|
PR TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR MULT TDN
|
Professional
|
Both
|
$1,843.00
|
|
|
Service Code
|
HCPCS 27397
|
| Min. Negotiated Rate |
$591.71 |
| Max. Negotiated Rate |
$1,404.80 |
| Rate for Payer: Aetna Commercial |
$1,208.29
|
| Rate for Payer: Aetna Medicare |
$901.71
|
| Rate for Payer: BCBS Complete |
$621.30
|
| Rate for Payer: BCBS MAPPO |
$901.71
|
| Rate for Payer: BCBS Trust/PPO |
$629.21
|
| Rate for Payer: BCN Commercial |
$1,344.35
|
| Rate for Payer: BCN Medicare Advantage |
$901.71
|
| Rate for Payer: Cash Price |
$1,474.40
|
| Rate for Payer: Cash Price |
$1,474.40
|
| Rate for Payer: Cofinity Commercial |
$1,208.29
|
| Rate for Payer: Cofinity Commercial |
$1,298.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$901.71
|
| Rate for Payer: Healthscope Commercial |
$1,082.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,082.05
|
| Rate for Payer: Meridian Medicaid |
$621.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$946.80
|
| Rate for Payer: PACE SWMI |
$901.71
|
| Rate for Payer: PHP Medicare Advantage |
$901.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$591.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,404.80
|
| Rate for Payer: Priority Health Medicare |
$901.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,404.80
|
| Rate for Payer: UHC Medicare Advantage |
$928.76
|
|
|
PR TRANSPOSITION OVARY
|
Professional
|
Both
|
$1,434.00
|
|
|
Service Code
|
HCPCS 58825
|
| Min. Negotiated Rate |
$82.94 |
| Max. Negotiated Rate |
$1,042.35 |
| Rate for Payer: Aetna Commercial |
$944.51
|
| Rate for Payer: Aetna Medicare |
$704.86
|
| Rate for Payer: BCBS Complete |
$479.06
|
| Rate for Payer: BCBS MAPPO |
$704.86
|
| Rate for Payer: BCBS Trust/PPO |
$82.94
|
| Rate for Payer: BCN Commercial |
$1,042.35
|
| Rate for Payer: BCN Medicare Advantage |
$704.86
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Cofinity Commercial |
$1,015.00
|
| Rate for Payer: Cofinity Commercial |
$944.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$704.86
|
| Rate for Payer: Healthscope Commercial |
$845.83
|
| Rate for Payer: Healthscope Whirlpool |
$845.83
|
| Rate for Payer: Meridian Medicaid |
$479.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$740.10
|
| Rate for Payer: PACE SWMI |
$704.86
|
| Rate for Payer: PHP Medicare Advantage |
$704.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$456.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,003.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,009.81
|
| Rate for Payer: Priority Health Medicare |
$704.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,009.81
|
| Rate for Payer: UHC Medicare Advantage |
$726.01
|
|
|
PR TRANSPTRSAL POST CRNL FOSSA CLIVUS/FORAMN MAGNUM
|
Professional
|
Both
|
$4,979.00
|
|
|
Service Code
|
HCPCS 61598
|
| Min. Negotiated Rate |
$1,835.31 |
| Max. Negotiated Rate |
$4,885.95 |
| Rate for Payer: Aetna Commercial |
$3,828.11
|
| Rate for Payer: Aetna Medicare |
$2,856.80
|
| Rate for Payer: BCBS Complete |
$1,936.14
|
| Rate for Payer: BCBS MAPPO |
$2,856.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,835.31
|
| Rate for Payer: BCN Commercial |
$4,216.80
|
| Rate for Payer: BCN Medicare Advantage |
$2,856.80
|
| Rate for Payer: Cash Price |
$3,983.20
|
| Rate for Payer: Cash Price |
$3,983.20
|
| Rate for Payer: Cofinity Commercial |
$4,113.79
|
| Rate for Payer: Cofinity Commercial |
$3,828.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,856.80
|
| Rate for Payer: Healthscope Commercial |
$3,428.16
|
| Rate for Payer: Healthscope Whirlpool |
$3,428.16
|
| Rate for Payer: Meridian Medicaid |
