|
PR RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR
|
Professional
|
Both
|
$1,678.00
|
|
|
Service Code
|
HCPCS 33234
|
| Min. Negotiated Rate |
$305.44 |
| Max. Negotiated Rate |
$1,090.70 |
| Rate for Payer: Aetna Commercial |
$652.14
|
| Rate for Payer: Aetna Medicare |
$839.00
|
| Rate for Payer: BCBS Complete |
$320.71
|
| Rate for Payer: BCN Commercial |
$700.27
|
| Rate for Payer: Cash Price |
$1,342.40
|
| Rate for Payer: Cash Price |
$1,342.40
|
| Rate for Payer: Meridian Medicaid |
$320.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$759.45
|
| Rate for Payer: Priority Health Narrow Network |
$759.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$651.95
|
| Rate for Payer: UHC Exchange |
$651.95
|
| Rate for Payer: UHCCP Medicaid |
$305.44
|
|
|
PR RMVL TRANSVNS PM ELTRD DUAL LEAD SYS
|
Professional
|
Both
|
$1,327.00
|
|
|
Service Code
|
HCPCS 33235
|
| Min. Negotiated Rate |
$401.29 |
| Max. Negotiated Rate |
$1,206.11 |
| Rate for Payer: Aetna Commercial |
$854.53
|
| Rate for Payer: Aetna Medicare |
$663.50
|
| Rate for Payer: BCBS Complete |
$421.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,206.11
|
| Rate for Payer: BCN Commercial |
$921.64
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Meridian Medicaid |
$421.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$401.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$998.24
|
| Rate for Payer: Priority Health Narrow Network |
$998.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.04
|
| Rate for Payer: UHC Exchange |
$849.04
|
| Rate for Payer: UHCCP Medicaid |
$401.29
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Facility
|
IP
|
$716.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$716.00 |
| Rate for Payer: Aetna Commercial |
$644.40
|
| Rate for Payer: ASR ASR |
$694.52
|
| Rate for Payer: ASR Commercial |
$694.52
|
| Rate for Payer: BCBS Trust/PPO |
$583.47
|
| Rate for Payer: BCN Commercial |
$555.11
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$673.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.80
|
| Rate for Payer: Healthscope Commercial |
$716.00
|
| Rate for Payer: Healthscope Whirlpool |
$694.52
|
| Rate for Payer: Mclaren Commercial |
$644.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$608.60
|
| Rate for Payer: Nomi Health Commercial |
$587.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$630.08
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
36590
|
| Min. Negotiated Rate |
$120.35 |
| Max. Negotiated Rate |
$1,132.68 |
| Rate for Payer: Aetna Commercial |
$252.86
|
| Rate for Payer: Aetna Medicare |
$358.00
|
| Rate for Payer: BCBS Complete |
$126.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,132.68
|
| Rate for Payer: BCN Commercial |
$325.95
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Meridian Medicaid |
$126.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.89
|
| Rate for Payer: Priority Health Narrow Network |
$298.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.40
|
| Rate for Payer: UHC Exchange |
$255.40
|
| Rate for Payer: UHCCP Medicaid |
$120.35
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 36590
|
| Min. Negotiated Rate |
$120.35 |
| Max. Negotiated Rate |
$1,132.68 |
| Rate for Payer: Aetna Commercial |
$252.86
|
| Rate for Payer: Aetna Medicare |
$358.00
|
| Rate for Payer: BCBS Complete |
$126.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,132.68
|
| Rate for Payer: BCN Commercial |
$325.95
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Meridian Medicaid |
$126.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.89
|
| Rate for Payer: Priority Health Narrow Network |
$298.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.40
|
| Rate for Payer: UHC Exchange |
$255.40
|
