|
PR VAGINECTOMY COMPLETE REMOVAL VAGINAL WALL
|
Professional
|
Both
|
$1,985.00
|
|
|
Service Code
|
HCPCS 57110
|
| Min. Negotiated Rate |
$579.79 |
| Max. Negotiated Rate |
$2,148.07 |
| Rate for Payer: Aetna Commercial |
$1,203.03
|
| Rate for Payer: Aetna Medicare |
$897.78
|
| Rate for Payer: BCBS Complete |
$608.78
|
| Rate for Payer: BCBS MAPPO |
$897.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,148.07
|
| Rate for Payer: BCN Commercial |
$1,325.29
|
| Rate for Payer: BCN Medicare Advantage |
$897.78
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cofinity Commercial |
$1,292.80
|
| Rate for Payer: Cofinity Commercial |
$1,203.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$897.78
|
| Rate for Payer: Healthscope Commercial |
$1,077.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,077.34
|
| Rate for Payer: Meridian Medicaid |
$608.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$942.67
|
| Rate for Payer: PACE SWMI |
$897.78
|
| Rate for Payer: PHP Medicare Advantage |
$897.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$579.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,389.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,283.92
|
| Rate for Payer: Priority Health Medicare |
$897.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,283.92
|
| Rate for Payer: UHC Medicare Advantage |
$924.71
|
|
|
PR VAGINECTOMY PARTIAL REMOVAL VAGINAL WALL
|
Professional
|
Both
|
$1,954.00
|
|
|
Service Code
|
HCPCS 57106
|
| Min. Negotiated Rate |
$346.76 |
| Max. Negotiated Rate |
$3,372.14 |
| Rate for Payer: Aetna Commercial |
$706.97
|
| Rate for Payer: Aetna Medicare |
$527.59
|
| Rate for Payer: BCBS Complete |
$364.10
|
| Rate for Payer: BCBS MAPPO |
$527.59
|
| Rate for Payer: BCBS Trust/PPO |
$3,372.14
|
| Rate for Payer: BCN Commercial |
$788.73
|
| Rate for Payer: BCN Medicare Advantage |
$527.59
|
| Rate for Payer: Cash Price |
$1,563.20
|
| Rate for Payer: Cash Price |
$1,563.20
|
| Rate for Payer: Cofinity Commercial |
$706.97
|
| Rate for Payer: Cofinity Commercial |
$759.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$527.59
|
| Rate for Payer: Healthscope Commercial |
$633.11
|
| Rate for Payer: Healthscope Whirlpool |
$633.11
|
| Rate for Payer: Meridian Medicaid |
$364.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$553.97
|
| Rate for Payer: PACE SWMI |
$527.59
|
| Rate for Payer: PHP Medicare Advantage |
$527.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$346.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,367.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$764.11
|
| Rate for Payer: Priority Health Medicare |
$527.59
|
| Rate for Payer: Priority Health Narrow Network |
$764.11
|
| Rate for Payer: UHC Medicare Advantage |
$543.42
|
|
|
PR VAGINECTOMY PRTL RMVL VAG WALL & PARAVAGINAL T
|
Professional
|
Both
|
$2,521.00
|
|
|
Service Code
|
HCPCS 57107
|
| Min. Negotiated Rate |
$936.35 |
| Max. Negotiated Rate |
$3,758.85 |
| Rate for Payer: Aetna Commercial |
$1,931.28
|
| Rate for Payer: Aetna Medicare |
$1,441.25
|
| Rate for Payer: BCBS Complete |
$983.17
|
| Rate for Payer: BCBS MAPPO |
$1,441.25
|
| Rate for Payer: BCBS Trust/PPO |
$3,758.85
|
| Rate for Payer: BCN Commercial |
$2,129.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.25
|
| Rate for Payer: Cash Price |
$2,016.80
|
| Rate for Payer: Cash Price |
$2,016.80
|
| Rate for Payer: Cofinity Commercial |
$2,075.40
|
| Rate for Payer: Cofinity Commercial |
$1,931.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.25
|
| Rate for Payer: Healthscope Commercial |
$1,729.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,729.50
|
| Rate for Payer: Meridian Medicaid |
$983.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.31
|
| Rate for Payer: PACE SWMI |
$1,441.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$936.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,063.18
|
| Rate for Payer: Priority Health Medicare |
$1,441.25
|
| Rate for Payer: Priority Health Narrow Network |
$2,063.18
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.49
