|
PR VERTEBRAL CORPECTOMY DCMPRN CERVICAL EA SEG
|
Professional
|
Both
|
$2,146.00
|
|
|
Service Code
|
HCPCS 63082
|
| Min. Negotiated Rate |
$170.19 |
| Max. Negotiated Rate |
$1,394.90 |
| Rate for Payer: Aetna Commercial |
$343.91
|
| Rate for Payer: Aetna Medicare |
$1,073.00
|
| Rate for Payer: BCBS Complete |
$178.70
|
| Rate for Payer: BCBS Trust/PPO |
$385.66
|
| Rate for Payer: BCN Commercial |
$424.54
|
| Rate for Payer: Cash Price |
$1,716.80
|
| Rate for Payer: Cash Price |
$1,716.80
|
| Rate for Payer: Meridian Medicaid |
$178.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$170.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$452.70
|
| Rate for Payer: Priority Health Narrow Network |
$452.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.36
|
| Rate for Payer: UHC Exchange |
$322.36
|
| Rate for Payer: UHCCP Medicaid |
$170.19
|
|
|
PR VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC 1 SEG
|
Professional
|
Both
|
$7,092.00
|
|
|
Service Code
|
HCPCS 63085
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$4,609.80 |
| Rate for Payer: Aetna Commercial |
$2,486.89
|
| Rate for Payer: Aetna Medicare |
$3,546.00
|
| Rate for Payer: BCBS Complete |
$1,310.81
|
| Rate for Payer: BCBS Trust/PPO |
$420.00
|
| Rate for Payer: BCN Commercial |
$3,110.60
|
| Rate for Payer: Cash Price |
$5,673.60
|
| Rate for Payer: Cash Price |
$5,673.60
|
| Rate for Payer: Meridian Medicaid |
$1,310.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,248.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,609.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,344.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,344.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,230.78
|
| Rate for Payer: UHC Exchange |
$2,230.78
|
| Rate for Payer: UHCCP Medicaid |
$1,248.39
|
|
|
PR VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC EA SEG
|
Professional
|
Both
|
$2,364.00
|
|
|
Service Code
|
HCPCS 63086
|
| Min. Negotiated Rate |
$122.05 |
| Max. Negotiated Rate |
$1,536.60 |
| Rate for Payer: Aetna Commercial |
$245.29
|
| Rate for Payer: Aetna Medicare |
$1,182.00
|
| Rate for Payer: BCBS Complete |
$128.15
|
| Rate for Payer: BCBS Trust/PPO |
$985.81
|
| Rate for Payer: BCN Commercial |
$302.94
|
| Rate for Payer: Cash Price |
$1,891.20
|
| Rate for Payer: Cash Price |
$1,891.20
|
| Rate for Payer: Meridian Medicaid |
$128.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,536.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$325.88
|
| Rate for Payer: Priority Health Narrow Network |
$325.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.99
|
| Rate for Payer: UHC Exchange |
$230.99
|
| Rate for Payer: UHCCP Medicaid |
$122.05
|
|
|
PR VERTEBRAL CORPECTOMY EXC INDRL LES EACH SEG
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 63308
|
| Min. Negotiated Rate |
$204.48 |
| Max. Negotiated Rate |
$1,016.60 |
| Rate for Payer: Aetna Commercial |
$416.97
|
| Rate for Payer: Aetna Medicare |
$782.00
|
| Rate for Payer: BCBS Complete |
$214.70
|
| Rate for Payer: BCBS Trust/PPO |
$257.81
|
| Rate for Payer: BCN Commercial |
$512.78
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Meridian Medicaid |
$214.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.53
|
| Rate for Payer: Priority Health Narrow Network |
$546.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.86
|
| Rate for Payer: UHC Exchange |
$384.86
|
| Rate for Payer: UHCCP Medicaid |
$204.48
|
|
|
PR VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL
|
Professional
|
Both
|
$1,757.00
|
|
|
Service Code
|
HCPCS 22512
|
| Min. Negotiated Rate |
$131.21 |
| Max. Negotiated Rate |
$1,142.05 |
| Rate for Payer: Aetna Commercial |
$277.49
|
| Rate for Payer: Aetna Medicare |
$878.50
|
| Rate for Payer: BCBS Complete |
$137.77
|
| Rate for Payer: BCBS Trust/PPO |
$214.49
|
| Rate for Payer: BCN Commercial |
$1,078.02
|
| Rate for Payer: Cash Price |
