|
PR TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 11103
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$23.78
|
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: BCBS Complete |
$14.54
|
| Rate for Payer: BCBS Trust/PPO |
$562.50
|
| Rate for Payer: BCN Commercial |
$59.29
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Meridian Medicaid |
$14.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.35
|
| Rate for Payer: Priority Health Narrow Network |
$29.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.59
|
| Rate for Payer: UHC Exchange |
$26.59
|
| Rate for Payer: UHCCP Medicaid |
$13.85
|
|
|
PR TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 11102
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$285.54 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Medicare |
$97.00
|
| Rate for Payer: BCBS Complete |
$25.05
|
| Rate for Payer: BCBS Trust/PPO |
$285.54
|
| Rate for Payer: BCN Commercial |
$119.76
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Meridian Medicaid |
$25.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.57
|
| Rate for Payer: Priority Health Narrow Network |
$50.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.94
|
| Rate for Payer: UHC Exchange |
$45.94
|
| Rate for Payer: UHCCP Medicaid |
$23.86
|
|
|
PR TAP BLOCK UNILATERAL BY INJECTION(S)
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 64486
|
| Min. Negotiated Rate |
$33.02 |
| Max. Negotiated Rate |
$164.20 |
| Rate for Payer: Aetna Commercial |
$72.82
|
| Rate for Payer: Aetna Medicare |
$57.00
|
| Rate for Payer: BCBS Complete |
$34.67
|
| Rate for Payer: BCBS Trust/PPO |
$92.98
|
| Rate for Payer: BCN Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Meridian Medicaid |
$34.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.70
|
| Rate for Payer: Priority Health Narrow Network |
$92.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.72
|
| Rate for Payer: UHC Exchange |
$79.72
|
| Rate for Payer: UHCCP Medicaid |
$33.02
|
|
|
PR TATTOOING INCL MICROPIGMENTATION 6.0 CM/<
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
HCPCS 11920
|
| Min. Negotiated Rate |
$73.27 |
| Max. Negotiated Rate |
$630.49 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Medicare |
$161.50
|
| Rate for Payer: BCBS Complete |
$76.93
|
| Rate for Payer: BCBS Trust/PPO |
$630.49
|
| Rate for Payer: BCN Commercial |
$281.97
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Meridian Medicaid |
$76.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.97
|
| Rate for Payer: Priority Health Narrow Network |
$153.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.84
|
| Rate for Payer: UHC Exchange |
$121.84
|
| Rate for Payer: UHCCP Medicaid |
$73.27
|
|
|
PR TATTOOING INCL MICROPIGMENTATION 6.1-20.0 CM
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 11921
|
| Min. Negotiated Rate |
$83.92 |
| Max. Negotiated Rate |
$2,064.94 |
| Rate for Payer: Aetna Commercial |
$140.70
|
| Rate for Payer: Aetna Medicare |
$186.00
|
| Rate for Payer: BCBS Complete |
$88.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,064.94
|
| Rate for Payer: BCN Commercial |
$327.90
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Meridian Medicaid |
$88.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.54
|
| Rate for Payer: Priority Health Narrow Network |
$176.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.21
|
| Rate for Payer: UHC Exchange |
$143.21
|
| Rate for Payer: UHCCP Medicaid |
$83.92
|
|
|
PR TATTOOING INCL MICROPIGMENTATION EA 20.0 CM
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 11922
|
| Min. Negotiated Rate |
$18.11 |
| Max. Negotiated Rate |
$89.43 |
| Rate for Payer: Aetna Commercial |
$31.98
|
| Rate for Payer: Aetna Medicare |
$60.50
|
| Rate for Payer: BCBS Complete |
$19.02
|
| Rate for Payer: BCBS Trust/PPO |
$62.82
|
| Rate for Payer: BCN Commercial |
$89.43
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Meridian Medicaid |
$19.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.83
|
| Rate for Payer: Priority Health Narrow Network |
$38.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.26
|
| Rate for Payer: UHC Exchange |
$32.26
|
| Rate for Payer: UHCCP Medicaid |
$18.11
|
|
|
PR TC99M DISOFENIN
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS A9510
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$1,959.99 |
| Rate for Payer: Aetna Commercial |
$67.20
