|
PR TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN
|
Professional
|
Both
|
$2,633.00
|
|
|
Service Code
|
HCPCS 25310
|
| Min. Negotiated Rate |
$467.54 |
| Max. Negotiated Rate |
$1,711.45 |
| Rate for Payer: Aetna Commercial |
$826.01
|
| Rate for Payer: Aetna Medicare |
$1,316.50
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS Trust/PPO |
$791.39
|
| Rate for Payer: BCN Commercial |
$919.20
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,711.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$966.33
|
| Rate for Payer: Priority Health Narrow Network |
$966.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$744.80
|
| Rate for Payer: UHC Exchange |
$744.80
|
| Rate for Payer: UHCCP Medicaid |
$467.54
|
|
|
PR TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1/TDN GR
|
Professional
|
Both
|
$1,583.00
|
|
|
Service Code
|
HCPCS 25312
|
| Min. Negotiated Rate |
$226.11 |
| Max. Negotiated Rate |
$1,111.35 |
| Rate for Payer: Aetna Commercial |
$951.85
|
| Rate for Payer: Aetna Medicare |
$791.50
|
| Rate for Payer: BCBS Complete |
$493.82
|
| Rate for Payer: BCBS Trust/PPO |
$226.11
|
| Rate for Payer: BCN Commercial |
$1,058.97
|
| Rate for Payer: Cash Price |
$1,266.40
|
| Rate for Payer: Cash Price |
$1,266.40
|
| Rate for Payer: Meridian Medicaid |
$493.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$470.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,028.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,111.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,111.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$868.03
|
| Rate for Payer: UHC Exchange |
$868.03
|
| Rate for Payer: UHCCP Medicaid |
$470.30
|
|
|
PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 90714
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$44.52 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Trust/PPO |
$35.19
|
| Rate for Payer: BCN Commercial |
$32.99
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.52
|
| Rate for Payer: UHC Exchange |
$44.52
|
|
|
PR TEAEC W/GRAFT EA ADDL TIBIAL/PERONEAL ART
|
Professional
|
Both
|
$942.00
|
|
|
Service Code
|
HCPCS 35306
|
| Min. Negotiated Rate |
$277.11 |
| Max. Negotiated Rate |
$991.62 |
| Rate for Payer: Aetna Commercial |
$600.76
|
| Rate for Payer: Aetna Medicare |
$471.00
|
| Rate for Payer: BCBS Complete |
$290.97
|
| Rate for Payer: BCBS Trust/PPO |
$991.62
|
| Rate for Payer: BCN Commercial |
$633.82
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Meridian Medicaid |
$290.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$689.78
|
| Rate for Payer: Priority Health Narrow Network |
$689.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$616.23
|
| Rate for Payer: UHC Exchange |
$616.23
|
| Rate for Payer: UHCCP Medicaid |
$277.11
|
|
|
PR TEAEC W/GRAFT POPLITEAL ARTERY
|
Professional
|
Both
|
$2,387.00
|
|
|
Service Code
|
HCPCS 35303
|
| Min. Negotiated Rate |
$765.52 |
| Max. Negotiated Rate |
$1,908.19 |
| Rate for Payer: Aetna Commercial |
$1,662.68
|
| Rate for Payer: Aetna Medicare |
$1,193.50
|
| Rate for Payer: BCBS Complete |
$803.80
|
| Rate for Payer: BCBS Trust/PPO |
$903.39
|
| Rate for Payer: BCN Commercial |
$1,765.10
|
| Rate for Payer: Cash Price |
$1,909.60
|
| Rate for Payer: Cash Price |
$1,909.60
|
| Rate for Payer: Meridian Medicaid |
$803.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$765.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,551.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,908.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,908.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,656.26
|
| Rate for Payer: UHC Exchange |
$1,656.26
|
| Rate for Payer: UHCCP Medicaid |
$765.52
|
|
|
PR TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY
|
Professional
|
Both
|
$2,192.00
|
|
|
Service Code
|
HCPCS 35302
|
| Min. Negotiated Rate |
$655.62 |
| Max. Negotiated Rate |
$1,740.66 |
| Rate for Payer: Aetna Commercial |
$1,506.99
|
| Rate for Payer: Aetna Medicare |