$1,936.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,999.64
|
| Rate for Payer: PACE SWMI |
$2,856.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,856.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,843.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,485.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,885.95
|
| Rate for Payer: Priority Health Medicare |
$2,856.80
|
| Rate for Payer: Priority Health Narrow Network |
$4,885.95
|
| Rate for Payer: UHC Medicare Advantage |
$2,942.50
|
|
|
PR TRANSRECTAL DRAINAGE OF PELVIC ABSCESS
|
Professional
|
Both
|
$802.00
|
|
|
Service Code
|
HCPCS 45000
|
| Min. Negotiated Rate |
$275.84 |
| Max. Negotiated Rate |
$2,674.78 |
| Rate for Payer: Aetna Commercial |
$565.47
|
| Rate for Payer: Aetna Medicare |
$421.99
|
| Rate for Payer: BCBS Complete |
$289.63
|
| Rate for Payer: BCBS MAPPO |
$421.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,674.78
|
| Rate for Payer: BCN Commercial |
$627.46
|
| Rate for Payer: BCN Medicare Advantage |
$421.99
|
| Rate for Payer: Cash Price |
$641.60
|
| Rate for Payer: Cash Price |
$641.60
|
| Rate for Payer: Cofinity Commercial |
$607.67
|
| Rate for Payer: Cofinity Commercial |
$565.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.99
|
| Rate for Payer: Healthscope Commercial |
$506.39
|
| Rate for Payer: Healthscope Whirlpool |
$506.39
|
| Rate for Payer: Meridian Medicaid |
$289.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$443.09
|
| Rate for Payer: PACE SWMI |
$421.99
|
| Rate for Payer: PHP Medicare Advantage |
$421.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$754.95
|
| Rate for Payer: Priority Health Medicare |
$421.99
|
| Rate for Payer: Priority Health Narrow Network |
$754.95
|
| Rate for Payer: UHC Medicare Advantage |
$434.65
|
|
|
PR TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 93293
|
| Min. Negotiated Rate |
$43.03 |
| Max. Negotiated Rate |
$525.66 |
| Rate for Payer: Aetna Commercial |
$57.66
|
| Rate for Payer: Aetna Medicare |
$43.03
|
| Rate for Payer: BCBS Complete |
$70.80
|
| Rate for Payer: BCBS MAPPO |
$43.03
|
| Rate for Payer: BCBS Trust/PPO |
$525.66
|
| Rate for Payer: BCN Commercial |
$66.46
|
| Rate for Payer: BCN Medicare Advantage |
$43.03
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cofinity Commercial |
$61.96
|
| Rate for Payer: Cofinity Commercial |
$57.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.03
|
| Rate for Payer: Healthscope Commercial |
$51.64
|
| Rate for Payer: Healthscope Whirlpool |
$51.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.18
|
| Rate for Payer: PACE SWMI |
$43.03
|
| Rate for Payer: PHP Medicare Advantage |
$43.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.31
|
| Rate for Payer: Priority Health Medicare |
$43.03
|
| Rate for Payer: Priority Health Narrow Network |
$64.31
|
| Rate for Payer: UHC Medicare Advantage |
$44.32
|
|
|
PR TRANSTEMP APPR POST CRAN FOSSA DCOMPR SINUS/NRV
|
Professional
|
Both
|
$6,126.00
|
|
|
Service Code
|
HCPCS 61595
|
| Min. Negotiated Rate |
$1,537.01 |
| Max. Negotiated Rate |
$4,288.20 |
| Rate for Payer: Aetna Commercial |
$3,165.16
|
| Rate for Payer: Aetna Medicare |
$2,362.06
|
| Rate for Payer: BCBS Complete |
$1,613.86
|
| Rate for Payer: BCBS MAPPO |
$2,362.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,960.52
|
| Rate for Payer: BCN Commercial |
$3,505.29
|
| Rate for Payer: BCN Medicare Advantage |
$2,362.06
|
| Rate for Payer: Cash Price |
$4,900.80
|
| Rate for Payer: Cash Price |
$4,900.80
|
| Rate for Payer: Cofinity Commercial |
$3,165.16
|
| Rate for Payer: Cofinity Commercial |