| Rate for Payer: UHCCP Medicaid |
$120.35
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Facility
|
OP
|
$716.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$2,359.15 |
| Rate for Payer: Aetna Commercial |
$644.40
|
| Rate for Payer: Aetna Medicare |
$1,522.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,902.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,902.54
|
| Rate for Payer: ASR ASR |
$694.52
|
| Rate for Payer: ASR Commercial |
$694.52
|
| Rate for Payer: BCBS Complete |
$856.60
|
| Rate for Payer: BCBS MAPPO |
$1,522.03
|
| Rate for Payer: BCBS Trust/PPO |
$586.33
|
| Rate for Payer: BCN Commercial |
$555.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,522.03
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$673.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,522.03
|
| Rate for Payer: Healthscope Commercial |
$716.00
|
| Rate for Payer: Healthscope Whirlpool |
$694.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,522.03
|
| Rate for Payer: Mclaren Commercial |
$644.40
|
| Rate for Payer: Mclaren Medicaid |
$815.81
|
| Rate for Payer: Mclaren Medicare |
$1,522.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,598.13
|
| Rate for Payer: Meridian Medicaid |
$856.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,750.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$608.60
|
| Rate for Payer: Nomi Health Commercial |
$587.12
|
| Rate for Payer: PACE Medicare |
$1,445.93
|
| Rate for Payer: PACE SWMI |
$1,522.03
|
| Rate for Payer: PHP Commercial |
$1,674.23
|
| Rate for Payer: PHP Medicaid |
$815.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,522.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$815.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$627.36
|
| Rate for Payer: Priority Health Medicare |
$1,522.03
|
| Rate for Payer: Priority Health Narrow Network |
$501.92
|
| Rate for Payer: Railroad Medicare Medicare |
$1,522.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$630.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,522.03
|
| Rate for Payer: UHC Exchange |
$2,359.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,522.03
|
| Rate for Payer: UHCCP DNSP |
$1,522.03
|
| Rate for Payer: UHCCP Medicaid |
$815.81
|
| Rate for Payer: VA VA |
$1,522.03
|
|
|
PR RMVL TUN CVC W/O SUBQ PORT/PMP
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
36589
|
| Min. Negotiated Rate |
$278.85 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Aetna Commercial |
$386.10
|
| Rate for Payer: ASR ASR |
$416.13
|
| Rate for Payer: ASR Commercial |
$416.13
|
| Rate for Payer: BCBS Trust/PPO |
$349.59
|
| Rate for Payer: BCN Commercial |
$332.60
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cofinity Commercial |
$403.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.20
|
| Rate for Payer: Healthscope Commercial |
$429.00
|
| Rate for Payer: Healthscope Whirlpool |
$416.13
|
| Rate for Payer: Mclaren Commercial |
$386.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.65
|
| Rate for Payer: Nomi Health Commercial |
$351.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.52
|
|
|
PR RMVL TUN CVC W/O SUBQ PORT/PMP
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
36589
|
| Min. Negotiated Rate |
$278.85 |
| Max. Negotiated Rate |
$938.93 |
| Rate for Payer: Aetna Commercial |
$386.10
|
| Rate for Payer: Aetna Medicare |
$605.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$757.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$757.20
|
| Rate for Payer: ASR ASR |
$416.13
|
| Rate for Payer: ASR Commercial |
$416.13
|
| Rate for Payer: BCBS Complete |
$340.92
|
| Rate for Payer: BCBS MAPPO |
$605.76
|
| Rate for Payer: BCBS Trust/PPO |
$351.31
|
| Rate for Payer: BCN Commercial |
$332.60
|