$1,096.00
|
| Rate for Payer: BCBS Complete |
$731.56
|
| Rate for Payer: BCBS Trust/PPO |
$655.62
|
| Rate for Payer: BCN Commercial |
$1,596.99
|
| Rate for Payer: Cash Price |
$1,753.60
|
| Rate for Payer: Cash Price |
$1,753.60
|
| Rate for Payer: Meridian Medicaid |
$731.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$696.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,424.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,740.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,740.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,504.39
|
| Rate for Payer: UHC Exchange |
$1,504.39
|
| Rate for Payer: UHCCP Medicaid |
$696.72
|
|
|
PR TEAEC W/GRAFT TIBIAL/PERONEAL ART 1ST VESSEL
|
Professional
|
Both
|
$2,411.00
|
|
|
Service Code
|
HCPCS 35305
|
| Min. Negotiated Rate |
$501.36 |
| Max. Negotiated Rate |
$1,910.85 |
| Rate for Payer: Aetna Commercial |
$1,655.42
|
| Rate for Payer: Aetna Medicare |
$1,205.50
|
| Rate for Payer: BCBS Complete |
$801.56
|
| Rate for Payer: BCBS Trust/PPO |
$501.36
|
| Rate for Payer: BCN Commercial |
$1,744.58
|
| Rate for Payer: Cash Price |
$1,928.80
|
| Rate for Payer: Cash Price |
$1,928.80
|
| Rate for Payer: Meridian Medicaid |
$801.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$763.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,567.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,910.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,910.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,654.50
|
| Rate for Payer: UHC Exchange |
$1,654.50
|
| Rate for Payer: UHCCP Medicaid |
$763.39
|
|
|
PR TEAEC W/GRAFT TIBIOPERONEAL TRUNK ARTERY
|
Professional
|
Both
|
$2,509.00
|
|
|
Service Code
|
HCPCS 35304
|
| Min. Negotiated Rate |
$795.56 |
| Max. Negotiated Rate |
$1,986.37 |
| Rate for Payer: Aetna Commercial |
$1,711.17
|
| Rate for Payer: Aetna Medicare |
$1,254.50
|
| Rate for Payer: BCBS Complete |
$835.34
|
| Rate for Payer: BCBS Trust/PPO |
$836.83
|
| Rate for Payer: BCN Commercial |
$1,812.99
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Meridian Medicaid |
$835.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$795.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,986.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,986.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,721.43
|
| Rate for Payer: UHC Exchange |
$1,721.43
|
| Rate for Payer: UHCCP Medicaid |
$795.56
|
|
|
PR TEAEC W/PATCH GRF CAROTID VERTB SUBCLAV NECK INC
|
Professional
|
Both
|
$3,698.00
|
|
|
Service Code
|
HCPCS 35301
|
| Min. Negotiated Rate |
$276.83 |
| Max. Negotiated Rate |
$2,403.70 |
| Rate for Payer: Aetna Commercial |
$1,520.42
|
| Rate for Payer: Aetna Medicare |
$1,849.00
|
| Rate for Payer: BCBS Complete |
$740.73
|
| Rate for Payer: BCBS Trust/PPO |
$276.83
|
| Rate for Payer: BCN Commercial |
$1,613.13
|
| Rate for Payer: Cash Price |
$2,958.40
|
| Rate for Payer: Cash Price |
$2,958.40
|
| Rate for Payer: Meridian Medicaid |
$740.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$705.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,403.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,760.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,760.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,411.15
|
| Rate for Payer: UHC Exchange |
$1,411.15
|
| Rate for Payer: UHCCP Medicaid |
$705.46
|
|
|
PR TEAEC W/WO PATCH GRAFT ABDOMINAL AORTA
|
Professional
|
Both
|
$4,734.00
|
|
|
Service Code
|
HCPCS 35331
|
| Min. Negotiated Rate |
$763.92 |
| Max. Negotiated Rate |
$3,077.10 |
| Rate for Payer: Aetna Commercial |
$1,949.74
|
| Rate for Payer: Aetna Medicare |
$2,367.00
|
| Rate for Payer: BCBS Complete |
$949.40
|
| Rate for Payer: BCBS Trust/PPO |
$763.92
|
| Rate for Payer: BCN Commercial |
$2,084.70
|
| Rate for Payer: Cash Price |
$3,787.20
|
| Rate for Payer: Cash Price |
$3,787.20
|
| Rate for Payer: Meridian Medicaid |