|
|
|
PR VAGINOPLASTY INTERSEX STATE
|
Professional
|
Both
|
$2,483.00
|
|
|
Service Code
|
HCPCS 57335
|
| Min. Negotiated Rate |
$755.51 |
| Max. Negotiated Rate |
$1,738.10 |
| Rate for Payer: Aetna Commercial |
$1,567.97
|
| Rate for Payer: Aetna Medicare |
$1,170.13
|
| Rate for Payer: BCBS Complete |
$793.29
|
| Rate for Payer: BCBS MAPPO |
$1,170.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,671.54
|
| Rate for Payer: BCN Commercial |
$1,727.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,170.13
|
| Rate for Payer: Cash Price |
$1,986.40
|
| Rate for Payer: Cash Price |
$1,986.40
|
| Rate for Payer: Cofinity Commercial |
$1,567.97
|
| Rate for Payer: Cofinity Commercial |
$1,684.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,170.13
|
| Rate for Payer: Healthscope Commercial |
$1,404.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.16
|
| Rate for Payer: Meridian Medicaid |
$793.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,228.64
|
| Rate for Payer: PACE SWMI |
$1,170.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,170.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$755.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,738.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,673.55
|
| Rate for Payer: Priority Health Medicare |
$1,170.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,673.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,205.23
|
|
|
PR VAGOTOMY PFRMD W/PRTL DSTL GSTRCT
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 43635
|
| Min. Negotiated Rate |
$71.14 |
| Max. Negotiated Rate |
$806.71 |
| Rate for Payer: Aetna Commercial |
$150.31
|
| Rate for Payer: Aetna Medicare |
$112.17
|
| Rate for Payer: BCBS Complete |
$74.70
|
| Rate for Payer: BCBS MAPPO |
$112.17
|
| Rate for Payer: BCBS Trust/PPO |
$806.71
|
| Rate for Payer: BCN Commercial |
$163.22
|
| Rate for Payer: BCN Medicare Advantage |
$112.17
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$161.52
|
| Rate for Payer: Cofinity Commercial |
$150.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.17
|
| Rate for Payer: Healthscope Commercial |
$134.60
|
| Rate for Payer: Healthscope Whirlpool |
$134.60
|
| Rate for Payer: Meridian Medicaid |
$74.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$117.78
|
| Rate for Payer: PACE SWMI |
$112.17
|
| Rate for Payer: PHP Medicare Advantage |
$112.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.38
|
| Rate for Payer: Priority Health Medicare |
$112.17
|
| Rate for Payer: Priority Health Narrow Network |
$196.38
|
| Rate for Payer: UHC Medicare Advantage |
$115.54
|
|
|
PR VALVOTOMY MITRAL VALVE OPEN HEART W/BYPASS
|
Professional
|
Both
|
$8,748.00
|
|
|
Service Code
|
HCPCS 33422
|
| Min. Negotiated Rate |
$495.02 |
| Max. Negotiated Rate |
$6,123.60 |
| Rate for Payer: Aetna Commercial |
$2,187.43
|
| Rate for Payer: Aetna Medicare |
$1,632.41
|
| Rate for Payer: BCBS Complete |
$1,092.54
|
| Rate for Payer: BCBS MAPPO |
$1,632.41
|
| Rate for Payer: BCBS Trust/PPO |
$495.02
|
| Rate for Payer: BCN Commercial |
$2,382.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,632.41
|
| Rate for Payer: Cash Price |
$6,998.40
|
| Rate for Payer: Cash Price |
$6,998.40
|
| Rate for Payer: Cofinity Commercial |
$2,350.67
|
| Rate for Payer: Cofinity Commercial |
$2,187.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,632.41
|
| Rate for Payer: Healthscope Commercial |
$1,958.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,958.89
|
| Rate for Payer: Meridian Medicaid |
$1,092.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,714.03
|
| Rate for Payer: PACE SWMI |
$1,632.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,632.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,040.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,123.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,593.83
|
| Rate for Payer: Priority Health Medicare |
$1,632.41
|
| Rate for Payer: Priority Health Narrow Network |
$2,593.83
|
| Rate for Payer: UHC Medicare Advantage |
$1,681.38
|
|
|
