|
PR VAGINAL HYSTERECTOMY >250 GM RPR ENTEROCELE
|
Professional
|
Both
|
$2,238.00
|
|
|
Service Code
|
HCPCS 58294
|
| Min. Negotiated Rate |
$327.55 |
| Max. Negotiated Rate |
$1,816.03 |
| Rate for Payer: Aetna Commercial |
$1,463.27
|
| Rate for Payer: Aetna Medicare |
$1,119.00
|
| Rate for Payer: BCBS Complete |
$817.45
|
| Rate for Payer: BCBS Trust/PPO |
$327.55
|
| Rate for Payer: BCN Commercial |
$1,784.65
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Meridian Medicaid |
$817.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$778.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,454.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,816.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,816.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,400.39
|
| Rate for Payer: UHC Exchange |
$1,400.39
|
| Rate for Payer: UHCCP Medicaid |
$778.52
|
|
|
PR VAGINAL HYSTERECTOMY 250 GM/< W/RPR ENTEROCELE
|
Professional
|
Both
|
$2,757.00
|
|
|
Service Code
|
HCPCS 58270
|
| Min. Negotiated Rate |
$233.51 |
| Max. Negotiated Rate |
$1,792.05 |
| Rate for Payer: Aetna Commercial |
$1,070.18
|
| Rate for Payer: Aetna Medicare |
$1,378.50
|
| Rate for Payer: BCBS Complete |
$602.07
|
| Rate for Payer: BCBS Trust/PPO |
$233.51
|
| Rate for Payer: BCN Commercial |
$1,313.56
|
| Rate for Payer: Cash Price |
$2,205.60
|
| Rate for Payer: Cash Price |
$2,205.60
|
| Rate for Payer: Meridian Medicaid |
$602.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,792.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,336.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,336.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,011.33
|
| Rate for Payer: UHC Exchange |
$1,011.33
|
| Rate for Payer: UHCCP Medicaid |
$573.40
|
|
|
PR VAGINAL HYSTERECTOMY UTERUS > 250 GM
|
Professional
|
Both
|
$2,917.00
|
|
|
Service Code
|
HCPCS 58290
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,896.05 |
| Rate for Payer: Aetna Commercial |
$1,382.79
|
| Rate for Payer: Aetna Medicare |
$1,458.50
|
| Rate for Payer: BCBS Complete |
$773.38
|
| Rate for Payer: BCBS Trust/PPO |
$137.36
|
| Rate for Payer: BCN Commercial |
$1,687.40
|
| Rate for Payer: Cash Price |
$2,333.60
|
| Rate for Payer: Cash Price |
$2,333.60
|
| Rate for Payer: Meridian Medicaid |
$773.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$736.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,896.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,718.31
|
| Rate for Payer: Priority Health Narrow Network |
$1,718.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,322.80
|
| Rate for Payer: UHC Exchange |
$1,322.80
|
| Rate for Payer: UHCCP Medicaid |
$736.55
|
|
|
PR VAGINAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$2,684.00
|
|
|
Service Code
|
HCPCS 58260
|
| Min. Negotiated Rate |
$240.90 |
| Max. Negotiated Rate |
$1,744.60 |
| Rate for Payer: Aetna Commercial |
$1,002.76
|
| Rate for Payer: Aetna Medicare |
$1,342.00
|
| Rate for Payer: BCBS Complete |
$564.94
|
| Rate for Payer: BCBS Trust/PPO |
$240.90
|
| Rate for Payer: BCN Commercial |
$1,231.47
|
| Rate for Payer: Cash Price |
$2,147.20
|
| Rate for Payer: Cash Price |
$2,147.20
|
| Rate for Payer: Meridian Medicaid |
$564.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$538.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,744.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,255.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,255.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$946.35
|
| Rate for Payer: UHC Exchange |
$946.35
|
| Rate for Payer: UHCCP Medicaid |
$538.04
|
|
|
PR VAGINAL HYSTERECTOMY W/TOT/PRTL VAGINECTOMY
|
Professional
|
Both
|
$2,416.00
|
|
|
Service Code
|
HCPCS 58275
|
| Min. Negotiated Rate |
$263.09 |
| Max. Negotiated Rate |
$1,570.40 |
| Rate for Payer: Aetna Commercial |
$1,185.50
|
| Rate for Payer: Aetna Medicare |
$1,208.00
|
| Rate for Payer: BCBS Complete |
$667.82
|
| Rate for Payer: BCBS Trust/PPO |
$263.09
|
| Rate for Payer: BCN Commercial |
$1,449.42
|
| Rate for Payer: Cash Price |
$1,932.80
|
| Rate for Payer: Cash Price |
$1,932.80
|
| Rate for Payer: Meridian Medicaid |