| Rate for Payer: BCN Medicare Advantage |
$605.76
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cofinity Commercial |
$403.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$605.76
|
| Rate for Payer: Healthscope Commercial |
$429.00
|
| Rate for Payer: Healthscope Whirlpool |
$416.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$605.76
|
| Rate for Payer: Mclaren Commercial |
$386.10
|
| Rate for Payer: Mclaren Medicaid |
$324.69
|
| Rate for Payer: Mclaren Medicare |
$605.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$636.05
|
| Rate for Payer: Meridian Medicaid |
$340.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$696.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.65
|
| Rate for Payer: Nomi Health Commercial |
$351.78
|
| Rate for Payer: PACE Medicare |
$575.47
|
| Rate for Payer: PACE SWMI |
$605.76
|
| Rate for Payer: PHP Commercial |
$666.34
|
| Rate for Payer: PHP Medicaid |
$324.69
|
| Rate for Payer: PHP Medicare Advantage |
$605.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$324.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.89
|
| Rate for Payer: Priority Health Medicare |
$605.76
|
| Rate for Payer: Priority Health Narrow Network |
$300.73
|
| Rate for Payer: Railroad Medicare Medicare |
$605.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.76
|
| Rate for Payer: UHC Exchange |
$938.93
|
| Rate for Payer: UHC Medicare Advantage |
$605.76
|
| Rate for Payer: UHCCP DNSP |
$605.76
|
| Rate for Payer: UHCCP Medicaid |
$324.69
|
| Rate for Payer: VA VA |
$605.76
|
|
|
PR RMVL TUN CVC W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 36589
|
| Min. Negotiated Rate |
$86.48 |
| Max. Negotiated Rate |
$1,048.15 |
| Rate for Payer: Aetna Commercial |
$183.56
|
| Rate for Payer: Aetna Medicare |
$214.50
|
| Rate for Payer: BCBS Complete |
$90.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,048.15
|
| Rate for Payer: BCN Commercial |
$240.92
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Meridian Medicaid |
$90.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.33
|
| Rate for Payer: Priority Health Narrow Network |
$214.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$177.98
|
| Rate for Payer: UHC Exchange |
$177.98
|
| Rate for Payer: UHCCP Medicaid |
$86.48
|
|
|
PR RMVL TUN CVC W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
36589
|
| Min. Negotiated Rate |
$86.48 |
| Max. Negotiated Rate |
$1,048.15 |
| Rate for Payer: Aetna Commercial |
$183.56
|
| Rate for Payer: Aetna Medicare |
$214.50
|
| Rate for Payer: BCBS Complete |
$90.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,048.15
|
| Rate for Payer: BCN Commercial |
$240.92
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Meridian Medicaid |
$90.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.33
|
| Rate for Payer: Priority Health Narrow Network |
$214.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$177.98
|
| Rate for Payer: UHC Exchange |
$177.98
|
| Rate for Payer: UHCCP Medicaid |
$86.48
|
|
|
PR RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS 11983
|
| Min. Negotiated Rate |
$66.03 |
| Max. Negotiated Rate |
$532.50 |
| Rate for Payer: Aetna Commercial |
$113.66
|
| Rate for Payer: Aetna Medicare |
$201.00
|
| Rate for Payer: BCBS Complete |
$69.33
|
| Rate for Payer: BCBS Trust/PPO |
$532.50
|
| Rate for Payer: BCN Commercial |
$208.18
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Meridian Medicaid |
$69.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.07
|
| Rate for Payer: Priority Health Narrow Network |
$139.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.11
|
| Rate for Payer: UHC Exchange |
$199.11
|
| Rate for Payer: UHCCP Medicaid |
$66.03
|
|
|
PR RNL NDSC NFROT/PLOT W/ENDOPYELOTOMY
|
Professional
|
Both
|