$3,401.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,362.06
|
| Rate for Payer: Healthscope Commercial |
$2,834.47
|
| Rate for Payer: Healthscope Whirlpool |
$2,834.47
|
| Rate for Payer: Meridian Medicaid |
$1,613.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,480.16
|
| Rate for Payer: PACE SWMI |
$2,362.06
|
| Rate for Payer: PHP Medicare Advantage |
$2,362.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,537.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,288.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,061.52
|
| Rate for Payer: Priority Health Medicare |
$2,362.06
|
| Rate for Payer: Priority Health Narrow Network |
$4,061.52
|
| Rate for Payer: UHC Medicare Advantage |
$2,432.92
|
|
|
PR TRANSURETEROURETEROSTOMY ANAST URETER CLAT URTR
|
Professional
|
Both
|
$2,118.00
|
|
|
Service Code
|
HCPCS 50770
|
| Min. Negotiated Rate |
$730.16 |
| Max. Negotiated Rate |
$2,761.42 |
| Rate for Payer: Aetna Commercial |
$1,506.09
|
| Rate for Payer: Aetna Medicare |
$1,123.95
|
| Rate for Payer: BCBS Complete |
$766.67
|
| Rate for Payer: BCBS MAPPO |
$1,123.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,761.42
|
| Rate for Payer: BCN Commercial |
$1,655.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,123.95
|
| Rate for Payer: Cash Price |
$1,694.40
|
| Rate for Payer: Cash Price |
$1,694.40
|
| Rate for Payer: Cofinity Commercial |
$1,506.09
|
| Rate for Payer: Cofinity Commercial |
$1,618.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,123.95
|
| Rate for Payer: Healthscope Commercial |
$1,348.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,348.74
|
| Rate for Payer: Meridian Medicaid |
$766.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,180.15
|
| Rate for Payer: PACE SWMI |
$1,123.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,123.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$730.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,482.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,830.74
|
| Rate for Payer: Priority Health Medicare |
$1,123.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,830.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,157.67
|
|
|
PR TRANSURETHRAL INCISION PROSTATE
|
Professional
|
Both
|
$1,436.00
|
|
|
Service Code
|
HCPCS 52450
|
| Min. Negotiated Rate |
$356.60 |
| Max. Negotiated Rate |
$1,005.20 |
| Rate for Payer: Aetna Commercial |
$618.65
|
| Rate for Payer: Aetna Medicare |
$461.68
|
| Rate for Payer: BCBS Complete |
$574.40
|
| Rate for Payer: BCBS MAPPO |
$461.68
|
| Rate for Payer: BCBS Trust/PPO |
$356.60
|
| Rate for Payer: BCN Commercial |
$685.61
|
| Rate for Payer: BCN Medicare Advantage |
$461.68
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cofinity Commercial |
$664.82
|
| Rate for Payer: Cofinity Commercial |
$618.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$461.68
|
| Rate for Payer: Healthscope Commercial |
$554.02
|
| Rate for Payer: Healthscope Whirlpool |
$554.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$484.76
|
| Rate for Payer: PACE SWMI |
$461.68
|
| Rate for Payer: PHP Medicare Advantage |
$461.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$758.13
|
| Rate for Payer: Priority Health Medicare |
$461.68
|
| Rate for Payer: Priority Health Narrow Network |
$758.13
|
| Rate for Payer: UHC Medicare Advantage |
$475.53
|
|
|
PR TRANSURETHRAL RESECTION BLADDER NECK
|
Professional
|
Both
|
$1,654.00
|
|
|
Service Code
|
HCPCS 52500
|
| Min. Negotiated Rate |
$315.67 |
| Max. Negotiated Rate |
$1,157.80 |
| Rate for Payer: Aetna Commercial |
$642.89
|
| Rate for Payer: Aetna Medicare |
$479.77
|
| Rate for Payer: BCBS Complete |