$667.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$636.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,570.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,481.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,481.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,128.35
|
| Rate for Payer: UHC Exchange |
$1,128.35
|
| Rate for Payer: UHCCP Medicaid |
$636.02
|
|
|
PR VAGINECTOMY COMPLETE REMOVAL VAGINAL WALL
|
Professional
|
Both
|
$2,025.00
|
|
|
Service Code
|
HCPCS 57110
|
| Min. Negotiated Rate |
$578.51 |
| Max. Negotiated Rate |
$2,148.07 |
| Rate for Payer: Aetna Commercial |
$1,082.64
|
| Rate for Payer: Aetna Medicare |
$1,012.50
|
| Rate for Payer: BCBS Complete |
$607.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,148.07
|
| Rate for Payer: BCN Commercial |
$1,325.29
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Meridian Medicaid |
$607.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$578.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,316.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,350.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,350.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,029.22
|
| Rate for Payer: UHC Exchange |
$1,029.22
|
| Rate for Payer: UHCCP Medicaid |
$578.51
|
|
|
PR VAGINECTOMY PARTIAL REMOVAL VAGINAL WALL
|
Professional
|
Both
|
$1,993.00
|
|
|
Service Code
|
HCPCS 57106
|
| Min. Negotiated Rate |
$345.70 |
| Max. Negotiated Rate |
$3,372.14 |
| Rate for Payer: Aetna Commercial |
$627.43
|
| Rate for Payer: Aetna Medicare |
$996.50
|
| Rate for Payer: BCBS Complete |
$362.98
|
| Rate for Payer: BCBS Trust/PPO |
$3,372.14
|
| Rate for Payer: BCN Commercial |
$788.73
|
| Rate for Payer: Cash Price |
$1,594.40
|
| Rate for Payer: Cash Price |
$1,594.40
|
| Rate for Payer: Meridian Medicaid |
$362.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$345.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$807.56
|
| Rate for Payer: Priority Health Narrow Network |
$807.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$543.69
|
| Rate for Payer: UHC Exchange |
$543.69
|
| Rate for Payer: UHCCP Medicaid |
$345.70
|
|
|
PR VAGINOPLASTY INTERSEX STATE
|
Professional
|
Both
|
$2,533.00
|
|
|
Service Code
|
HCPCS 57335
|
| Min. Negotiated Rate |
$753.17 |
| Max. Negotiated Rate |
$1,759.48 |
| Rate for Payer: Aetna Commercial |
$1,408.00
|
| Rate for Payer: Aetna Medicare |
$1,266.50
|
| Rate for Payer: BCBS Complete |
$790.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,671.54
|
| Rate for Payer: BCN Commercial |
$1,727.47
|
| Rate for Payer: Cash Price |
$2,026.40
|
| Rate for Payer: Cash Price |
$2,026.40
|
| Rate for Payer: Meridian Medicaid |
$790.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$753.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,646.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,759.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,759.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,339.78
|
| Rate for Payer: UHC Exchange |
$1,339.78
|
| Rate for Payer: UHCCP Medicaid |
$753.17
|
|
|
PR VAGNC PRTL RMVL VAG WALL W/RMVL PARAVAGINAL TISS
|
Professional
|
Both
|
$2,571.00
|
|
|
Service Code
|
HCPCS 57107
|
| Min. Negotiated Rate |
$935.28 |
| Max. Negotiated Rate |
$3,758.85 |
| Rate for Payer: Aetna Commercial |
$1,723.00
|
| Rate for Payer: Aetna Medicare |
$1,285.50
|
| Rate for Payer: BCBS Complete |
$982.04
|
| Rate for Payer: BCBS Trust/PPO |
$3,758.85
|
| Rate for Payer: BCN Commercial |
$2,129.66
|
| Rate for Payer: Cash Price |
$2,056.80
|
| Rate for Payer: Cash Price |
$2,056.80
|
| Rate for Payer: Meridian Medicaid |
$982.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$935.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,671.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,180.62
|
| Rate for Payer: Priority Health Narrow Network |
$2,180.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,605.75
|
| Rate for Payer: UHC Exchange |
$1,605.75
|
| Rate for Payer: UHCCP Medicaid |
$935.28
|
|
|
PR VAGOTOMY PFRMD W/PRTL DSTL GSTRCT
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 43635
|
| Min. Negotiated Rate |
$71.57 |
| Max. Negotiated Rate |
$806.71 |
| Rate for Payer: Aetna Commercial |
$151.79
|
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$75.15
|
| Rate for Payer: BCBS Trust/PPO |
$806.71
|