$1,386.00
|
|
|
Service Code
|
HCPCS 50575
|
| Min. Negotiated Rate |
$449.64 |
| Max. Negotiated Rate |
$1,116.86 |
| Rate for Payer: Aetna Commercial |
$915.90
|
| Rate for Payer: Aetna Medicare |
$693.00
|
| Rate for Payer: BCBS Complete |
$472.12
|
| Rate for Payer: BCBS Trust/PPO |
$838.41
|
| Rate for Payer: BCN Commercial |
$1,016.45
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Meridian Medicaid |
$472.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$449.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$900.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,116.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,116.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$875.29
|
| Rate for Payer: UHC Exchange |
$875.29
|
| Rate for Payer: UHCCP Medicaid |
$449.64
|
|
|
PR ROBOTIC SURGICAL SYSTEM
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS S2900
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$486.56 |
| Rate for Payer: Aetna Commercial |
$318.14
|
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS Trust/PPO |
$486.56
|
| Rate for Payer: BCN Commercial |
$50.51
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
|
|
PR ROM MEAS&REPRT HAND W/WO COMPARISON NORMAL SID
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 95852
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$1,012.22 |
| Rate for Payer: Aetna Commercial |
$6.11
|
| Rate for Payer: Aetna Medicare |
$40.00
|
| Rate for Payer: BCBS Complete |
$3.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,012.22
|
| Rate for Payer: BCN Commercial |
$25.41
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Meridian Medicaid |
$3.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.24
|
| Rate for Payer: Priority Health Narrow Network |
$7.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.16
|
| Rate for Payer: UHC Exchange |
$6.16
|
| Rate for Payer: UHCCP Medicaid |
$3.62
|
|
|
PR ROPRTJ > 1 MO AFTER ORIGINAL OPRATION
|
Professional
|
Both
|
$578.00
|
|
|
Service Code
|
HCPCS 35700
|
| Min. Negotiated Rate |
$94.36 |
| Max. Negotiated Rate |
$1,875.47 |
| Rate for Payer: Aetna Commercial |
$205.39
|
| Rate for Payer: Aetna Medicare |
$289.00
|
| Rate for Payer: BCBS Complete |
$99.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,875.47
|
| Rate for Payer: BCN Commercial |
$215.51
|
| Rate for Payer: Cash Price |
$462.40
|
| Rate for Payer: Cash Price |
$462.40
|
| Rate for Payer: Meridian Medicaid |
$99.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.07
|
| Rate for Payer: Priority Health Narrow Network |
$235.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.26
|
| Rate for Payer: UHC Exchange |
$208.26
|
| Rate for Payer: UHCCP Medicaid |
$94.36
|
|
|
PR ROPRTJ CAB/VALVE PX > 1 MO AFTER ORIGINAL OPERJ
|
Professional
|
Both
|
$1,703.00
|
|
|
Service Code
|
HCPCS 33530
|
| Min. Negotiated Rate |
$327.17 |
| Max. Negotiated Rate |
$1,106.95 |
| Rate for Payer: Aetna Commercial |
$707.24
|
| Rate for Payer: Aetna Medicare |
$851.50
|
| Rate for Payer: BCBS Complete |
$343.53
|
| Rate for Payer: BCBS Trust/PPO |
$357.13
|
| Rate for Payer: BCN Commercial |
$748.66
|
| Rate for Payer: Cash Price |
$1,362.40
|
| Rate for Payer: Cash Price |
$1,362.40
|
| Rate for Payer: Meridian Medicaid |
$343.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$327.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,106.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$814.75
|
| Rate for Payer: Priority Health Narrow Network |
$814.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$692.33
|
| Rate for Payer: UHC Exchange |
$692.33
|
| Rate for Payer: UHCCP Medicaid |
$327.17
|
|
|
PR ROPRTJ CRTD TEAEC > 1 MO AFTER ORIGINAL OPRATIO
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 35390