$1,405.60
|
| Rate for Payer: Cash Price |
$1,405.60
|
| Rate for Payer: Meridian Medicaid |
$137.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.93
|
| Rate for Payer: Priority Health Narrow Network |
$311.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.55
|
| Rate for Payer: UHC Exchange |
$270.55
|
| Rate for Payer: UHCCP Medicaid |
$131.21
|
|
|
PR VESICULOTOMY COMPLICATED
|
Professional
|
Both
|
$830.00
|
|
|
Service Code
|
HCPCS 55605
|
| Min. Negotiated Rate |
$337.39 |
| Max. Negotiated Rate |
$2,259.54 |
| Rate for Payer: Aetna Commercial |
$670.35
|
| Rate for Payer: Aetna Medicare |
$415.00
|
| Rate for Payer: BCBS Complete |
$354.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,259.54
|
| Rate for Payer: BCN Commercial |
$758.92
|
| Rate for Payer: Cash Price |
$664.00
|
| Rate for Payer: Cash Price |
$664.00
|
| Rate for Payer: Meridian Medicaid |
$354.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$337.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$539.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$839.38
|
| Rate for Payer: Priority Health Narrow Network |
$839.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$607.15
|
| Rate for Payer: UHC Exchange |
$607.15
|
| Rate for Payer: UHCCP Medicaid |
$337.39
|
|
|
PR VESSEL MAPPING HEMO ACCESS
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
HCPCS G0365
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Aetna Medicare |
$183.00
|
| Rate for Payer: BCBS Complete |
$146.40
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.90
|
|
|
PR VGTMY W/PYLORPLSTY W/WO GASTROST TRUNCAL/SLCTV
|
Professional
|
Both
|
$3,629.00
|
|
|
Service Code
|
HCPCS 43640
|
| Min. Negotiated Rate |
$767.44 |
| Max. Negotiated Rate |
$2,358.85 |
| Rate for Payer: Aetna Commercial |
$1,594.37
|
| Rate for Payer: Aetna Medicare |
$1,814.50
|
| Rate for Payer: BCBS Complete |
$805.81
|
| Rate for Payer: BCBS Trust/PPO |
$864.30
|
| Rate for Payer: BCN Commercial |
$1,740.67
|
| Rate for Payer: Cash Price |
$2,903.20
|
| Rate for Payer: Cash Price |
$2,903.20
|
| Rate for Payer: Meridian Medicaid |
$805.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$767.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,358.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,136.41
|
| Rate for Payer: Priority Health Narrow Network |
$2,136.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,418.59
|
| Rate for Payer: UHC Exchange |
$1,418.59
|
| Rate for Payer: UHCCP Medicaid |
$767.44
|
|
|
PR VISCER AND INFRARENAL ABDOM AORTA 1 PROSTHESIS
|
Professional
|
Both
|
$871.00
|
|
|
Service Code
|
HCPCS 34845
|
| Min. Negotiated Rate |
$435.50 |
| Max. Negotiated Rate |
$2,938.32 |
| Rate for Payer: Aetna Commercial |
$2,344.71
|
| Rate for Payer: Aetna Medicare |
$435.50
|
| Rate for Payer: BCBS Complete |
$1,424.60
|
| Rate for Payer: BCBS Trust/PPO |
$660.38
|
| Rate for Payer: BCN Commercial |
$1,812.17
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Meridian Medicaid |
$1,424.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,356.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,938.32
|
| Rate for Payer: Priority Health Narrow Network |
$2,938.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,920.45
|
| Rate for Payer: UHC Exchange |
$1,920.45
|
| Rate for Payer: UHCCP Medicaid |
$1,356.76
|
|
|
PR VISCER AND INFRARENAL ABDOM AORTA 2 PROSTHESIS
|
Professional
|
Both
|
$3,060.00
|
|
|
Service Code
|
HCPCS 34846
|
| Min. Negotiated Rate |
$1,492.43 |
| Max. Negotiated Rate |
$3,305.82 |
| Rate for Payer: Aetna Commercial |
$2,496.07
|
| Rate for Payer: Aetna Medicare |
$1,530.00
|
| Rate for Payer: BCBS Complete |
$1,567.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,564.30
|
| Rate for Payer: BCN Commercial |
$2,013.51
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Meridian Medicaid |
