|
PR DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL
|
Professional
|
Both
|
$1,360.00
|
|
|
Service Code
|
HCPCS 45910
|
| Min. Negotiated Rate |
$119.92 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna Commercial |
$255.45
|
| Rate for Payer: Aetna Medicare |
$680.00
|
| Rate for Payer: BCBS Complete |
$125.92
|
| Rate for Payer: BCN Commercial |
$292.32
|
| Rate for Payer: Cash Price |
$1,088.00
|
| Rate for Payer: Cash Price |
$1,088.00
|
| Rate for Payer: Mclaren Medicaid |
$119.92
|
| Rate for Payer: Meridian Medicaid |
$125.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,020.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$356.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$356.16
|
| Rate for Payer: UHC Medicaid |
$119.92
|
| Rate for Payer: UHCCP Medicaid |
$119.92
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE 1ST
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 53600
|
| Min. Negotiated Rate |
$35.78 |
| Max. Negotiated Rate |
$132.75 |
| Rate for Payer: Aetna Commercial |
$81.77
|
| Rate for Payer: Aetna Medicare |
$88.50
|
| Rate for Payer: BCBS Complete |
$37.57
|
| Rate for Payer: BCN Commercial |
$95.12
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Mclaren Medicaid |
$35.78
|
| Rate for Payer: Meridian Medicaid |
$37.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$103.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.61
|
| Rate for Payer: UHC Medicaid |
$35.78
|
| Rate for Payer: UHCCP Medicaid |
$35.78
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE SBSQ
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 53601
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna Commercial |
$68.82
|
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: BCBS Complete |
$31.98
|
| Rate for Payer: BCN Commercial |
$79.68
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Mclaren Medicaid |
$30.46
|
| Rate for Payer: Meridian Medicaid |
$31.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$86.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.79
|
| Rate for Payer: UHC Medicaid |
$30.46
|
| Rate for Payer: UHCCP Medicaid |
$30.46
|
|
|
PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 53620
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Aetna Commercial |
$111.68
|
| Rate for Payer: Aetna Medicare |
$134.50
|
| Rate for Payer: BCBS Complete |
$51.66
|
| Rate for Payer: BCN Commercial |
$129.48
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Mclaren Medicaid |
$49.20
|
| Rate for Payer: Meridian Medicaid |
$51.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$141.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.04
|
| Rate for Payer: UHC Medicaid |
$49.20
|
| Rate for Payer: UHCCP Medicaid |
$49.20
|
|
|
PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE SBSQ
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS 53621
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$189.75 |
| Rate for Payer: Aetna Commercial |
$91.87
|
| Rate for Payer: Aetna Medicare |
$126.50
|
| Rate for Payer: BCBS Complete |
$42.71
|
| Rate for Payer: BCN Commercial |
$106.57
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Mclaren Medicaid |
$40.68
|
| Rate for Payer: Meridian Medicaid |
$42.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$116.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.08
|
| Rate for Payer: UHC Medicaid |
$40.68
|
| Rate for Payer: UHCCP Medicaid |
$40.68
|
|
|
PR DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 53605
|
| Min. Negotiated Rate |
$35.57 |
| Max. Negotiated Rate |
$103.07 |
| Rate for Payer: Aetna Commercial |
$82.91
|
| Rate for Payer: Aetna Medicare |
$64.50
|
| Rate for Payer: BCBS Complete |
$37.35
|
| Rate for Payer: BCN Commercial |
$94.61
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Mclaren Medicaid |
$35.57
|
| Rate for Payer: Meridian Medicaid |
$37.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$103.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.07
|
| Rate for Payer: UHC Medicaid |
$35.57
|
| Rate for Payer: UHCCP Medicaid |
$35.57
|
|
|
PR DIPHENHYDRAMINE HCL INJECTIO
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS J1200
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna Commercial |
$0.83
|
| Rate for Payer: Aetna Medicare |
$10.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.27