| Rate for Payer: BCN Commercial |
$163.22
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Meridian Medicaid |
$75.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$199.26
|
| Rate for Payer: Priority Health Narrow Network |
$199.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.80
|
| Rate for Payer: UHC Exchange |
$138.80
|
| Rate for Payer: UHCCP Medicaid |
$71.57
|
|
|
PR VALVECTOMY TRICUSPID VALVE W/CARDIOPULMONARY BYP
|
Professional
|
Both
|
$4,859.00
|
|
|
Service Code
|
HCPCS 33460
|
| Min. Negotiated Rate |
$1,500.37 |
| Max. Negotiated Rate |
$3,731.81 |
| Rate for Payer: Aetna Commercial |
$3,229.82
|
| Rate for Payer: Aetna Medicare |
$2,429.50
|
| Rate for Payer: BCBS Complete |
$1,575.39
|
| Rate for Payer: BCN Commercial |
$3,425.63
|
| Rate for Payer: Cash Price |
$3,887.20
|
| Rate for Payer: Cash Price |
$3,887.20
|
| Rate for Payer: Meridian Medicaid |
$1,575.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,500.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,158.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,731.81
|
| Rate for Payer: Priority Health Narrow Network |
$3,731.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,314.76
|
| Rate for Payer: UHC Exchange |
$3,314.76
|
| Rate for Payer: UHCCP Medicaid |
$1,500.37
|
|
|
PR VALVOTOMY MITRAL VALVE OPEN HEART W/BYPASS
|
Professional
|
Both
|
$8,923.00
|
|
|
Service Code
|
HCPCS 33422
|
| Min. Negotiated Rate |
$495.02 |
| Max. Negotiated Rate |
$5,799.95 |
| Rate for Payer: Aetna Commercial |
$2,232.21
|
| Rate for Payer: Aetna Medicare |
$4,461.50
|
| Rate for Payer: BCBS Complete |
$1,098.79
|
| Rate for Payer: BCBS Trust/PPO |
$495.02
|
| Rate for Payer: BCN Commercial |
$2,382.79
|
| Rate for Payer: Cash Price |
$7,138.40
|
| Rate for Payer: Cash Price |
$7,138.40
|
| Rate for Payer: Meridian Medicaid |
$1,098.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,046.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,799.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,597.96
|
| Rate for Payer: Priority Health Narrow Network |
$2,597.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,210.33
|
| Rate for Payer: UHC Exchange |
$2,210.33
|
| Rate for Payer: UHCCP Medicaid |
$1,046.47
|
|
|
PR VALVULOPLASTY MITRAL VALVE W/CARDIAC BYPASS
|
Professional
|
Both
|
$8,513.00
|
|
|
Service Code
|
HCPCS 33425
|
| Min. Negotiated Rate |
$763.39 |
| Max. Negotiated Rate |
$5,533.45 |
| Rate for Payer: Aetna Commercial |
$3,670.08
|
| Rate for Payer: Aetna Medicare |
$4,256.50
|
| Rate for Payer: BCBS Complete |
$1,797.47
|
| Rate for Payer: BCBS Trust/PPO |
$763.39
|
| Rate for Payer: BCN Commercial |
$3,906.98
|
| Rate for Payer: Cash Price |
$6,810.40
|
| Rate for Payer: Cash Price |
$6,810.40
|
| Rate for Payer: Meridian Medicaid |
$1,797.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,711.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,533.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,266.83
|
| Rate for Payer: Priority Health Narrow Network |
$4,266.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,547.24
|
| Rate for Payer: UHC Exchange |
$3,547.24
|
| Rate for Payer: UHCCP Medicaid |
$1,711.88
|
|
|
PR VALVULOPLASTY TRICUSPID VALVE W/O RING INSERTION
|
Professional
|
Both
|
$7,544.00
|
|
|
Service Code
|
HCPCS 33463
|
| Min. Negotiated Rate |
$1,183.92 |
| Max. Negotiated Rate |
$4,903.60 |
| Rate for Payer: Aetna Commercial |
$4,125.63
|
| Rate for Payer: Aetna Medicare |
$3,772.00
|
| Rate for Payer: BCBS Complete |
$2,024.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,183.92
|
| Rate for Payer: BCN Commercial |
$4,392.23
|
| Rate for Payer: Cash Price |
$6,035.20
|
| Rate for Payer: Cash Price |
$6,035.20
|
| Rate for Payer: Meridian Medicaid |
$2,024.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,928.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,903.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,801.85
|
| Rate for Payer: Priority Health Narrow Network |
$4,801.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,023.78
|
| Rate for Payer: UHC Exchange |
$4,023.78
|
| Rate for Payer: UHCCP Medicaid |
$1,928.50
|
|
|
PR VALVULOPLASTY TRICUSPID VALVE W/RING INSERTION
|
Professional
|
Both
|
$5,116.00
|
|
|
Service Code
|