$1,567.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,492.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,989.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,305.82
|
| Rate for Payer: Priority Health Narrow Network |
$3,305.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,925.10
|
| Rate for Payer: UHC Exchange |
$1,925.10
|
| Rate for Payer: UHCCP Medicaid |
$1,492.43
|
|
|
PR VISCER AND INFRARENAL ABDOM AORTA 3 PROSTHESIS
|
Professional
|
Both
|
$5,100.00
|
|
|
Service Code
|
HCPCS 34847
|
| Min. Negotiated Rate |
$1,628.11 |
| Max. Negotiated Rate |
$3,521.22 |
| Rate for Payer: Aetna Commercial |
$2,642.90
|
| Rate for Payer: Aetna Medicare |
$2,550.00
|
| Rate for Payer: BCBS Complete |
$1,709.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,672.07
|
| Rate for Payer: BCN Commercial |
$2,416.22
|
| Rate for Payer: Cash Price |
$4,080.00
|
| Rate for Payer: Cash Price |
$4,080.00
|
| Rate for Payer: Meridian Medicaid |
$1,709.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,628.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,315.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,521.22
|
| Rate for Payer: Priority Health Narrow Network |
$3,521.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,153.90
|
| Rate for Payer: UHC Exchange |
$2,153.90
|
| Rate for Payer: UHCCP Medicaid |
$1,628.11
|
|
|
PR VISCO GEL SPACER - LARGE
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00039
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
|
|
PR VISCO GEL SPACER - MEDIUM
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00038
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
|
|
PR VISCO GEL SPACER - SMALL
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00037
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
|
|
PR VISION EXAM
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: ASR Commercial |
$49.47
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$41.76
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.69
|
| Rate for Payer: Priority Health Narrow Network |
$35.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
PR VISION EXAM
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: ASR Commercial |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$41.56
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
PR VISIT TO DETERM LDCT ELIG
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS G0296
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$735.92 |
| Rate for Payer: Aetna Commercial |
$26.13
|
| Rate for Payer: Aetna Medicare |
$27.00
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS Trust/PPO |
$735.92
|
| Rate for Payer: BCN Commercial |
$41.05
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.93
|
| Rate for Payer: Priority Health Narrow Network |
$33.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.22
|
| Rate for Payer: UHC Exchange |
$30.22
|
|
|
PR VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 95930
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$177.45 |
| Rate for Payer: Aetna Commercial |
$71.41
|
| Rate for Payer: Aetna Medicare |
$136.50
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS Trust/PPO |
$64.98
|
| Rate for Payer: BCN Commercial |
$96.76
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.43
|
| Rate for Payer: Priority Health Narrow Network |
$24.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.07
|
| Rate for Payer: UHC Exchange |
$116.07
|
| Rate for Payer: UHCCP Medicaid |
$11.50
|
|
|
PR VISUAL REINFORCEMENT AUDIOMETRY
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 92579
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$2,273.80 |
| Rate for Payer: Aetna Commercial |
$42.06
|
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,273.80
|
| Rate for Payer: BCN Commercial |
$65.48
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.30
|
| Rate for Payer: Priority Health Narrow Network |
$49.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.72
|