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.75
|
|
|
PR DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 90700
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$36.75 |
| Rate for Payer: Aetna Commercial |
$29.53
|
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: BCBS Trust/PPO |
$29.59
|
| Rate for Payer: BCN Commercial |
$29.53
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.75
|
|
|
PR DIR/PTCH CLS SINUS VENOSUS W/WO ANOM PUL VEN DRG
|
Professional
|
Both
|
$7,857.00
|
|
|
Service Code
|
HCPCS 33645
|
| Min. Negotiated Rate |
$1,031.99 |
| Max. Negotiated Rate |
$5,892.75 |
| Rate for Payer: Aetna Commercial |
$2,324.74
|
| Rate for Payer: Aetna Medicare |
$3,928.50
|
| Rate for Payer: BCBS Complete |
$1,083.59
|
| Rate for Payer: BCN Commercial |
$2,547.17
|
| Rate for Payer: Cash Price |
$6,285.60
|
| Rate for Payer: Cash Price |
$6,285.60
|
| Rate for Payer: Mclaren Medicaid |
$1,031.99
|
| Rate for Payer: Meridian Medicaid |
$1,083.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,892.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,031.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,739.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,739.16
|
| Rate for Payer: UHC Medicaid |
$1,031.99
|
| Rate for Payer: UHCCP Medicaid |
$1,031.99
|
|
|
PR DIR RPR ANEURYSM ABDOM AORTA W/ILIAC VESSELS
|
Professional
|
Both
|
$3,833.00
|
|
|
Service Code
|
HCPCS 35102
|
| Min. Negotiated Rate |
$1,084.60 |
| Max. Negotiated Rate |
$2,948.00 |
| Rate for Payer: Aetna Commercial |
$2,527.67
|
| Rate for Payer: Aetna Medicare |
$1,916.50
|
| Rate for Payer: BCBS Complete |
$1,138.83
|
| Rate for Payer: BCN Commercial |
$2,741.38
|
| Rate for Payer: Cash Price |
$3,066.40
|
| Rate for Payer: Cash Price |
$3,066.40
|
| Rate for Payer: Mclaren Medicaid |
$1,084.60
|
| Rate for Payer: Meridian Medicaid |
$1,138.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,874.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,084.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,948.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,948.00
|
| Rate for Payer: UHC Medicaid |
$1,084.60
|
| Rate for Payer: UHCCP Medicaid |
$1,084.60
|
|
|
PR DIR RPR ANEURYSM ABDOM AORTA W/VISCERAL VESSELS
|
Professional
|
Both
|
$3,680.00
|
|
|
Service Code
|
HCPCS 35091
|
| Min. Negotiated Rate |
$1,022.83 |
| Max. Negotiated Rate |
$2,793.79 |
| Rate for Payer: Aetna Commercial |
$2,414.09
|
| Rate for Payer: Aetna Medicare |
$1,840.00
|
| Rate for Payer: BCBS Complete |
$1,073.97
|
| Rate for Payer: BCN Commercial |
$2,597.96
|
| Rate for Payer: Cash Price |
$2,944.00
|
| Rate for Payer: Cash Price |
$2,944.00
|
| Rate for Payer: Mclaren Medicaid |
$1,022.83
|
| Rate for Payer: Meridian Medicaid |
$1,073.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,760.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,022.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,793.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,793.79
|
| Rate for Payer: UHC Medicaid |
$1,022.83
|
| Rate for Payer: UHCCP Medicaid |
$1,022.83
|
|
|
PR DIR RPR ANEURYSM ABDOMINAL AORTA
|
Professional
|
Both
|
$5,852.00
|
|
|
Service Code
|
HCPCS 35081
|
| Min. Negotiated Rate |
$1,003.66 |
| Max. Negotiated Rate |
$4,389.00 |
| Rate for Payer: Aetna Commercial |
$2,327.67
|
| Rate for Payer: Aetna Medicare |
$2,926.00
|
| Rate for Payer: BCBS Complete |
$1,053.84
|
| Rate for Payer: BCN Commercial |
$2,523.27
|
| Rate for Payer: Cash Price |
$4,681.60
|
| Rate for Payer: Cash Price |
$4,681.60
|
| Rate for Payer: Mclaren Medicaid |
$1,003.66
|
| Rate for Payer: Meridian Medicaid |
$1,053.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,389.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,003.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,713.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,713.46
|
| Rate for Payer: UHC Medicaid |
$1,003.66
|
| Rate for Payer: UHCCP Medicaid |
$1,003.66
|
|
|
PR DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION
|
Professional
|
Both
|
$3,832.00
|
|
|
Service Code
|
HCPCS 35011
|
| Min. Negotiated Rate |
$582.98 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna Commercial |
$1,351.29
|
| Rate for Payer: Aetna Medicare |
$1,916.00
|
| Rate for Payer: BCBS Complete |
$612.13
|
| Rate for Payer: BCN Commercial |
$1,476.51
|
| Rate for Payer: Cash Price |
