38900
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Aetna Commercial |
$274.50
|
| Rate for Payer: Aetna Medicare |
$152.50
|
| Rate for Payer: ASR ASR |
$295.85
|
| Rate for Payer: ASR Commercial |
$295.85
|
| Rate for Payer: BCBS Complete |
$122.00
|
| Rate for Payer: BCBS Trust/PPO |
$249.76
|
| Rate for Payer: BCN Commercial |
$236.47
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$286.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.00
|
| Rate for Payer: Healthscope Commercial |
$305.00
|
| Rate for Payer: Healthscope Whirlpool |
$295.85
|
| Rate for Payer: Mclaren Commercial |
$274.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.25
|
| Rate for Payer: Nomi Health Commercial |
$250.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.24
|
| Rate for Payer: Priority Health Narrow Network |
$213.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.40
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
38900
|
| Min. Negotiated Rate |
$87.54 |
| Max. Negotiated Rate |
$438.49 |
| Rate for Payer: Aetna Commercial |
$172.38
|
| Rate for Payer: Aetna Medicare |
$152.50
|
| Rate for Payer: BCBS Complete |
$91.92
|
| Rate for Payer: BCBS Trust/PPO |
$438.49
|
| Rate for Payer: BCN Commercial |
$198.40
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Meridian Medicaid |
$91.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.30
|
| Rate for Payer: Priority Health Narrow Network |
$272.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.55
|
| Rate for Payer: UHC Exchange |
$171.55
|
| Rate for Payer: UHCCP Medicaid |
$87.54
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 38900
|
| Hospital Charge Code |
38900
|
| Min. Negotiated Rate |
$198.25 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Aetna Commercial |
$274.50
|
| Rate for Payer: ASR ASR |
$295.85
|
| Rate for Payer: ASR Commercial |
$295.85
|
| Rate for Payer: BCBS Trust/PPO |
$248.54
|
| Rate for Payer: BCN Commercial |
$236.47
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$286.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.00
|
| Rate for Payer: Healthscope Commercial |
$305.00
|
| Rate for Payer: Healthscope Whirlpool |
$295.85
|
| Rate for Payer: Mclaren Commercial |
$274.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.25
|
| Rate for Payer: Nomi Health Commercial |
$250.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.40
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR MASTICATOR SPACE
|
Professional
|
Both
|
$683.00
|
|
|
Service Code
|
HCPCS 41009
|
| Min. Negotiated Rate |
$185.95 |
| Max. Negotiated Rate |
$1,140.60 |
| Rate for Payer: Aetna Commercial |
$371.20
|
| Rate for Payer: Aetna Medicare |
$341.50
|
| Rate for Payer: BCBS Complete |
$195.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,140.60
|
| Rate for Payer: BCN Commercial |
$621.60
|
| Rate for Payer: Cash Price |
$546.40
|
| Rate for Payer: Cash Price |
$546.40
|
| Rate for Payer: Meridian Medicaid |
$195.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$185.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$513.07
|
| Rate for Payer: Priority Health Narrow Network |
$513.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$344.55
|
| Rate for Payer: UHC Exchange |
$344.55
|
| Rate for Payer: UHCCP Medicaid |
$185.95
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
HCPCS 41006
|
| Min. Negotiated Rate |
$151.44 |
| Max. Negotiated Rate |
$931.39 |
| Rate for Payer: Aetna Commercial |
$301.56
|
| Rate for Payer: Aetna Medicare |
$300.50
|
| Rate for Payer: BCBS Complete |
$159.01
|
| Rate for Payer: BCBS Trust/PPO |
$931.39
|
| Rate for Payer: BCN Commercial |
$499.43
|
| Rate for Payer: Cash Price |
$480.80
|
| Rate for Payer: Cash Price |
$480.80
|
| Rate for Payer: Meridian Medicaid |
$159.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$151.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$414.64
|
| Rate for Payer: Priority Health Narrow Network |
$414.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$306.43
|
| Rate for Payer: UHC Exchange |
$306.43
|
| Rate for Payer: UHCCP Medicaid |
$151.44
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBLNGL SUPFC
|
Professional
|
Both
|
$392.00
|
|
|
Service Code
|
HCPCS 41005
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$795.62 |
| Rate for Payer: Aetna Commercial |
$144.95
|
| Rate for Payer: Aetna Medicare |
$196.00
|
| Rate for Payer: BCBS Complete |
$80.06
|