$331.45
|
| Rate for Payer: BCBS MAPPO |
$479.77
|
| Rate for Payer: BCBS Trust/PPO |
$652.45
|
| Rate for Payer: BCN Commercial |
$712.00
|
| Rate for Payer: BCN Medicare Advantage |
$479.77
|
| Rate for Payer: Cash Price |
$1,323.20
|
| Rate for Payer: Cash Price |
$1,323.20
|
| Rate for Payer: Cofinity Commercial |
$642.89
|
| Rate for Payer: Cofinity Commercial |
$690.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$479.77
|
| Rate for Payer: Healthscope Commercial |
$575.72
|
| Rate for Payer: Healthscope Whirlpool |
$575.72
|
| Rate for Payer: Meridian Medicaid |
$331.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$503.76
|
| Rate for Payer: PACE SWMI |
$479.77
|
| Rate for Payer: PHP Medicare Advantage |
$479.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$315.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,157.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$787.31
|
| Rate for Payer: Priority Health Medicare |
$479.77
|
| Rate for Payer: Priority Health Narrow Network |
$787.31
|
| Rate for Payer: UHC Medicare Advantage |
$494.16
|
|
|
PR TRANSV AORTIC ARCH GRAFT W BYPASS
|
Professional
|
Both
|
$10,083.00
|
|
|
Service Code
|
HCPCS 33870
|
| Min. Negotiated Rate |
$4,033.20 |
| Max. Negotiated Rate |
$7,058.10 |
| Rate for Payer: BCBS Complete |
$4,033.20
|
| Rate for Payer: Cash Price |
$8,066.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,058.10
|
|
|
PR TRANSVRS A-ARCH GRF W/CARD BYP PRFD HYPOTHERMIA
|
Professional
|
Both
|
$5,519.00
|
|
|
Service Code
|
HCPCS 33871
|
| Min. Negotiated Rate |
$972.07 |
| Max. Negotiated Rate |
$5,064.77 |
| Rate for Payer: Aetna Commercial |
$4,290.80
|
| Rate for Payer: Aetna Medicare |
$3,202.09
|
| Rate for Payer: BCBS Complete |
$2,134.07
|
| Rate for Payer: BCBS MAPPO |
$3,202.09
|
| Rate for Payer: BCBS Trust/PPO |
$972.07
|
| Rate for Payer: BCN Commercial |
$4,652.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,202.09
|
| Rate for Payer: Cash Price |
$4,415.20
|
| Rate for Payer: Cash Price |
$4,415.20
|
| Rate for Payer: Cofinity Commercial |
$4,290.80
|
| Rate for Payer: Cofinity Commercial |
$4,611.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,202.09
|
| Rate for Payer: Healthscope Commercial |
$3,842.51
|
| Rate for Payer: Healthscope Whirlpool |
$3,842.51
|
| Rate for Payer: Meridian Medicaid |
$2,134.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,362.19
|
| Rate for Payer: PACE SWMI |
$3,202.09
|
| Rate for Payer: PHP Medicare Advantage |
$3,202.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,032.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,863.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,064.77
|
| Rate for Payer: Priority Health Medicare |
$3,202.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,064.77
|
| Rate for Payer: UHC Medicare Advantage |
$3,298.15
|
|
|
PR TRAY FEE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 00521
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.10
|
|
|
PR TREATMENT CLOSED ELBOW DISLOCATION REQ ANES
|
Professional
|
Both
|
$1,286.00
|
|
|
Service Code
|
HCPCS 24605
|
| Min. Negotiated Rate |
$213.96 |
| Max. Negotiated Rate |
$900.20 |
| Rate for Payer: Aetna Commercial |
$633.50
|
| Rate for Payer: Aetna Medicare |
$472.76
|
| Rate for Payer: BCBS Complete |
$329.66
|
| Rate for Payer: BCBS MAPPO |
$472.76
|
| Rate for Payer: BCBS Trust/PPO |
$213.96
|
| Rate for Payer: BCN Commercial |
$711.51
|
| Rate for Payer: BCN Medicare Advantage |
$472.76
|
| Rate for Payer: Cash Price |
$1,028.80
|
| Rate for Payer: Cash Price |
$1,028.80
|
| Rate for Payer: Cofinity Commercial |
$680.77
|