|
| Min. Negotiated Rate |
$99.26 |
| Max. Negotiated Rate |
$601.21 |
| Rate for Payer: Aetna Commercial |
$214.00
|
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: BCBS Complete |
$104.22
|
| Rate for Payer: BCBS Trust/PPO |
$601.21
|
| Rate for Payer: BCN Commercial |
$225.76
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Meridian Medicaid |
$104.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$246.23
|
| Rate for Payer: Priority Health Narrow Network |
$246.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.55
|
| Rate for Payer: UHC Exchange |
$216.55
|
| Rate for Payer: UHCCP Medicaid |
$99.26
|
|
|
PR ROUT FOOT CARE PER VISIT
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS S0390
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$31.70 |
| Rate for Payer: Aetna Commercial |
$25.38
|
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$31.70
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
|
|
PR ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB
|
Professional
|
Both
|
$4,028.00
|
|
|
Service Code
|
HCPCS 59610
|
| Min. Negotiated Rate |
$92.98 |
| Max. Negotiated Rate |
$3,564.47 |
| Rate for Payer: Aetna Commercial |
$2,150.00
|
| Rate for Payer: Aetna Medicare |
$2,014.00
|
| Rate for Payer: BCBS Complete |
$2,452.58
|
| Rate for Payer: BCBS Trust/PPO |
$92.98
|
| Rate for Payer: BCN Commercial |
$3,361.90
|
| Rate for Payer: Cash Price |
$3,222.40
|
| Rate for Payer: Cash Price |
$3,222.40
|
| Rate for Payer: Meridian Medicaid |
$2,452.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,335.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,618.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,564.47
|
| Rate for Payer: Priority Health Narrow Network |
$3,564.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,257.16
|
| Rate for Payer: UHC Exchange |
$2,257.16
|
| Rate for Payer: UHCCP Medicaid |
$2,335.79
|
|
|
PR ROUTINE OBSTETRICAL CARE ATTEMPTED VBAC
|
Professional
|
Both
|
$4,323.00
|
|
|
Service Code
|
HCPCS 59618
|
| Min. Negotiated Rate |
$209.74 |
| Max. Negotiated Rate |
$3,821.11 |
| Rate for Payer: Aetna Commercial |
$2,150.00
|
| Rate for Payer: Aetna Medicare |
$2,161.50
|
| Rate for Payer: BCBS Complete |
$2,628.76
|
| Rate for Payer: BCBS Trust/PPO |
$209.74
|
| Rate for Payer: BCN Commercial |
$3,361.90
|
| Rate for Payer: Cash Price |
$3,458.40
|
| Rate for Payer: Cash Price |
$3,458.40
|
| Rate for Payer: Meridian Medicaid |
$2,628.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,503.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,809.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,821.11
|
| Rate for Payer: Priority Health Narrow Network |
$3,821.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,536.86
|
| Rate for Payer: UHC Exchange |
$2,536.86
|
| Rate for Payer: UHCCP Medicaid |
$2,503.58
|
|
|
PR RPLCMT ALL/PART URETER INTESTINE SGM W/ANAST
|
Professional
|
Both
|
$2,539.00
|
|
|
Service Code
|
HCPCS 50840
|
| Min. Negotiated Rate |
$785.76 |
| Max. Negotiated Rate |
$4,261.27 |
| Rate for Payer: Aetna Commercial |
$1,579.43
|
| Rate for Payer: Aetna Medicare |
$1,269.50
|
| Rate for Payer: BCBS Complete |
$825.05
|
| Rate for Payer: BCBS Trust/PPO |
$4,261.27
|
| Rate for Payer: BCN Commercial |
$1,769.99
|
| Rate for Payer: Cash Price |
$2,031.20
|
| Rate for Payer: Cash Price |
$2,031.20
|
| Rate for Payer: Meridian Medicaid |
$825.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$785.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,650.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,950.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,950.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,483.44
|
| Rate for Payer: UHC Exchange |
$1,483.44
|
| Rate for Payer: UHCCP Medicaid |