$949.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$904.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,077.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,265.58
|
| Rate for Payer: Priority Health Narrow Network |
$2,265.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,977.10
|
| Rate for Payer: UHC Exchange |
$1,977.10
|
| Rate for Payer: UHCCP Medicaid |
$904.19
|
|
|
PR TEAEC W/WO PATCH GRAFT COMBINED AORTOILIOFEMORAL
|
Professional
|
Both
|
$3,341.00
|
|
|
Service Code
|
HCPCS 35363
|
| Min. Negotiated Rate |
$1,015.37 |
| Max. Negotiated Rate |
$2,528.30 |
| Rate for Payer: Aetna Commercial |
$2,184.46
|
| Rate for Payer: Aetna Medicare |
$1,670.50
|
| Rate for Payer: BCBS Complete |
$1,066.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,218.79
|
| Rate for Payer: BCN Commercial |
$2,312.43
|
| Rate for Payer: Cash Price |
$2,672.80
|
| Rate for Payer: Cash Price |
$2,672.80
|
| Rate for Payer: Meridian Medicaid |
$1,066.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,015.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,171.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,528.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,528.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,317.95
|
| Rate for Payer: UHC Exchange |
$2,317.95
|
| Rate for Payer: UHCCP Medicaid |
$1,015.37
|
|
|
PR TEAEC W/WO PATCH GRAFT COMMON FEMORAL
|
Professional
|
Both
|
$1,751.00
|
|
|
Service Code
|
HCPCS 35371
|
| Min. Negotiated Rate |
$508.86 |
| Max. Negotiated Rate |
$1,269.46 |
| Rate for Payer: Aetna Commercial |
$1,096.85
|
| Rate for Payer: Aetna Medicare |
$875.50
|
| Rate for Payer: BCBS Complete |
$534.30
|
| Rate for Payer: BCBS Trust/PPO |
$666.19
|
| Rate for Payer: BCN Commercial |
$1,163.54
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Meridian Medicaid |
$534.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,138.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,269.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,269.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,106.74
|
| Rate for Payer: UHC Exchange |
$1,106.74
|
| Rate for Payer: UHCCP Medicaid |
$508.86
|
|
|
PR TEAEC W/WO PATCH GRAFT DEEP PROFUNDA FEMORAL
|
Professional
|
Both
|
$3,773.00
|
|
|
Service Code
|
HCPCS 35372
|
| Min. Negotiated Rate |
$608.97 |
| Max. Negotiated Rate |
$2,452.45 |
| Rate for Payer: Aetna Commercial |
$1,311.71
|
| Rate for Payer: Aetna Medicare |
$1,886.50
|
| Rate for Payer: BCBS Complete |
$639.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,194.49
|
| Rate for Payer: BCN Commercial |
$1,392.25
|
| Rate for Payer: Cash Price |
$3,018.40
|
| Rate for Payer: Cash Price |
$3,018.40
|
| Rate for Payer: Meridian Medicaid |
$639.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$608.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,452.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,521.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,521.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,326.98
|
| Rate for Payer: UHC Exchange |
$1,326.98
|
| Rate for Payer: UHCCP Medicaid |
$608.97
|
|
|
PR TEAEC W/WO PATCH GRAFT ILIAC
|
Professional
|
Both
|
$2,528.00
|
|
|
Service Code
|
HCPCS 35351
|
| Min. Negotiated Rate |
$804.08 |
| Max. Negotiated Rate |
$2,001.79 |
| Rate for Payer: Aetna Commercial |
$1,728.25
|
| Rate for Payer: Aetna Medicare |
$1,264.00
|
| Rate for Payer: BCBS Complete |
$844.28
|
| Rate for Payer: BCBS Trust/PPO |
$942.49
|
| Rate for Payer: BCN Commercial |
$1,831.56
|
| Rate for Payer: Cash Price |
$2,022.40
|
| Rate for Payer: Cash Price |
$2,022.40
|
| Rate for Payer: Meridian Medicaid |
$844.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$804.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,643.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,001.79
|
| Rate for Payer: Priority Health Narrow Network |
$2,001.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,733.86
|
| Rate for Payer: UHC Exchange |
$1,733.86
|
| Rate for Payer: UHCCP Medicaid |
$804.08
|
|
|