| Rate for Payer: BCBS Trust/PPO |
$795.62
|
| Rate for Payer: BCN Commercial |
$353.31
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Meridian Medicaid |
$80.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.81
|
| Rate for Payer: Priority Health Narrow Network |
$208.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.29
|
| Rate for Payer: UHC Exchange |
$149.29
|
| Rate for Payer: UHCCP Medicaid |
$76.25
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE
|
Professional
|
Both
|
$707.00
|
|
|
Service Code
|
HCPCS 41008
|
| Min. Negotiated Rate |
$170.19 |
| Max. Negotiated Rate |
$1,030.71 |
| Rate for Payer: Aetna Commercial |
$338.86
|
| Rate for Payer: Aetna Medicare |
$353.50
|
| Rate for Payer: BCBS Complete |
$178.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,030.71
|
| Rate for Payer: BCN Commercial |
$575.17
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Meridian Medicaid |
$178.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$170.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$463.55
|
| Rate for Payer: Priority Health Narrow Network |
$463.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.89
|
| Rate for Payer: UHC Exchange |
$316.89
|
| Rate for Payer: UHCCP Medicaid |
$170.19
|
|
|
PR INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 94610
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$1,160.68 |
| Rate for Payer: Aetna Commercial |
$61.24
|
| Rate for Payer: Aetna Medicare |
$56.00
|
| Rate for Payer: BCBS Complete |
$36.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,160.68
|
| Rate for Payer: BCN Commercial |
$81.12
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Meridian Medicaid |
$36.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.54
|
| Rate for Payer: Priority Health Narrow Network |
$75.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.91
|
| Rate for Payer: UHC Exchange |
$61.91
|
| Rate for Payer: UHCCP Medicaid |
$35.15
|
|
|
PR INTRAUT COPPER CONTRACEPTIVE
|
Professional
|
Both
|
$1,353.00
|
|
|
Service Code
|
HCPCS J7300
|
| Min. Negotiated Rate |
$676.50 |
| Max. Negotiated Rate |
$1,267.71 |
| Rate for Payer: Aetna Commercial |
$1,085.00
|
| Rate for Payer: Aetna Medicare |
$676.50
|
| Rate for Payer: BCBS Complete |
$1,267.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,100.19
|
| Rate for Payer: BCN Commercial |
$896.88
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Meridian Medicaid |
$1,267.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,207.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,117.55
|
| Rate for Payer: UHC Exchange |
$1,117.55
|
| Rate for Payer: UHCCP Medicaid |
$1,207.34
|
|
|
PR INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL
|
Professional
|
Both
|
$424.00
|
|
|
Service Code
|
HCPCS 37253
|
| Min. Negotiated Rate |
$44.30 |
| Max. Negotiated Rate |
$1,099.39 |
| Rate for Payer: Aetna Commercial |
$95.73
|
| Rate for Payer: Aetna Medicare |
$212.00
|
| Rate for Payer: BCBS Complete |
$46.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.39
|
| Rate for Payer: BCN Commercial |
$250.20
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Meridian Medicaid |
$46.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.55
|
| Rate for Payer: Priority Health Narrow Network |
$109.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.14
|
| Rate for Payer: UHC Exchange |
$100.14
|
| Rate for Payer: UHCCP Medicaid |
$44.30
|
|
|
PR INTRAVASCULAR US NONCORONARY RS&I INTIAL VESSEL
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
HCPCS 37252
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$1,597.58 |
| Rate for Payer: Aetna Commercial |
$120.70
|
| Rate for Payer: Aetna Medicare |
$96.50
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,597.58
|
| Rate for Payer: BCN Commercial |
$1,403.97
|
| Rate for Payer: Cash Price |
$154.40
|
| Rate for Payer: Cash Price |
$154.40
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.74
|
| Rate for Payer: Priority Health Narrow Network |
$137.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$125.10
|
| Rate for Payer: UHC Exchange |
$125.10
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
|
|
PR INTRAVASC US DURING DX EVAL/ INTERVENTION,EA ADDN VESSEL
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 37251
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
|
|
PR INTRA-VNTR MAPG TACHYCARDIA SITES W/CATH MNPJ
|
Professional
|
Both
|
$584.00
|
|
|
Service Code
|