$785.76
|
|
|
PR RPLCMT AORTIC VALVE ANNULUS ENLGMENT NONC SINUS
|
Professional
|
Both
|
$9,690.00
|
|
|
Service Code
|
HCPCS 33411
|
| Min. Negotiated Rate |
$995.85 |
| Max. Negotiated Rate |
$6,298.50 |
| Rate for Payer: Aetna Commercial |
$4,508.90
|
| Rate for Payer: Aetna Medicare |
$4,845.00
|
| Rate for Payer: BCBS Complete |
$2,207.88
|
| Rate for Payer: BCBS Trust/PPO |
$995.85
|
| Rate for Payer: BCN Commercial |
$4,794.41
|
| Rate for Payer: Cash Price |
$7,752.00
|
| Rate for Payer: Cash Price |
$7,752.00
|
| Rate for Payer: Meridian Medicaid |
$2,207.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,102.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,298.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,233.15
|
| Rate for Payer: Priority Health Narrow Network |
$5,233.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,408.33
|
| Rate for Payer: UHC Exchange |
$4,408.33
|
| Rate for Payer: UHCCP Medicaid |
$2,102.74
|
|
|
PR RPLCMT AORTIC VALVE OPN ALLOGRAFT VALVE FREEHAND
|
Professional
|
Both
|
$6,847.00
|
|
|
Service Code
|
HCPCS 33406
|
| Min. Negotiated Rate |
$820.45 |
| Max. Negotiated Rate |
$4,510.40 |
| Rate for Payer: Aetna Commercial |
$3,869.40
|
| Rate for Payer: Aetna Medicare |
$3,423.50
|
| Rate for Payer: BCBS Complete |
$1,901.70
|
| Rate for Payer: BCBS Trust/PPO |
$820.45
|
| Rate for Payer: BCN Commercial |
$4,128.35
|
| Rate for Payer: Cash Price |
$5,477.60
|
| Rate for Payer: Cash Price |
$5,477.60
|
| Rate for Payer: Meridian Medicaid |
$1,901.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,450.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,510.40
|
| Rate for Payer: Priority Health Narrow Network |
$4,510.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,789.30
|
| Rate for Payer: UHC Exchange |
$3,789.30
|
| Rate for Payer: UHCCP Medicaid |
$1,811.14
|
|
|
PR RPLCMT AORTIC VALVE OPN W/STENTLESS TISSUE VALVE
|
Professional
|
Both
|
$8,127.00
|
|
|
Service Code
|
HCPCS 33410
|
| Min. Negotiated Rate |
$920.83 |
| Max. Negotiated Rate |
$5,282.55 |
| Rate for Payer: Aetna Commercial |
$3,414.07
|
| Rate for Payer: Aetna Medicare |
$4,063.50
|
| Rate for Payer: BCBS Complete |
$1,679.61
|
| Rate for Payer: BCBS Trust/PPO |
$920.83
|
| Rate for Payer: BCN Commercial |
$3,639.18
|
| Rate for Payer: Cash Price |
$6,501.60
|
| Rate for Payer: Cash Price |
$6,501.60
|
| Rate for Payer: Meridian Medicaid |
$1,679.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,599.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,282.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,971.67
|
| Rate for Payer: Priority Health Narrow Network |
$3,971.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,346.91
|
| Rate for Payer: UHC Exchange |
$3,346.91
|
| Rate for Payer: UHCCP Medicaid |
$1,599.63
|
|
|
PR RPLCMT BONE FLAP/PROSTHETIC PLATE SKULL
|
Professional
|
Both
|
$5,033.00
|
|
|
Service Code
|
HCPCS 62143
|
| Min. Negotiated Rate |
$685.22 |
| Max. Negotiated Rate |
$3,271.45 |
| Rate for Payer: Aetna Commercial |
$1,349.48
|
| Rate for Payer: Aetna Medicare |
$2,516.50
|
| Rate for Payer: BCBS Complete |
$719.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,064.60
|
| Rate for Payer: BCN Commercial |
$2,147.01
|
| Rate for Payer: Cash Price |
$4,026.40
|
| Rate for Payer: Cash Price |
$4,026.40
|
| Rate for Payer: Meridian Medicaid |
$719.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$685.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,271.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,815.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,815.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,188.95
|
| Rate for Payer: UHC Exchange |
$1,188.95
|
| Rate for Payer: UHCCP Medicaid |
$685.22
|
|