PR VALVULOPLASTY MITRAL VALVE W/CARDIAC BYPASS
|
Professional
|
Both
|
$8,346.00
|
|
|
Service Code
|
HCPCS 33425
|
| Min. Negotiated Rate |
$763.39 |
| Max. Negotiated Rate |
$5,842.20 |
| Rate for Payer: Aetna Commercial |
$3,596.75
|
| Rate for Payer: Aetna Medicare |
$2,684.14
|
| Rate for Payer: BCBS Complete |
$1,794.34
|
| Rate for Payer: BCBS MAPPO |
$2,684.14
|
| Rate for Payer: BCBS Trust/PPO |
$763.39
|
| Rate for Payer: BCN Commercial |
$3,906.98
|
| Rate for Payer: BCN Medicare Advantage |
$2,684.14
|
| Rate for Payer: Cash Price |
$6,676.80
|
| Rate for Payer: Cash Price |
$6,676.80
|
| Rate for Payer: Cofinity Commercial |
$3,865.16
|
| Rate for Payer: Cofinity Commercial |
$3,596.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,684.14
|
| Rate for Payer: Healthscope Commercial |
$3,220.97
|
| Rate for Payer: Healthscope Whirlpool |
$3,220.97
|
| Rate for Payer: Meridian Medicaid |
$1,794.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,818.35
|
| Rate for Payer: PACE SWMI |
$2,684.14
|
| Rate for Payer: PHP Medicare Advantage |
$2,684.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,708.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,842.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,253.00
|
| Rate for Payer: Priority Health Medicare |
$2,684.14
|
| Rate for Payer: Priority Health Narrow Network |
$4,253.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,764.66
|
|
|
PR VALVULOPLASTY TRICUSPID VALVE W/O RING INSERTION
|
Professional
|
Both
|
$7,396.00
|
|
|
Service Code
|
HCPCS 33463
|
| Min. Negotiated Rate |
$1,183.92 |
| Max. Negotiated Rate |
$5,177.20 |
| Rate for Payer: Aetna Commercial |
$4,040.57
|
| Rate for Payer: Aetna Medicare |
$3,015.35
|
| Rate for Payer: BCBS Complete |
$2,019.34
|
| Rate for Payer: BCBS MAPPO |
$3,015.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,183.92
|
| Rate for Payer: BCN Commercial |
$4,392.23
|
| Rate for Payer: BCN Medicare Advantage |
$3,015.35
|
| Rate for Payer: Cash Price |
$5,916.80
|
| Rate for Payer: Cash Price |
$5,916.80
|
| Rate for Payer: Cofinity Commercial |
$4,040.57
|
| Rate for Payer: Cofinity Commercial |
$4,342.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,015.35
|
| Rate for Payer: Healthscope Commercial |
$3,618.42
|
| Rate for Payer: Healthscope Whirlpool |
$3,618.42
|
| Rate for Payer: Meridian Medicaid |
$2,019.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,166.12
|
| Rate for Payer: PACE SWMI |
$3,015.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,015.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,923.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,177.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,781.23
|
| Rate for Payer: Priority Health Medicare |
$3,015.35
|
| Rate for Payer: Priority Health Narrow Network |
$4,781.23
|
| Rate for Payer: UHC Medicare Advantage |
$3,105.81
|
|
|
PR VALVULOPLASTY TRICUSPID VALVE W/RING INSERTION
|
Professional
|
Both
|
$5,015.98
|
|
|
Service Code
|
HCPCS 33464
|
| Min. Negotiated Rate |
$309.58 |
| Max. Negotiated Rate |
$3,796.05 |
| Rate for Payer: Aetna Commercial |
$3,208.36
|
| Rate for Payer: Aetna Medicare |
$2,394.30
|
| Rate for Payer: BCBS Complete |
$1,602.01
|
| Rate for Payer: BCBS MAPPO |
$2,394.30
|
| Rate for Payer: BCBS Trust/PPO |
$309.58
|
| Rate for Payer: BCN Commercial |
$3,487.20
|
| Rate for Payer: BCN Medicare Advantage |
$2,394.30
|
| Rate for Payer: Cash Price |
$4,012.78
|
| Rate for Payer: Cash Price |
$4,012.78
|
| Rate for Payer: Cofinity Commercial |
$3,447.79
|
| Rate for Payer: Cofinity Commercial |
$3,208.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,394.30
|
| Rate for Payer: Healthscope Commercial |
$2,873.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,873.16
|
| Rate for Payer: Meridian Medicaid |
$1,602.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,514.02
|
| Rate for Payer: PACE SWMI |
$2,394.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,394.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,525.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,511.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,796.05