| Rate for Payer: UHC Exchange |
$41.72
|
|
|
PR VITAL CAPACITY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 94150
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$1,708.52 |
| Rate for Payer: Aetna Commercial |
$26.29
|
| Rate for Payer: Aetna Medicare |
$22.00
|
| Rate for Payer: BCBS Complete |
$2.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,708.52
|
| Rate for Payer: BCN Commercial |
$36.16
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Meridian Medicaid |
$2.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.97
|
| Rate for Payer: Priority Health Narrow Network |
$4.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.29
|
| Rate for Payer: UHC Exchange |
$23.29
|
| Rate for Payer: UHCCP Medicaid |
$2.34
|
|
|
PR VITAMIN B12 INJECTION
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J3420
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$1.49
|
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.11
|
| Rate for Payer: UHC Exchange |
$1.11
|
|
|
PR VITAMIN K PHYTONADIONE INJ
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J3430
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$2.99
|
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$2.62
|
| Rate for Payer: BCN Commercial |
$2.70
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.85
|
| Rate for Payer: UHC Exchange |
$2.85
|
|
|
PR VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING
|
Professional
|
Both
|
$5,124.00
|
|
|
Service Code
|
HCPCS 33427
|
| Min. Negotiated Rate |
$359.24 |
| Max. Negotiated Rate |
$3,811.05 |
| Rate for Payer: Aetna Commercial |
$3,275.80
|
| Rate for Payer: Aetna Medicare |
$2,562.00
|
| Rate for Payer: BCBS Complete |
$1,607.82
|
| Rate for Payer: BCBS Trust/PPO |
$359.24
|
| Rate for Payer: BCN Commercial |
$3,487.69
|
| Rate for Payer: Cash Price |
$4,099.20
|
| Rate for Payer: Cash Price |
$4,099.20
|
| Rate for Payer: Meridian Medicaid |
$1,607.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,531.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,330.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,811.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,811.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,247.75
|
| Rate for Payer: UHC Exchange |
$3,247.75
|
| Rate for Payer: UHCCP Medicaid |
$1,531.26
|
|
|
PR VLVP MITRAL VALVE W/CARD BYP W/PROSTC RING
|
Professional
|
Both
|
$8,903.00
|
|
|
Service Code
|
HCPCS 33426
|
| Min. Negotiated Rate |
$951.47 |
| Max. Negotiated Rate |
$5,786.95 |
| Rate for Payer: Aetna Commercial |
$3,196.20
|
| Rate for Payer: Aetna Medicare |
$4,451.50
|
| Rate for Payer: BCBS Complete |
$1,573.15
|
| Rate for Payer: BCBS Trust/PPO |
$951.47
|
| Rate for Payer: BCN Commercial |
$3,410.48
|
| Rate for Payer: Cash Price |
$7,122.40
|
| Rate for Payer: Cash Price |
$7,122.40
|
| Rate for Payer: Meridian Medicaid |
$1,573.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,498.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,727.03
|
| Rate for Payer: Priority Health Narrow Network |
$3,727.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,147.31
|
| Rate for Payer: UHC Exchange |
$3,147.31
|
| Rate for Payer: UHCCP Medicaid |
$1,498.24
|
|
|
PR VNPNXR <3 YEARS PHY/QHP SKILL FEMORAL/JUGULAR VN
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 36400
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$2,334.03 |
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna Medicare |
$41.50
|
| Rate for Payer: BCBS Complete |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,334.03
|
| Rate for Payer: BCN Commercial |
$40.07
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Meridian Medicaid |
$12.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.25
|
| Rate for Payer: Priority Health Narrow Network |
$29.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.95
|
| Rate for Payer: UHC Exchange |
$23.95
|
| Rate for Payer: UHCCP Medicaid |
$11.72
|
|