| Rate for Payer: Cofinity Commercial |
$633.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$472.76
|
| Rate for Payer: Healthscope Commercial |
$567.31
|
| Rate for Payer: Healthscope Whirlpool |
$567.31
|
| Rate for Payer: Meridian Medicaid |
$329.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$496.40
|
| Rate for Payer: PACE SWMI |
$472.76
|
| Rate for Payer: PHP Medicare Advantage |
$472.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$900.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$743.51
|
| Rate for Payer: Priority Health Medicare |
$472.76
|
| Rate for Payer: Priority Health Narrow Network |
$743.51
|
| Rate for Payer: UHC Medicare Advantage |
$486.94
|
|
|
PR TREATMENT CLOSED ELBOW DISLOCATION W/O ANES
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 24600
|
| Min. Negotiated Rate |
$227.06 |
| Max. Negotiated Rate |
$567.84 |
| Rate for Payer: Aetna Commercial |
$459.10
|
| Rate for Payer: Aetna Medicare |
$342.61
|
| Rate for Payer: BCBS Complete |
$238.41
|
| Rate for Payer: BCBS MAPPO |
$342.61
|
| Rate for Payer: BCBS Trust/PPO |
$525.13
|
| Rate for Payer: BCN Commercial |
$567.84
|
| Rate for Payer: BCN Medicare Advantage |
$342.61
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cofinity Commercial |
$459.10
|
| Rate for Payer: Cofinity Commercial |
$493.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.61
|
| Rate for Payer: Healthscope Commercial |
$411.13
|
| Rate for Payer: Healthscope Whirlpool |
$411.13
|
| Rate for Payer: Meridian Medicaid |
$238.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.74
|
| Rate for Payer: PACE SWMI |
$342.61
|
| Rate for Payer: PHP Medicare Advantage |
$342.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.69
|
| Rate for Payer: Priority Health Medicare |
$342.61
|
| Rate for Payer: Priority Health Narrow Network |
$536.69
|
| Rate for Payer: UHC Medicare Advantage |
$352.89
|
|
|
PR TRIAMCINOLONE ACETONIDE INJ
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J3301
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna Commercial |
$1.35
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$1.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.55
|
| Rate for Payer: BCN Commercial |
$0.73
|
| Rate for Payer: BCN Medicare Advantage |
$1.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$1.35
|
| Rate for Payer: Cofinity Commercial |
$1.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.00
|
| Rate for Payer: Healthscope Commercial |
$1.21
|
| Rate for Payer: Healthscope Whirlpool |
$1.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.06
|
| Rate for Payer: PACE SWMI |
$1.00
|
| Rate for Payer: PHP Medicare Advantage |
$1.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health Medicare |
$1.00
|
| Rate for Payer: UHC Medicare Advantage |
$1.04
|
|
|
PR TRIMETHOBENZAMIDE HCL INJ
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS J3250
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$64.86 |
| Rate for Payer: Aetna Commercial |
$60.35
|
| Rate for Payer: Aetna Medicare |
$45.04
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$45.04
|
| Rate for Payer: BCBS Trust/PPO |
$48.74
|
| Rate for Payer: BCN Commercial |
$45.78
|
| Rate for Payer: BCN Medicare Advantage |
$45.04
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$60.35
|
| Rate for Payer: Cofinity Commercial |
$64.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.04
|
| Rate for Payer: Healthscope Commercial |
$54.05
|
| Rate for Payer: Healthscope Whirlpool |
$54.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47.29
|
| Rate for Payer: PACE SWMI |
$45.04
|
| Rate for Payer: PHP Medicare Advantage |