|
| Rate for Payer: Priority Health Medicare |
$2,394.30
|
| Rate for Payer: Priority Health Narrow Network |
$3,796.05
|
| Rate for Payer: UHC Medicare Advantage |
$2,466.13
|
|
|
PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 90716
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$177.68 |
| Rate for Payer: Aetna Commercial |
$177.68
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: BCBS Trust/PPO |
$160.76
|
| Rate for Payer: BCN Commercial |
$157.78
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.40
|
|
|
PR VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX
|
Professional
|
Both
|
$1,309.00
|
|
|
Service Code
|
HCPCS 37500
|
| Min. Negotiated Rate |
$395.54 |
| Max. Negotiated Rate |
$1,413.20 |
| Rate for Payer: Aetna Commercial |
$832.42
|
| Rate for Payer: Aetna Medicare |
$621.21
|
| Rate for Payer: BCBS Complete |
$415.32
|
| Rate for Payer: BCBS MAPPO |
$621.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,413.20
|
| Rate for Payer: BCN Commercial |
$902.59
|
| Rate for Payer: BCN Medicare Advantage |
$621.21
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cofinity Commercial |
$832.42
|
| Rate for Payer: Cofinity Commercial |
$894.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$621.21
|
| Rate for Payer: Healthscope Commercial |
$745.45
|
| Rate for Payer: Healthscope Whirlpool |
$745.45
|
| Rate for Payer: Meridian Medicaid |
$415.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$652.27
|
| Rate for Payer: PACE SWMI |
$621.21
|
| Rate for Payer: PHP Medicare Advantage |
$621.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$916.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$982.53
|
| Rate for Payer: Priority Health Medicare |
$621.21
|
| Rate for Payer: Priority Health Narrow Network |
$982.53
|
| Rate for Payer: UHC Medicare Advantage |
$639.85
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I
|
Professional
|
Both
|
$1,485.00
|
|
|
Service Code
|
HCPCS 37242
|
| Min. Negotiated Rate |
$294.79 |
| Max. Negotiated Rate |
$10,507.06 |
| Rate for Payer: Aetna Commercial |
$624.68
|
| Rate for Payer: Aetna Medicare |
$466.18
|
| Rate for Payer: BCBS Complete |
$309.53
|
| Rate for Payer: BCBS MAPPO |
$466.18
|
| Rate for Payer: BCBS Trust/PPO |
$658.79
|
| Rate for Payer: BCN Commercial |
$10,507.06
|
| Rate for Payer: BCN Medicare Advantage |
$466.18
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cofinity Commercial |
$671.30
|
| Rate for Payer: Cofinity Commercial |
$624.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$466.18
|
| Rate for Payer: Healthscope Commercial |
$559.42
|
| Rate for Payer: Healthscope Whirlpool |
$559.42
|
| Rate for Payer: Meridian Medicaid |
$309.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$489.49
|
| Rate for Payer: PACE SWMI |
$466.18
|
| Rate for Payer: PHP Medicare Advantage |
$466.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$294.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$737.83
|
| Rate for Payer: Priority Health Medicare |
$466.18
|
| Rate for Payer: Priority Health Narrow Network |
$737.83
|
| Rate for Payer: UHC Medicare Advantage |
$480.17
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE
|
Professional
|
Both
|
$9,512.00
|
|
|
Service Code
|
HCPCS 37244
|
| Min. Negotiated Rate |
$408.32 |
| Max. Negotiated Rate |
$9,737.39 |
| Rate for Payer: Aetna Commercial |
$863.59
|
| Rate for Payer: Aetna Medicare |
$644.47
|
| Rate for Payer: BCBS Complete |
$428.74
|
| Rate for Payer: BCBS MAPPO |
$644.47
|
| Rate for Payer: BCBS Trust/PPO |
$624.45
|
| Rate for Payer: BCN Commercial |
$9,737.39
|
| Rate for Payer: BCN Medicare Advantage |
$644.47
|
| Rate for Payer: Cash Price |
$7,609.60
|
| Rate for Payer: Cash Price |
$7,609.60
|
| Rate for Payer: Cofinity Commercial |
$928.04
|
| Rate for Payer: Cofinity Commercial |
$863.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.47
|
| Rate for Payer: Healthscope Commercial |
$773.36
|
| Rate for Payer: Healthscope Whirlpool |
$773.36
|
| Rate for Payer: Meridian Medicaid |