|
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,959.99
|
| Rate for Payer: BCN Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.80
|
| Rate for Payer: UHC Exchange |
$79.80
|
|
|
PR TC99M MEBROFENIN
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS A9537
|
| Min. Negotiated Rate |
$53.10 |
| Max. Negotiated Rate |
$2,874.48 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Aetna Medicare |
$121.50
|
| Rate for Payer: BCBS Complete |
$97.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,874.48
|
| Rate for Payer: BCN Commercial |
$69.79
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.06
|
| Rate for Payer: UHC Exchange |
$63.06
|
|
|
PR TC99M MEDRONATE
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS A9503
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$1,603.92 |
| Rate for Payer: Aetna Commercial |
$12.48
|
| Rate for Payer: Aetna Medicare |
$46.00
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,603.92
|
| Rate for Payer: BCN Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.82
|
| Rate for Payer: UHC Exchange |
$14.82
|
|
|
PR TC99M PERTECHNETATE
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS A9512
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1,517.81 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.81
|
| Rate for Payer: BCN Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.90
|
| Rate for Payer: UHC Exchange |
$1.90
|
|
|
PR TC99M SESTAMIBI
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS A9500
|
| Min. Negotiated Rate |
$102.48 |
| Max. Negotiated Rate |
$1,830.03 |
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna Medicare |
$160.00
|
| Rate for Payer: BCBS Complete |
$128.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,830.03
|
| Rate for Payer: BCN Commercial |
$128.10
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$450.58
|
| Rate for Payer: UHC Exchange |
$450.58
|
|
|
PR TCATH STENT PLACEMT ANTEGRADE CAROTID/INNOMINATE
|
Professional
|
Both
|
$1,814.00
|
|
|
Service Code
|
HCPCS 37218
|
| Min. Negotiated Rate |
$520.36 |
| Max. Negotiated Rate |
$1,292.34 |
| Rate for Payer: Aetna Commercial |
$1,098.34
|
| Rate for Payer: Aetna Medicare |
$907.00
|
| Rate for Payer: BCBS Complete |
$546.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,155.92
|
| Rate for Payer: BCN Commercial |
$1,179.18
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Meridian Medicaid |
$546.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$520.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,179.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,292.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,292.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,110.49
|
| Rate for Payer: UHC Exchange |
$1,110.49
|
| Rate for Payer: UHCCP Medicaid |
$520.36
|
|
|
PR TCATH STENT PLACEMT RETROGRAD CAROTID/INNOMINATE
|
Professional
|
Both
|
$1,755.00
|
|
|
Service Code
|
HCPCS 37217
|
| Min. Negotiated Rate |
$677.34 |
| Max. Negotiated Rate |
$1,679.50 |
| Rate for Payer: Aetna Commercial |
$1,445.26
|
| Rate for Payer: Aetna Medicare |
$877.50
|
| Rate for Payer: BCBS Complete |
$711.21
|
| Rate for Payer: BCBS Trust/PPO |
$721.66
|
| Rate for Payer: BCN Commercial |
$1,545.19
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Meridian Medicaid |
$711.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$677.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,140.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,679.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,679.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,499.88
|
| Rate for Payer: UHC Exchange |
$1,499.88
|
| Rate for Payer: UHCCP Medicaid |
$677.34
|
|
|
PR TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR
|
Professional
|
Both
|
$687.00
|
|
|
Service Code
|
HCPCS 33289
|
| Min. Negotiated Rate |
$209.38 |
| Max. Negotiated Rate |
$1,657.81 |
| Rate for Payer: Aetna Commercial |
$447.42
|
| Rate for Payer: Aetna Medicare |
$343.50
|
| Rate for Payer: BCBS Complete |
$219.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,657.81
|
| Rate for Payer: BCN Commercial |
$476.95
|
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Meridian Medicaid |
$219.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$520.65
|
| Rate for Payer: Priority Health Narrow Network |
$520.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$439.31
|
| Rate for Payer: UHC Exchange |