HCPCS 33464
|
| Min. Negotiated Rate |
$309.58 |
| Max. Negotiated Rate |
$3,809.45 |
| Rate for Payer: Aetna Commercial |
$3,273.60
|
| Rate for Payer: Aetna Medicare |
$2,558.00
|
| Rate for Payer: BCBS Complete |
$1,607.15
|
| Rate for Payer: BCBS Trust/PPO |
$309.58
|
| Rate for Payer: BCN Commercial |
$3,487.20
|
| Rate for Payer: Cash Price |
$4,092.80
|
| Rate for Payer: Cash Price |
$4,092.80
|
| Rate for Payer: Meridian Medicaid |
$1,607.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,530.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,325.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,809.45
|
| Rate for Payer: Priority Health Narrow Network |
$3,809.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,196.23
|
| Rate for Payer: UHC Exchange |
$3,196.23
|
| Rate for Payer: UHCCP Medicaid |
$1,530.62
|
|
|
PR VANTAS IMPLANT
|
Professional
|
Both
|
$3,401.00
|
|
|
Service Code
|
HCPCS J9225
|
| Min. Negotiated Rate |
$1,360.40 |
| Max. Negotiated Rate |
$5,425.63 |
| Rate for Payer: Aetna Commercial |
$4,678.90
|
| Rate for Payer: Aetna Medicare |
$1,700.50
|
| Rate for Payer: BCBS Complete |
$1,360.40
|
| Rate for Payer: BCBS Trust/PPO |
$5,264.35
|
| Rate for Payer: BCN Commercial |
$5,264.35
|
| Rate for Payer: Cash Price |
$2,720.80
|
| Rate for Payer: Cash Price |
$2,720.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,210.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,425.63
|
| Rate for Payer: UHC Exchange |
$5,425.63
|
|
|
PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 90716
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Aetna Commercial |
$177.68
|
| Rate for Payer: Aetna Medicare |
$108.00
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS Trust/PPO |
$160.76
|
| Rate for Payer: BCN Commercial |
$157.78
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.60
|
| Rate for Payer: UHC Exchange |
$219.60
|
|
|
PR VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX
|
Professional
|
Both
|
$1,335.00
|
|
|
Service Code
|
HCPCS 37500
|
| Min. Negotiated Rate |
$396.82 |
| Max. Negotiated Rate |
$1,413.20 |
| Rate for Payer: Aetna Commercial |
$846.67
|
| Rate for Payer: Aetna Medicare |
$667.50
|
| Rate for Payer: BCBS Complete |
$416.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,413.20
|
| Rate for Payer: BCN Commercial |
$902.59
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Meridian Medicaid |
$416.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$396.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$867.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$987.60
|
| Rate for Payer: Priority Health Narrow Network |
$987.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$904.70
|
| Rate for Payer: UHC Exchange |
$904.70
|
| Rate for Payer: UHCCP Medicaid |
$396.82
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I
|
Professional
|
Both
|
$1,515.00
|
|
|
Service Code
|
HCPCS 37242
|
| Min. Negotiated Rate |
$295.86 |
| Max. Negotiated Rate |
$10,507.06 |
| Rate for Payer: Aetna Commercial |
$637.38
|
| Rate for Payer: Aetna Medicare |
$757.50
|
| Rate for Payer: BCBS Complete |
$310.65
|
| Rate for Payer: BCBS Trust/PPO |
$658.79
|
| Rate for Payer: BCN Commercial |
$10,507.06
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Meridian Medicaid |
$310.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$295.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$736.05
|
| Rate for Payer: Priority Health Narrow Network |
$736.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$665.34
|
| Rate for Payer: UHC Exchange |
$665.34
|
| Rate for Payer: UHCCP Medicaid |
$295.86
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE
|
Professional
|
Both
|
$9,702.00
|
|
|
Service Code
|
HCPCS 37244
|
| Min. Negotiated Rate |
$410.88 |
| Max. Negotiated Rate |
$9,737.39 |
| Rate for Payer: Aetna Commercial |
$883.47
|
| Rate for Payer: Aetna Medicare |
$4,851.00
|
| Rate for Payer: BCBS Complete |
$431.42
|
| Rate for Payer: BCBS Trust/PPO |
$624.45
|
| Rate for Payer: BCN Commercial |
$9,737.39
|
| Rate for Payer: Cash Price |
$7,761.60
|
| Rate for Payer: Cash Price |
$7,761.60
|
| Rate for Payer: Meridian Medicaid |