$428.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$676.69
|
| Rate for Payer: PACE SWMI |
$644.47
|
| Rate for Payer: PHP Medicare Advantage |
$644.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,658.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,025.09
|
| Rate for Payer: Priority Health Medicare |
$644.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,025.09
|
| Rate for Payer: UHC Medicare Advantage |
$663.80
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 37241
|
| Min. Negotiated Rate |
$264.76 |
| Max. Negotiated Rate |
$6,882.05 |
| Rate for Payer: Aetna Commercial |
$562.68
|
| Rate for Payer: Aetna Medicare |
$419.91
|
| Rate for Payer: BCBS Complete |
$278.00
|
| Rate for Payer: BCBS MAPPO |
$419.91
|
| Rate for Payer: BCBS Trust/PPO |
$583.24
|
| Rate for Payer: BCN Commercial |
$6,882.05
|
| Rate for Payer: BCN Medicare Advantage |
$419.91
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cofinity Commercial |
$604.67
|
| Rate for Payer: Cofinity Commercial |
$562.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$419.91
|
| Rate for Payer: Healthscope Commercial |
$503.89
|
| Rate for Payer: Healthscope Whirlpool |
$503.89
|
| Rate for Payer: Meridian Medicaid |
$278.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$440.91
|
| Rate for Payer: PACE SWMI |
$419.91
|
| Rate for Payer: PHP Medicare Advantage |
$419.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$264.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$665.48
|
| Rate for Payer: Priority Health Medicare |
$419.91
|
| Rate for Payer: Priority Health Narrow Network |
$665.48
|
| Rate for Payer: UHC Medicare Advantage |
$432.51
|
|
|
PR VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT
|
Professional
|
Both
|
$1,193.00
|
|
|
Service Code
|
HCPCS 37243
|
| Min. Negotiated Rate |
$346.34 |
| Max. Negotiated Rate |
$12,761.33 |
| Rate for Payer: Aetna Commercial |
$731.14
|
| Rate for Payer: Aetna Medicare |
$545.63
|
| Rate for Payer: BCBS Complete |
$363.66
|
| Rate for Payer: BCBS MAPPO |
$545.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,206.64
|
| Rate for Payer: BCN Commercial |
$12,761.33
|
| Rate for Payer: BCN Medicare Advantage |
$545.63
|
| Rate for Payer: Cash Price |
$954.40
|
| Rate for Payer: Cash Price |
$954.40
|
| Rate for Payer: Cofinity Commercial |
$785.71
|
| Rate for Payer: Cofinity Commercial |
$731.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$545.63
|
| Rate for Payer: Healthscope Commercial |
$654.76
|
| Rate for Payer: Healthscope Whirlpool |
$654.76
|
| Rate for Payer: Meridian Medicaid |
$363.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$572.91
|
| Rate for Payer: PACE SWMI |
$545.63
|
| Rate for Payer: PHP Medicare Advantage |
$545.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$346.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$835.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$867.62
|
| Rate for Payer: Priority Health Medicare |
$545.63
|
| Rate for Payer: Priority Health Narrow Network |
$867.62
|
| Rate for Payer: UHC Medicare Advantage |
$562.00
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
55250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$612.50 |
| Max. Negotiated Rate |
$2,263.10 |
| Rate for Payer: Aetna Commercial |
$787.50
|
| Rate for Payer: Aetna Medicare |
$1,810.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,263.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,263.10
|
| Rate for Payer: ASR ASR |
$848.75
|
| Rate for Payer: BCBS Complete |
$1,039.94
|
| Rate for Payer: BCBS MAPPO |
$1,810.48
|
| Rate for Payer: BCBS Trust/PPO |
$678.39
|
| Rate for Payer: BCN Commercial |
$678.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,810.48
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cofinity Commercial |
$822.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,810.48
|
| Rate for Payer: Healthscope Commercial |
$875.00
|
| Rate for Payer: Healthscope Whirlpool |
$848.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,810.48
|
| Rate for Payer: Mclaren Commercial |