HCPCS 93609
|
| Min. Negotiated Rate |
$169.12 |
| Max. Negotiated Rate |
$995.32 |
| Rate for Payer: Aetna Commercial |
$507.22
|
| Rate for Payer: Aetna Medicare |
$292.00
|
| Rate for Payer: BCBS Complete |
$177.58
|
| Rate for Payer: BCBS Trust/PPO |
$995.32
|
| Rate for Payer: BCN Commercial |
$544.39
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Meridian Medicaid |
$177.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$373.37
|
| Rate for Payer: Priority Health Narrow Network |
$373.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$496.76
|
| Rate for Payer: UHC Exchange |
$496.76
|
| Rate for Payer: UHCCP Medicaid |
$169.12
|
|
|
PR INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 57180
|
| Min. Negotiated Rate |
$77.75 |
| Max. Negotiated Rate |
$527.77 |
| Rate for Payer: Aetna Commercial |
$141.44
|
| Rate for Payer: Aetna Medicare |
$110.50
|
| Rate for Payer: BCBS Complete |
$81.64
|
| Rate for Payer: BCBS Trust/PPO |
$527.77
|
| Rate for Payer: BCN Commercial |
$295.16
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Meridian Medicaid |
$81.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.55
|
| Rate for Payer: Priority Health Narrow Network |
$181.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.13
|
| Rate for Payer: UHC Exchange |
$121.13
|
| Rate for Payer: UHCCP Medicaid |
$77.75
|
|
|
PR INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
HCPCS 36901
|
| Min. Negotiated Rate |
$105.22 |
| Max. Negotiated Rate |
$1,036.97 |
| Rate for Payer: Aetna Commercial |
$225.47
|
| Rate for Payer: Aetna Medicare |
$189.00
|
| Rate for Payer: BCBS Complete |
$110.48
|
| Rate for Payer: BCBS Trust/PPO |
$647.17
|
| Rate for Payer: BCN Commercial |
$1,036.97
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Meridian Medicaid |
$110.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.60
|
| Rate for Payer: Priority Health Narrow Network |
$260.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.23
|
| Rate for Payer: UHC Exchange |
$194.23
|
| Rate for Payer: UHCCP Medicaid |
$105.22
|
|
|
PR INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT
|
Professional
|
Both
|
$771.00
|
|
|
Service Code
|
HCPCS 36903
|
| Min. Negotiated Rate |
$196.39 |
| Max. Negotiated Rate |
$6,303.94 |
| Rate for Payer: Aetna Commercial |
$423.38
|
| Rate for Payer: Aetna Medicare |
$385.50
|
| Rate for Payer: BCBS Complete |
$206.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,744.97
|
| Rate for Payer: BCN Commercial |
$6,303.94
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Meridian Medicaid |
$206.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$488.74
|
| Rate for Payer: Priority Health Narrow Network |
$488.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.04
|
| Rate for Payer: UHC Exchange |
$396.04
|
| Rate for Payer: UHCCP Medicaid |
$196.39
|
|
|
PR INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 36902
|
| Min. Negotiated Rate |
$149.31 |
| Max. Negotiated Rate |
$1,793.58 |
| Rate for Payer: Aetna Commercial |
$321.04
|
| Rate for Payer: Aetna Medicare |
$281.50
|
| Rate for Payer: BCBS Complete |
$156.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,793.58
|
| Rate for Payer: BCN Commercial |
$1,774.88
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Meridian Medicaid |
$156.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$149.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$371.75
|
| Rate for Payer: Priority Health Narrow Network |
$371.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.34
|
| Rate for Payer: UHC Exchange |
$289.34
|
| Rate for Payer: UHCCP Medicaid |
$149.31
|
|
|
PR INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY
|
Professional
|
Both
|
$747.00
|
|
|
Service Code
|
HCPCS 36013
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$1,157.67 |
| Rate for Payer: Aetna Commercial |
$165.19
|
| Rate for Payer: Aetna Medicare |
$373.50
|
| Rate for Payer: BCBS Complete |
$82.75
|
| Rate for Payer: BCBS Trust/PPO |
$800.37
|
| Rate for Payer: BCN Commercial |
$1,157.67
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Meridian Medicaid |
$82.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$485.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.19
|
| Rate for Payer: Priority Health Narrow Network |
$195.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.20
|
| Rate for Payer: UHC Exchange |
$171.20
|
| Rate for Payer: UHCCP Medicaid |
$78.81
|
|