PR TEAEC W/WO PATCH GRAFT ILIOFEMORAL
|
Professional
|
Both
|
$2,053.00
|
|
|
Service Code
|
HCPCS 35355
|
| Min. Negotiated Rate |
$642.20 |
| Max. Negotiated Rate |
$1,601.33 |
| Rate for Payer: Aetna Commercial |
$1,386.40
|
| Rate for Payer: Aetna Medicare |
$1,026.50
|
| Rate for Payer: BCBS Complete |
$674.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,096.22
|
| Rate for Payer: BCN Commercial |
$1,466.52
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Meridian Medicaid |
$674.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$642.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,601.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,601.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,408.49
|
| Rate for Payer: UHC Exchange |
$1,408.49
|
| Rate for Payer: UHCCP Medicaid |
$642.20
|
|
|
PR TEAEC W/WO PATCH GRAFT MESENTERIC CELIAC/RENAL
|
Professional
|
Both
|
$4,508.00
|
|
|
Service Code
|
HCPCS 35341
|
| Min. Negotiated Rate |
$859.67 |
| Max. Negotiated Rate |
$2,930.20 |
| Rate for Payer: Aetna Commercial |
$1,840.86
|
| Rate for Payer: Aetna Medicare |
$2,254.00
|
| Rate for Payer: BCBS Complete |
$902.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,030.71
|
| Rate for Payer: BCN Commercial |
$1,972.30
|
| Rate for Payer: Cash Price |
$3,606.40
|
| Rate for Payer: Cash Price |
$3,606.40
|
| Rate for Payer: Meridian Medicaid |
$902.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$859.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,930.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,160.80
|
| Rate for Payer: Priority Health Narrow Network |
$2,160.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,854.95
|
| Rate for Payer: UHC Exchange |
$1,854.95
|
| Rate for Payer: UHCCP Medicaid |
$859.67
|
|
|
PR TEAEC W/WO PATCH GRF AXILLARY-BRACHIAL
|
Professional
|
Both
|
$3,855.00
|
|
|
Service Code
|
HCPCS 35321
|
| Min. Negotiated Rate |
$568.50 |
| Max. Negotiated Rate |
$2,505.75 |
| Rate for Payer: Aetna Commercial |
$1,199.86
|
| Rate for Payer: Aetna Medicare |
$1,927.50
|
| Rate for Payer: BCBS Complete |
$596.92
|
| Rate for Payer: BCBS Trust/PPO |
$677.28
|
| Rate for Payer: BCN Commercial |
$1,280.34
|
| Rate for Payer: Cash Price |
$3,084.00
|
| Rate for Payer: Cash Price |
$3,084.00
|
| Rate for Payer: Meridian Medicaid |
$596.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$568.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,505.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,402.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,402.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,198.66
|
| Rate for Payer: UHC Exchange |
$1,198.66
|
| Rate for Payer: UHCCP Medicaid |
$568.50
|
|
|
PR TEAEC W/WO PATCH GRF SUBCLAV INNOM THORACIC INC
|
Professional
|
Both
|
$2,846.00
|
|
|
Service Code
|
HCPCS 35311
|
| Min. Negotiated Rate |
$973.84 |
| Max. Negotiated Rate |
$2,421.92 |
| Rate for Payer: Aetna Commercial |
$2,093.18
|
| Rate for Payer: Aetna Medicare |
$1,423.00
|
| Rate for Payer: BCBS Complete |
$1,022.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,646.71
|
| Rate for Payer: BCN Commercial |
$2,224.46
|
| Rate for Payer: Cash Price |
$2,276.80
|
| Rate for Payer: Cash Price |
$2,276.80
|
| Rate for Payer: Meridian Medicaid |
$1,022.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$973.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,849.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,421.92
|
| Rate for Payer: Priority Health Narrow Network |
$2,421.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,033.35
|
| Rate for Payer: UHC Exchange |
$2,033.35
|
| Rate for Payer: UHCCP Medicaid |
$973.84
|
|
|
PR TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 99368
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$852.68 |
| Rate for Payer: Aetna Commercial |
$36.09
|
| Rate for Payer: Aetna Medicare |
$29.50
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: BCBS Trust/PPO |
$852.68
|
| Rate for Payer: BCN Commercial |