$787.50
|
| Rate for Payer: Mclaren Medicaid |
$990.33
|
| Rate for Payer: Mclaren Medicare |
$1,810.48
|
| Rate for Payer: Meridian Medicaid |
$1,039.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,901.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$743.75
|
| Rate for Payer: PACE Medicare |
$1,719.96
|
| Rate for Payer: PACE SWMI |
$1,810.48
|
| Rate for Payer: PHP Commercial |
$1,991.53
|
| Rate for Payer: PHP Medicaid |
$990.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,810.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$796.25
|
| Rate for Payer: Priority Health Medicare |
$1,810.48
|
| Rate for Payer: Priority Health Narrow Network |
$621.25
|
| Rate for Payer: Railroad Medicare Medicare |
$1,810.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$770.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,864.79
|
| Rate for Payer: VA VA |
$1,810.48
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 55250
|
| Min. Negotiated Rate |
$147.61 |
| Max. Negotiated Rate |
$1,543.69 |
| Rate for Payer: Aetna Commercial |
$297.91
|
| Rate for Payer: Aetna Medicare |
$222.32
|
| Rate for Payer: BCBS Complete |
$154.99
|
| Rate for Payer: BCBS MAPPO |
$222.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.69
|
| Rate for Payer: BCN Commercial |
$393.05
|
| Rate for Payer: BCN Medicare Advantage |
$222.32
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cofinity Commercial |
$297.91
|
| Rate for Payer: Cofinity Commercial |
$320.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.32
|
| Rate for Payer: Healthscope Commercial |
$266.78
|
| Rate for Payer: Healthscope Whirlpool |
$266.78
|
| Rate for Payer: Meridian Medicaid |
$154.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$233.44
|
| Rate for Payer: PACE SWMI |
$222.32
|
| Rate for Payer: PHP Medicare Advantage |
$222.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$367.44
|
| Rate for Payer: Priority Health Medicare |
$222.32
|
| Rate for Payer: Priority Health Narrow Network |
$367.44
|
| Rate for Payer: UHC Medicare Advantage |
$228.99
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
55250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$612.50 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$787.50
|
| Rate for Payer: ASR ASR |
$848.75
|
| Rate for Payer: BCBS Trust/PPO |
$678.39
|
| Rate for Payer: BCN Commercial |
$678.39
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cofinity Commercial |
$822.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.00
|
| Rate for Payer: Healthscope Commercial |
$875.00
|
| Rate for Payer: Healthscope Whirlpool |
$848.75
|
| Rate for Payer: Mclaren Commercial |
$787.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$743.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$770.00
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
55250
|
| Min. Negotiated Rate |
$147.61 |
| Max. Negotiated Rate |
$1,543.69 |
| Rate for Payer: Aetna Commercial |
$297.91
|
| Rate for Payer: Aetna Medicare |
$222.32
|
| Rate for Payer: BCBS Complete |
$154.99
|
| Rate for Payer: BCBS MAPPO |
$222.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.69
|
| Rate for Payer: BCN Commercial |
$393.05
|
| Rate for Payer: BCN Medicare Advantage |
$222.32
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cofinity Commercial |
$320.14
|
| Rate for Payer: Cofinity Commercial |
$297.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.32
|
| Rate for Payer: Healthscope Commercial |
$266.78
|
| Rate for Payer: Healthscope Whirlpool |
$266.78
|
| Rate for Payer: Meridian Medicaid |
$154.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$233.44
|
| Rate for Payer: PACE SWMI |
$222.32
|
| Rate for Payer: PHP Medicare Advantage |
$222.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$367.44
|
| Rate for Payer: Priority Health Medicare |
$222.32
|
| Rate for Payer: Priority Health Narrow Network |
$367.44
|
| Rate for Payer: UHC Medicare Advantage |
$228.99
|
|
|
PR VASOVASOSTOMY VASOVASORRHAPHY
|
Professional
|
Both
|
$933.00
|
|
|
Service Code
|
HCPCS 55400
|