$45.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: Priority Health Medicare |
$45.04
|
| Rate for Payer: UHC Medicare Advantage |
$46.39
|
|
|
PR TRIMMING NONDYSTROPHIC NAILS ANY NUMBER
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 11719
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$9.86
|
| Rate for Payer: Aetna Medicare |
$7.36
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS MAPPO |
$7.36
|
| Rate for Payer: BCBS Trust/PPO |
$12.00
|
| Rate for Payer: BCN Commercial |
$16.49
|
| Rate for Payer: BCN Medicare Advantage |
$7.36
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$9.86
|
| Rate for Payer: Cofinity Commercial |
$10.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.36
|
| Rate for Payer: Healthscope Commercial |
$8.83
|
| Rate for Payer: Healthscope Whirlpool |
$8.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.73
|
| Rate for Payer: PACE SWMI |
$7.36
|
| Rate for Payer: PHP Medicare Advantage |
$7.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.05
|
| Rate for Payer: Priority Health Medicare |
$7.36
|
| Rate for Payer: Priority Health Narrow Network |
$9.05
|
| Rate for Payer: UHC Medicare Advantage |
$7.58
|
|
|
PR TRIM NAIL(S)
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G0127
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$1,929.35 |
| Rate for Payer: Aetna Commercial |
$9.86
|
| Rate for Payer: Aetna Medicare |
$7.36
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$7.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,929.35
|
| Rate for Payer: BCN Commercial |
$34.21
|
| Rate for Payer: BCN Medicare Advantage |
$7.36
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$9.86
|
| Rate for Payer: Cofinity Commercial |
$10.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.36
|
| Rate for Payer: Healthscope Commercial |
$8.83
|
| Rate for Payer: Healthscope Whirlpool |
$8.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.73
|
| Rate for Payer: PACE SWMI |
$7.36
|
| Rate for Payer: PHP Medicare Advantage |
$7.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.05
|
| Rate for Payer: Priority Health Medicare |
$7.36
|
| Rate for Payer: Priority Health Narrow Network |
$9.05
|
| Rate for Payer: UHC Medicare Advantage |
$7.58
|
|
|
PR TRLML BALO ANGIOP OPEN/PERQ IMG S&I 1ST ART
|
Professional
|
Both
|
$1,076.00
|
|
|
Service Code
|
HCPCS 37246
|
| Min. Negotiated Rate |
$215.98 |
| Max. Negotiated Rate |
$2,674.54 |
| Rate for Payer: Aetna Commercial |
$456.36
|
| Rate for Payer: Aetna Medicare |
$340.57
|
| Rate for Payer: BCBS Complete |
$226.78
|
| Rate for Payer: BCBS MAPPO |
$340.57
|
| Rate for Payer: BCBS Trust/PPO |
$786.64
|
| Rate for Payer: BCN Commercial |
$2,674.54
|
| Rate for Payer: BCN Medicare Advantage |
$340.57
|
| Rate for Payer: Cash Price |
$860.80
|
| Rate for Payer: Cash Price |
$860.80
|
| Rate for Payer: Cofinity Commercial |
$456.36
|
| Rate for Payer: Cofinity Commercial |
$490.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$340.57
|
| Rate for Payer: Healthscope Commercial |
$408.68
|
| Rate for Payer: Healthscope Whirlpool |
$408.68
|
| Rate for Payer: Meridian Medicaid |
$226.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$357.60
|
| Rate for Payer: PACE SWMI |
$340.57
|
| Rate for Payer: PHP Medicare Advantage |
$340.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$215.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$753.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$538.34
|
| Rate for Payer: Priority Health Medicare |
$340.57
|
| Rate for Payer: Priority Health Narrow Network |
$538.34
|
| Rate for Payer: UHC Medicare Advantage |