$439.31
|
| Rate for Payer: UHCCP Medicaid |
$209.38
|
|
|
PR TCAT INSJ/RPL PERM LEADLESS PACEMAKER RV W/IMG
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
HCPCS 33274
|
| Min. Negotiated Rate |
$300.54 |
| Max. Negotiated Rate |
$1,157.51 |
| Rate for Payer: Aetna Commercial |
$648.93
|
| Rate for Payer: Aetna Medicare |
$510.00
|
| Rate for Payer: BCBS Complete |
$315.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,157.51
|
| Rate for Payer: BCN Commercial |
$692.95
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Meridian Medicaid |
$315.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$300.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.81
|
| Rate for Payer: Priority Health Narrow Network |
$748.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$653.83
|
| Rate for Payer: UHC Exchange |
$653.83
|
| Rate for Payer: UHCCP Medicaid |
$300.54
|
|
|
PR TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ
|
Professional
|
Both
|
$2,110.00
|
|
|
Service Code
|
HCPCS 37215
|
| Min. Negotiated Rate |
$617.91 |
| Max. Negotiated Rate |
$1,544.42 |
| Rate for Payer: Aetna Commercial |
$1,335.45
|
| Rate for Payer: Aetna Medicare |
$1,055.00
|
| Rate for Payer: BCBS Complete |
$648.81
|
| Rate for Payer: BCBS Trust/PPO |
$967.85
|
| Rate for Payer: BCN Commercial |
$1,417.66
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Meridian Medicaid |
$648.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$617.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,544.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,544.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,478.94
|
| Rate for Payer: UHC Exchange |
$1,478.94
|
| Rate for Payer: UHCCP Medicaid |
$617.91
|
|
|
PR TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ
|
Professional
|
Both
|
$4,184.00
|
|
|
Service Code
|
HCPCS 37216
|
| Min. Negotiated Rate |
$471.24 |
| Max. Negotiated Rate |
$2,719.60 |
| Rate for Payer: Aetna Commercial |
$1,302.62
|
| Rate for Payer: Aetna Medicare |
$2,092.00
|
| Rate for Payer: BCBS Complete |
$1,673.60
|
| Rate for Payer: BCBS Trust/PPO |
$471.24
|
| Rate for Payer: BCN Commercial |
$1,417.16
|
| Rate for Payer: Cash Price |
$3,347.20
|
| Rate for Payer: Cash Price |
$3,347.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,719.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,551.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,551.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,291.25
|
| Rate for Payer: UHC Exchange |
$1,291.25
|
|
|
PR TCAT MITRAL VALVE REPAIR INITIAL PROSTHESIS
|
Professional
|
Both
|
$3,759.00
|
|
|
Service Code
|
HCPCS 33418
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$2,810.16 |
| Rate for Payer: Aetna Commercial |
$2,411.52
|
| Rate for Payer: Aetna Medicare |
$1,879.50
|
| Rate for Payer: BCBS Complete |
$1,183.78
|
| Rate for Payer: BCBS Trust/PPO |
$308.00
|
| Rate for Payer: BCN Commercial |
$2,567.02
|
| Rate for Payer: Cash Price |
$3,007.20
|
| Rate for Payer: Cash Price |
$3,007.20
|
| Rate for Payer: Meridian Medicaid |
$1,183.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,127.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,443.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,810.16
|
| Rate for Payer: Priority Health Narrow Network |
$2,810.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,490.25
|
| Rate for Payer: UHC Exchange |
$2,490.25
|
| Rate for Payer: UHCCP Medicaid |
$1,127.41
|
|
|
PR TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS
|
Professional
|
Both
|
$4,624.00
|
|
|
Service Code
|
HCPCS 61624
|
| Min. Negotiated Rate |
$113.06 |
| Max. Negotiated Rate |
$3,005.60 |
| Rate for Payer: Aetna Commercial |
$1,488.12
|
| Rate for Payer: Aetna Medicare |
$2,312.00
|
| Rate for Payer: BCBS Complete |
$782.55
|
| Rate for Payer: BCBS Trust/PPO |
$113.06
|
| Rate for Payer: BCN Commercial |
$2,342.26
|
| Rate for Payer: Cash Price |
$3,699.20
|
| Rate for Payer: Cash Price |
$3,699.20
|
| Rate for Payer: Meridian Medicaid |
$782.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,005.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,977.43
|
| Rate for Payer: Priority Health Narrow Network |
$1,977.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,350.34
|
| Rate for Payer: UHC Exchange |
$1,350.34
|
| Rate for Payer: UHCCP Medicaid |
$745.29
|
|
|
PR TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS
|
Professional
|
Both
|
$1,849.00
|
|
|
Service Code
|
HCPCS 61626
|
| Min. Negotiated Rate |
$73.96 |
| Max. Negotiated Rate |
$1,532.69 |
| Rate for Payer: Aetna Commercial |
$1,145.58
|
| Rate for Payer: Aetna Medicare |
$924.50
|
| Rate for Payer: BCBS Complete |
$606.98
|
| Rate for Payer: BCBS Trust/PPO |
$73.96
|
| Rate for Payer: BCN Commercial |
$1,301.35
|
| Rate for Payer: Cash Price |
$1,479.20
|
| Rate for Payer: Cash Price |
$1,479.20
|
| Rate for Payer: Meridian Medicaid |
$606.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$578.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,201.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,532.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,532.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,071.10
|
| Rate for Payer: UHC Exchange |
$1,071.10
|
| Rate for Payer: UHCCP Medicaid |
$578.08
|
|
|
PR TCAT PLMT IV STENT ICRA W/BALO ANGIOP IF PFRMD
|
Professional
|
Both
|
$6,793.00
|
|
|
Service Code
|
HCPCS 61635
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$4,415.45 |
| Rate for Payer: Aetna Commercial |
$1,871.57
|
| Rate for Payer: Aetna Medicare |
$3,396.50
|
| Rate for Payer: BCBS Complete |
$2,717.20
|
| Rate for Payer: BCBS Trust/PPO |
$63.40
|
| Rate for Payer: BCN Commercial |
$2,155.07
|
| Rate for Payer: Cash Price |
$5,434.40
|
| Rate for Payer: Cash Price |
$5,434.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,415.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,527.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,527.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,666.68
|
| Rate for Payer: UHC Exchange |
$1,666.68
|
|
|
PR TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL
|
Professional
|
Both
|
$9,873.00
|
|
|
Service Code
|
HCPCS 0075T
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$7,288.01 |
| Rate for Payer: Aetna Commercial |
$1,381.29
|
| Rate for Payer: Aetna Medicare |
$4,936.50
|
| Rate for Payer: BCBS Complete |
$3,949.20
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$6,440.29
|
| Rate for Payer: Cash Price |
$7,898.40
|
| Rate for Payer: Cash Price |
$7,898.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,417.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,200.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,200.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,288.01
|
| Rate for Payer: UHC Exchange |
$7,288.01
|
|
|
PR TCAT REMOVAL PERM LEADLESS PM RIGHT VENTR W/IMG
|
Professional
|
Both
|
$1,729.00
|
|
|
Service Code
|
HCPCS 33275
|
| Min. Negotiated Rate |
$317.80 |
| Max. Negotiated Rate |
$1,123.85 |
| Rate for Payer: Aetna Commercial |
$704.22
|
| Rate for Payer: Aetna Medicare |
$864.50
|
| Rate for Payer: BCBS Complete |
$333.69
|
| Rate for Payer: BCN Commercial |
$722.76
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Meridian Medicaid |
$333.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$317.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,123.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$791.36
|
| Rate for Payer: Priority Health Narrow Network |
$791.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$695.90
|
| Rate for Payer: UHC Exchange |
$695.90
|
| Rate for Payer: UHCCP Medicaid |
$317.80
|
|
|
PR TCD STD ICR ART VEN-ARTL SHNT DETCJ IV MBUBB NJX
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 93893
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$578.11 |
| Rate for Payer: Aetna Commercial |
$176.86
|
| Rate for Payer: Aetna Medicare |
$337.50
|
| Rate for Payer: BCBS Complete |
$39.14
|
| Rate for Payer: BCBS Trust/PPO |
$346.04
|
| Rate for Payer: BCN Commercial |
$578.11
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Meridian Medicaid |
$39.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.61
|
| Rate for Payer: Priority Health Narrow Network |
$79.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$301.75
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHCCP Medicaid |
$37.28
|
|
|
PR TDAP VACCINE 7 YRS/> IM
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 90715
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$57.22 |
| Rate for Payer: Aetna Commercial |
$38.31
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Trust/PPO |
$40.48
|
| Rate for Payer: BCN Commercial |
$42.12
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.22
|
| Rate for Payer: UHC Exchange |
$57.22
|
|