$431.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$410.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,306.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,019.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,019.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$925.34
|
| Rate for Payer: UHC Exchange |
$925.34
|
| Rate for Payer: UHCCP Medicaid |
$410.88
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 37241
|
| Min. Negotiated Rate |
$265.82 |
| Max. Negotiated Rate |
$6,882.05 |
| Rate for Payer: Aetna Commercial |
$579.41
|
| Rate for Payer: Aetna Medicare |
$345.50
|
| Rate for Payer: BCBS Complete |
$279.11
|
| Rate for Payer: BCBS Trust/PPO |
$583.24
|
| Rate for Payer: BCN Commercial |
$6,882.05
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Meridian Medicaid |
$279.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$265.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$661.05
|
| Rate for Payer: Priority Health Narrow Network |
$661.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$595.81
|
| Rate for Payer: UHC Exchange |
$595.81
|
| Rate for Payer: UHCCP Medicaid |
$265.82
|
|
|
PR VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT
|
Professional
|
Both
|
$1,217.00
|
|
|
Service Code
|
HCPCS 37243
|
| Min. Negotiated Rate |
$349.32 |
| Max. Negotiated Rate |
$12,761.33 |
| Rate for Payer: Aetna Commercial |
$745.17
|
| Rate for Payer: Aetna Medicare |
$608.50
|
| Rate for Payer: BCBS Complete |
$366.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,206.64
|
| Rate for Payer: BCN Commercial |
$12,761.33
|
| Rate for Payer: Cash Price |
$973.60
|
| Rate for Payer: Cash Price |
$973.60
|
| Rate for Payer: Meridian Medicaid |
$366.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$349.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$864.74
|
| Rate for Payer: Priority Health Narrow Network |
$864.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$793.28
|
| Rate for Payer: UHC Exchange |
$793.28
|
| Rate for Payer: UHCCP Medicaid |
$349.32
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
IP
|
$893.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
55250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$580.45 |
| Max. Negotiated Rate |
$893.00 |
| Rate for Payer: Aetna Commercial |
$803.70
|
| Rate for Payer: ASR ASR |
$866.21
|
| Rate for Payer: ASR Commercial |
$866.21
|
| Rate for Payer: BCBS Trust/PPO |
$727.71
|
| Rate for Payer: BCN Commercial |
$692.34
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Commercial |
$839.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$714.40
|
| Rate for Payer: Healthscope Commercial |
$893.00
|
| Rate for Payer: Healthscope Whirlpool |
$866.21
|
| Rate for Payer: Mclaren Commercial |
$803.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.05
|
| Rate for Payer: Nomi Health Commercial |
$732.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$785.84
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
HCPCS 55250
|
| Min. Negotiated Rate |
$148.89 |
| Max. Negotiated Rate |
$1,543.69 |
| Rate for Payer: Aetna Commercial |
$290.03
|
| Rate for Payer: Aetna Medicare |
$446.50
|
| Rate for Payer: BCBS Complete |
$156.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.69
|
| Rate for Payer: BCN Commercial |
$393.05
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Meridian Medicaid |
$156.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.09
|
| Rate for Payer: Priority Health Narrow Network |
$369.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.96
|
| Rate for Payer: UHC Exchange |
$268.96
|
| Rate for Payer: UHCCP Medicaid |
$148.89
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
55250
|
| Min. Negotiated Rate |
$148.89 |
| Max. Negotiated Rate |
$1,543.69 |
| Rate for Payer: Aetna Commercial |
$290.03
|
| Rate for Payer: Aetna Medicare |
$446.50
|
| Rate for Payer: BCBS Complete |
$156.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.69
|
| Rate for Payer: BCN Commercial |
$393.05
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Meridian Medicaid |
$156.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.09
|
| Rate for Payer: Priority Health Narrow Network |
$369.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.96
|
| Rate for Payer: UHC Exchange |
$268.96
|
| Rate for Payer: UHCCP Medicaid |
$148.89
|
|