$350.79
|
|
|
PR TRLML BALO ANGIOP OPEN/PERQ IMG S&I EA ADDL ART
|
Professional
|
Both
|
$820.00
|
|
|
Service Code
|
HCPCS 37247
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$1,142.18 |
| Rate for Payer: Aetna Commercial |
$226.71
|
| Rate for Payer: Aetna Medicare |
$169.19
|
| Rate for Payer: BCBS Complete |
$112.95
|
| Rate for Payer: BCBS MAPPO |
$169.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,142.18
|
| Rate for Payer: BCN Commercial |
$828.80
|
| Rate for Payer: BCN Medicare Advantage |
$169.19
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cofinity Commercial |
$226.71
|
| Rate for Payer: Cofinity Commercial |
$243.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.19
|
| Rate for Payer: Healthscope Commercial |
$203.03
|
| Rate for Payer: Healthscope Whirlpool |
$203.03
|
| Rate for Payer: Meridian Medicaid |
$112.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$177.65
|
| Rate for Payer: PACE SWMI |
$169.19
|
| Rate for Payer: PHP Medicare Advantage |
$169.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$266.50
|
| Rate for Payer: Priority Health Medicare |
$169.19
|
| Rate for Payer: Priority Health Narrow Network |
$266.50
|
| Rate for Payer: UHC Medicare Advantage |
$174.27
|
|
|
PR TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I 1ST VEIN
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 37248
|
| Min. Negotiated Rate |
$184.25 |
| Max. Negotiated Rate |
$1,997.22 |
| Rate for Payer: Aetna Commercial |
$387.62
|
| Rate for Payer: Aetna Medicare |
$289.27
|
| Rate for Payer: BCBS Complete |
$193.46
|
| Rate for Payer: BCBS MAPPO |
$289.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,245.73
|
| Rate for Payer: BCN Commercial |
$1,997.22
|
| Rate for Payer: BCN Medicare Advantage |
$289.27
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cofinity Commercial |
$387.62
|
| Rate for Payer: Cofinity Commercial |
$416.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.27
|
| Rate for Payer: Healthscope Commercial |
$347.12
|
| Rate for Payer: Healthscope Whirlpool |
$347.12
|
| Rate for Payer: Meridian Medicaid |
$193.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$303.73
|
| Rate for Payer: PACE SWMI |
$289.27
|
| Rate for Payer: PHP Medicare Advantage |
$289.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$184.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$647.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$459.08
|
| Rate for Payer: Priority Health Medicare |
$289.27
|
| Rate for Payer: Priority Health Narrow Network |
$459.08
|
| Rate for Payer: UHC Medicare Advantage |
$297.95
|
|
|
PR TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I ADDL VEIN
|
Professional
|
Both
|
$454.00
|
|
|
Service Code
|
HCPCS 37249
|
| Min. Negotiated Rate |
$90.31 |
| Max. Negotiated Rate |
$647.99 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: Aetna Medicare |
$142.39
|
| Rate for Payer: BCBS Complete |
$94.83
|
| Rate for Payer: BCBS MAPPO |
$142.39
|
| Rate for Payer: BCBS Trust/PPO |
$260.45
|
| Rate for Payer: BCN Commercial |
$647.99
|
| Rate for Payer: BCN Medicare Advantage |
$142.39
|
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Cofinity Commercial |
$190.80
|
| Rate for Payer: Cofinity Commercial |
$205.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.39
|
| Rate for Payer: Healthscope Commercial |
$170.87
|
| Rate for Payer: Healthscope Whirlpool |
$170.87
|
| Rate for Payer: Meridian Medicaid |
$94.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$149.51
|
| Rate for Payer: PACE SWMI |
$142.39
|
| Rate for Payer: PHP Medicare Advantage |