| Min. Negotiated Rate |
$373.20 |
| Max. Negotiated Rate |
$2,224.67 |
| Rate for Payer: Aetna Commercial |
$653.85
|
| Rate for Payer: Aetna Medicare |
$487.95
|
| Rate for Payer: BCBS Complete |
$373.20
|
| Rate for Payer: BCBS MAPPO |
$487.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,224.67
|
| Rate for Payer: BCN Commercial |
$722.27
|
| Rate for Payer: BCN Medicare Advantage |
$487.95
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cofinity Commercial |
$702.65
|
| Rate for Payer: Cofinity Commercial |
$653.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$487.95
|
| Rate for Payer: Healthscope Commercial |
$585.54
|
| Rate for Payer: Healthscope Whirlpool |
$585.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$512.35
|
| Rate for Payer: PACE SWMI |
$487.95
|
| Rate for Payer: PHP Medicare Advantage |
$487.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$653.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$798.64
|
| Rate for Payer: Priority Health Medicare |
$487.95
|
| Rate for Payer: Priority Health Narrow Network |
$798.64
|
| Rate for Payer: UHC Medicare Advantage |
$502.59
|
|
|
PR VCRPEC LAT XTRCAVITARY DCMPRN THRC/LMBR EA SEG
|
Professional
|
Both
|
$2,716.00
|
|
|
Service Code
|
HCPCS 63103
|
| Min. Negotiated Rate |
$187.01 |
| Max. Negotiated Rate |
$4,342.63 |
| Rate for Payer: Aetna Commercial |
$394.44
|
| Rate for Payer: Aetna Medicare |
$294.36
|
| Rate for Payer: BCBS Complete |
$196.36
|
| Rate for Payer: BCBS MAPPO |
$294.36
|
| Rate for Payer: BCBS Trust/PPO |
$4,342.63
|
| Rate for Payer: BCN Commercial |
$429.06
|
| Rate for Payer: BCN Medicare Advantage |
$294.36
|
| Rate for Payer: Cash Price |
$2,172.80
|
| Rate for Payer: Cash Price |
$2,172.80
|
| Rate for Payer: Cofinity Commercial |
$423.88
|
| Rate for Payer: Cofinity Commercial |
$394.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.36
|
| Rate for Payer: Healthscope Commercial |
$353.23
|
| Rate for Payer: Healthscope Whirlpool |
$353.23
|
| Rate for Payer: Meridian Medicaid |
$196.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$309.08
|
| Rate for Payer: PACE SWMI |
$294.36
|
| Rate for Payer: PHP Medicare Advantage |
$294.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,901.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$497.14
|
| Rate for Payer: Priority Health Medicare |
$294.36
|
| Rate for Payer: Priority Health Narrow Network |
$497.14
|
| Rate for Payer: UHC Medicare Advantage |
$303.19
|
|
|
PR VCRPEC LES 1 SGM XDRL CERVICAL
|
Professional
|
Both
|
$4,613.00
|
|
|
Service Code
|
HCPCS 63300
|
| Min. Negotiated Rate |
$519.85 |
| Max. Negotiated Rate |
$3,229.10 |
| Rate for Payer: Aetna Commercial |
$2,436.66
|
| Rate for Payer: Aetna Medicare |
$1,818.40
|
| Rate for Payer: BCBS Complete |
$1,228.96
|
| Rate for Payer: BCBS MAPPO |
$1,818.40
|
| Rate for Payer: BCBS Trust/PPO |
$519.85
|
| Rate for Payer: BCN Commercial |
$2,941.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,818.40
|
| Rate for Payer: Cash Price |
$3,690.40
|
| Rate for Payer: Cash Price |
$3,690.40
|
| Rate for Payer: Cofinity Commercial |
$2,618.50
|
| Rate for Payer: Cofinity Commercial |
$2,436.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,818.40
|
| Rate for Payer: Healthscope Commercial |
$2,182.08
|
| Rate for Payer: Healthscope Whirlpool |
$2,182.08
|
| Rate for Payer: Meridian Medicaid |
$1,228.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,909.32
|
| Rate for Payer: PACE SWMI |
$1,818.40
|
| Rate for Payer: PHP Medicare Advantage |
$1,818.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,170.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,229.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,094.97
|
| Rate for Payer: Priority Health Medicare |
$1,818.40
|
| Rate for Payer: Priority Health Narrow Network |
$3,094.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,872.95
|
|
|
PR VCRPEC LES 1 SGM XDRL THORACIC TTHRC
|
Professional
|
Both
|
$4,564.00
|
|
|
Service Code
|
HCPCS 63301
|
| Min. Negotiated Rate |
$1,431.79 |
| Max. Negotiated Rate |