$50.82
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.67
|
| Rate for Payer: Priority Health Narrow Network |
$46.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.27
|
| Rate for Payer: UHC Exchange |
$40.27
|
|
|
PR TEAM CONFERENCE NON-FACE-TO-FACE PHYSICIAN
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 99367
|
| Min. Negotiated Rate |
$55.68 |
| Max. Negotiated Rate |
$232.98 |
| Rate for Payer: Aetna Commercial |
$55.68
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$232.98
|
| Rate for Payer: BCN Commercial |
$145.07
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.80
|
| Rate for Payer: Priority Health Narrow Network |
$71.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.64
|
| Rate for Payer: UHC Exchange |
$61.64
|
|
|
PR TELEPHONE ASSMT&MGMT SVC NQHP EST PT 11-20 MIN
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 98967
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$1,248.37 |
| Rate for Payer: Aetna Commercial |
$27.83
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,248.37
|
| Rate for Payer: BCN Commercial |
$28.04
|
| 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: Priority Health HMO/PPO/Tiered Network |
$29.85
|
| Rate for Payer: Priority Health Narrow Network |
$29.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.90
|
| Rate for Payer: UHC Exchange |
$26.90
|
|
|
PR TELEPHONE ASSMT&MGMT SVC NQHP EST PT 21-30 MIN
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 98968
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$1,647.77 |
| Rate for Payer: Aetna Commercial |
$41.55
|
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,647.77
|
| Rate for Payer: BCN Commercial |
$41.49
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.61
|
| Rate for Payer: Priority Health Narrow Network |
$41.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.39
|
| Rate for Payer: UHC Exchange |
$40.39
|
|
|
PR TELEPHONE ASSMT&MGMT SVC NQHP EST PT 5-10 MIN
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 98966
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$564.75 |
| Rate for Payer: Aetna Commercial |
$14.10
|
| Rate for Payer: Aetna Medicare |
$14.50
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Trust/PPO |
$564.75
|
| Rate for Payer: BCN Commercial |
$14.56
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.38
|
| Rate for Payer: Priority Health Narrow Network |
$15.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
| Rate for Payer: UHC Exchange |
$13.08
|
|
|
PR TEMPORARY CLOSURE EYELIDS SUTURE
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
HCPCS 67875
|
| Min. Negotiated Rate |
$105.08 |
| Max. Negotiated Rate |
$266.33 |
| Rate for Payer: Aetna Commercial |
$124.95
|
| Rate for Payer: Aetna Medicare |
$190.50
|
| Rate for Payer: BCBS Complete |
$152.40
|
| Rate for Payer: BCN Commercial |
$266.33
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.12
|
| Rate for Payer: Priority Health Narrow Network |
$166.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.08
|
| Rate for Payer: UHC Exchange |
$105.08
|
|
|
PR TENDON GRAFT FROM A DISTANCE
|
Professional
|
Both
|
$1,113.00
|
|
|
Service Code
|
HCPCS 20924
|
| Min. Negotiated Rate |
$329.72 |
| Max. Negotiated Rate |
$11,952.59 |
| Rate for Payer: Aetna Commercial |
$672.54
|
| Rate for Payer: Aetna Medicare |
$556.50
|
| Rate for Payer: BCBS Complete |
$346.21
|
| Rate for Payer: BCBS Trust/PPO |
$11,952.59
|
| Rate for Payer: BCN Commercial |
$741.81
|
| Rate for Payer: Cash Price |
$890.40
|
| Rate for Payer: Cash Price |
$890.40
|
| Rate for Payer: Meridian Medicaid |
$346.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$329.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$723.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$779.57
|
| Rate for Payer: Priority Health Narrow Network |
$779.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$574.42
|
| Rate for Payer: UHC Exchange |
$574.42
|
| Rate for Payer: UHCCP Medicaid |
$329.72
|
|