$142.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.01
|
| Rate for Payer: Priority Health Medicare |
$142.39
|
| Rate for Payer: Priority Health Narrow Network |
$225.01
|
| Rate for Payer: UHC Medicare Advantage |
$146.66
|
|
|
PR TRLUML BALO ANGIOP CTR DIALYSIS SEG W/IMG S&I
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
HCPCS 36907
|
| Min. Negotiated Rate |
$90.53 |
| Max. Negotiated Rate |
$1,983.24 |
| Rate for Payer: Aetna Commercial |
$191.65
|
| Rate for Payer: Aetna Medicare |
$143.02
|
| Rate for Payer: BCBS Complete |
$95.06
|
| Rate for Payer: BCBS MAPPO |
$143.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,983.24
|
| Rate for Payer: BCN Commercial |
$867.89
|
| Rate for Payer: BCN Medicare Advantage |
$143.02
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cofinity Commercial |
$191.65
|
| Rate for Payer: Cofinity Commercial |
$205.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.02
|
| Rate for Payer: Healthscope Commercial |
$171.62
|
| Rate for Payer: Healthscope Whirlpool |
$171.62
|
| Rate for Payer: Meridian Medicaid |
$95.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$150.17
|
| Rate for Payer: PACE SWMI |
$143.02
|
| Rate for Payer: PHP Medicare Advantage |
$143.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.61
|
| Rate for Payer: Priority Health Medicare |
$143.02
|
| Rate for Payer: Priority Health Narrow Network |
$226.61
|
| Rate for Payer: UHC Medicare Advantage |
$147.31
|
|
|
PR TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL
|
Professional
|
Both
|
$9,628.00
|
|
|
Service Code
|
HCPCS 0237T
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$9,819.16 |
| Rate for Payer: Aetna Commercial |
$4,395.81
|
| Rate for Payer: BCBS Complete |
$260.96
|
| Rate for Payer: BCBS Trust/PPO |
$100.60
|
| Rate for Payer: BCN Commercial |
$9,819.16
|
| Rate for Payer: Cash Price |
$7,702.40
|
| Rate for Payer: Cash Price |
$7,702.40
|
| Rate for Payer: Meridian Medicaid |
$260.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$248.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,739.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,548.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,548.58
|
|
|
PR TRNSCONDLR POST CRNL FOSSA DCOMPR ART W/WO MOBIL
|
Professional
|
Both
|
$8,584.00
|
|
|
Service Code
|
HCPCS 61597
|
| Min. Negotiated Rate |
$1,813.13 |
| Max. Negotiated Rate |
$6,047.84 |
| Rate for Payer: Aetna Commercial |
$3,971.26
|
| Rate for Payer: Aetna Medicare |
$2,963.63
|
| Rate for Payer: BCBS Complete |
$2,010.61
|
| Rate for Payer: BCBS MAPPO |
$2,963.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,813.13
|
| Rate for Payer: BCN Commercial |
$6,047.84
|
| Rate for Payer: BCN Medicare Advantage |
$2,963.63
|
| Rate for Payer: Cash Price |
$6,867.20
|
| Rate for Payer: Cash Price |
$6,867.20
|
| Rate for Payer: Cofinity Commercial |
$4,267.63
|
| Rate for Payer: Cofinity Commercial |
$3,971.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,963.63
|
| Rate for Payer: Healthscope Commercial |
$3,556.36
|
| Rate for Payer: Healthscope Whirlpool |
$3,556.36
|
| Rate for Payer: Meridian Medicaid |
$2,010.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,111.81
|
| Rate for Payer: PACE SWMI |
$2,963.63
|
| Rate for Payer: PHP Medicare Advantage |
$2,963.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,914.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,008.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,051.28
|
| Rate for Payer: Priority Health Medicare |
$2,963.63
|
| Rate for Payer: Priority Health Narrow Network |
$5,051.28
|
| Rate for Payer: UHC Medicare Advantage |
$3,052.54
|
|