$3,772.74 |
| Rate for Payer: Aetna Commercial |
$2,979.73
|
| Rate for Payer: Aetna Medicare |
$2,223.68
|
| Rate for Payer: BCBS Complete |
$1,503.38
|
| Rate for Payer: BCBS MAPPO |
$2,223.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,593.88
|
| Rate for Payer: BCN Commercial |
$3,585.18
|
| Rate for Payer: BCN Medicare Advantage |
$2,223.68
|
| Rate for Payer: Cash Price |
$3,651.20
|
| Rate for Payer: Cash Price |
$3,651.20
|
| Rate for Payer: Cofinity Commercial |
$3,202.10
|
| Rate for Payer: Cofinity Commercial |
$2,979.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,223.68
|
| Rate for Payer: Healthscope Commercial |
$2,668.42
|
| Rate for Payer: Healthscope Whirlpool |
$2,668.42
|
| Rate for Payer: Meridian Medicaid |
$1,503.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,334.86
|
| Rate for Payer: PACE SWMI |
$2,223.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,223.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,431.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,194.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,772.74
|
| Rate for Payer: Priority Health Medicare |
$2,223.68
|
| Rate for Payer: Priority Health Narrow Network |
$3,772.74
|
| Rate for Payer: UHC Medicare Advantage |
$2,290.39
|
|
|
PR VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR 1 SEG
|
Professional
|
Both
|
$9,042.00
|
|
|
Service Code
|
HCPCS 63087
|
| Min. Negotiated Rate |
$232.45 |
| Max. Negotiated Rate |
$6,329.40 |
| Rate for Payer: Aetna Commercial |
$3,230.62
|
| Rate for Payer: Aetna Medicare |
$2,410.91
|
| Rate for Payer: BCBS Complete |
$1,635.10
|
| Rate for Payer: BCBS MAPPO |
$2,410.91
|
| Rate for Payer: BCBS Trust/PPO |
$232.45
|
| Rate for Payer: BCN Commercial |
$3,891.88
|
| Rate for Payer: BCN Medicare Advantage |
$2,410.91
|
| Rate for Payer: Cash Price |
$7,233.60
|
| Rate for Payer: Cash Price |
$7,233.60
|
| Rate for Payer: Cofinity Commercial |
$3,471.71
|
| Rate for Payer: Cofinity Commercial |
$3,230.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,410.91
|
| Rate for Payer: Healthscope Commercial |
$2,893.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,893.09
|
| Rate for Payer: Meridian Medicaid |
$1,635.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,531.46
|
| Rate for Payer: PACE SWMI |
$2,410.91
|
| Rate for Payer: PHP Medicare Advantage |
$2,410.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,557.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,329.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,095.49
|
| Rate for Payer: Priority Health Medicare |
$2,410.91
|
| Rate for Payer: Priority Health Narrow Network |
$4,095.49
|
| Rate for Payer: UHC Medicare Advantage |
$2,483.24
|
|
|
PR VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR EA SEG
|
Professional
|
Both
|
$3,100.00
|
|
|
Service Code
|
HCPCS 63088
|
| Min. Negotiated Rate |
$165.08 |
| Max. Negotiated Rate |
$2,170.00 |
| Rate for Payer: Aetna Commercial |
$345.76
|
| Rate for Payer: Aetna Medicare |
$258.03
|
| Rate for Payer: BCBS Complete |
$173.33
|
| Rate for Payer: BCBS MAPPO |
$258.03
|
| Rate for Payer: BCBS Trust/PPO |
$342.34
|
| Rate for Payer: BCN Commercial |
$375.79
|
| Rate for Payer: BCN Medicare Advantage |
$258.03
|
| Rate for Payer: Cash Price |
$2,480.00
|
| Rate for Payer: Cash Price |
$2,480.00
|
| Rate for Payer: Cofinity Commercial |
$371.56
|
| Rate for Payer: Cofinity Commercial |
$345.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$258.03
|
| Rate for Payer: Healthscope Commercial |
$309.64
|
| Rate for Payer: Healthscope Whirlpool |
$309.64
|
| Rate for Payer: Meridian Medicaid |
$173.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$270.93
|
| Rate for Payer: PACE SWMI |
$258.03
|
| Rate for Payer: PHP Medicare Advantage |
$258.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,170.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.42
|
| Rate for Payer: Priority Health Medicare |
$258.03
|
| Rate for Payer: Priority Health Narrow Network |
$435.42
|
| Rate for Payer: UHC Medicare Advantage |
$265.77
|
|