$3,065.60
|
| Rate for Payer: Cash Price |
$3,065.60
|
| Rate for Payer: Mclaren Medicaid |
$582.98
|
| Rate for Payer: Meridian Medicaid |
$612.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,874.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$582.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,587.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,587.80
|
| Rate for Payer: UHC Medicaid |
$582.98
|
| Rate for Payer: UHCCP Medicaid |
$582.98
|
|
|
PR DIR RPR ANEURYSM CAROTID-SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$2,279.00
|
|
|
Service Code
|
HCPCS 35001
|
| Min. Negotiated Rate |
$641.98 |
| Max. Negotiated Rate |
$1,745.24 |
| Rate for Payer: Aetna Commercial |
$1,514.12
|
| Rate for Payer: Aetna Medicare |
$1,139.50
|
| Rate for Payer: BCBS Complete |
$674.08
|
| Rate for Payer: BCN Commercial |
$1,622.92
|
| Rate for Payer: Cash Price |
$1,823.20
|
| Rate for Payer: Cash Price |
$1,823.20
|
| Rate for Payer: Mclaren Medicaid |
$641.98
|
| Rate for Payer: Meridian Medicaid |
$674.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,709.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$641.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,745.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,745.24
|
| Rate for Payer: UHC Medicaid |
$641.98
|
| Rate for Payer: UHCCP Medicaid |
$641.98
|
|
|
PR DIR RPR ANEURYSM & GRAFT COMMON FEMORAL ARTERY
|
Professional
|
Both
|
$2,241.00
|
|
|
Service Code
|
HCPCS 35141
|
| Min. Negotiated Rate |
$631.76 |
| Max. Negotiated Rate |
$1,715.79 |
| Rate for Payer: Aetna Commercial |
$1,476.41
|
| Rate for Payer: Aetna Medicare |
$1,120.50
|
| Rate for Payer: BCBS Complete |
$663.35
|
| Rate for Payer: BCN Commercial |
$1,595.53
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Mclaren Medicaid |
$631.76
|
| Rate for Payer: Meridian Medicaid |
$663.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,680.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$631.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,715.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,715.79
|
| Rate for Payer: UHC Medicaid |
$631.76
|
| Rate for Payer: UHCCP Medicaid |
$631.76
|
|
|
PR DIR RPR ANEURYSM & GRAFT ILIAC ARTERY
|
Professional
|
Both
|
$5,104.00
|
|
|
Service Code
|
HCPCS 35131
|
| Min. Negotiated Rate |
$803.01 |
| Max. Negotiated Rate |
$3,828.00 |
| Rate for Payer: Aetna Commercial |
$1,850.09
|
| Rate for Payer: Aetna Medicare |
$2,552.00
|
| Rate for Payer: BCBS Complete |
$843.16
|
| Rate for Payer: BCN Commercial |
$2,025.28
|
| Rate for Payer: Cash Price |
$4,083.20
|
| Rate for Payer: Cash Price |
$4,083.20
|
| Rate for Payer: Mclaren Medicaid |
$803.01
|
| Rate for Payer: Meridian Medicaid |
$843.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,828.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$803.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,177.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,177.94
|
| Rate for Payer: UHC Medicaid |
$803.01
|
| Rate for Payer: UHCCP Medicaid |
$803.01
|
|
|
PR DIR RPR ANEURYSM & GRAFT POPLITEAL ARTERY
|
Professional
|
Both
|
$2,531.00
|
|
|
Service Code
|
HCPCS 35151
|
| Min. Negotiated Rate |
$716.11 |
| Max. Negotiated Rate |
$1,944.45 |
| Rate for Payer: Aetna Commercial |
$1,658.62
|
| Rate for Payer: Aetna Medicare |
$1,265.50
|
| Rate for Payer: BCBS Complete |
$751.92
|
| Rate for Payer: BCN Commercial |
$1,808.17
|
| Rate for Payer: Cash Price |
$2,024.80
|
| Rate for Payer: Cash Price |
$2,024.80
|
| Rate for Payer: Mclaren Medicaid |
$716.11
|
| Rate for Payer: Meridian Medicaid |
$751.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,898.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$716.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,944.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,944.45
|
| Rate for Payer: UHC Medicaid |
$716.11
|
| Rate for Payer: UHCCP Medicaid |
$716.11
|
|
|
PR DIR RPR ANEURYSM HEPATIC/CELIAC/RENAL/MESENTERIC
|
Professional
|
Both
|
$3,292.00
|
|
|
Service Code
|
HCPCS 35121
|
| Min. Negotiated Rate |
$916.33 |
| Max. Negotiated Rate |
$2,484.80 |
| Rate for Payer: Aetna Commercial |
$2,126.67
|
| Rate for Payer: Aetna Medicare |
$1,646.00
|
| Rate for Payer: BCBS Complete |
$962.15
|
| Rate for Payer: BCN Commercial |
$2,310.63
|
| Rate for Payer: Cash Price |
$2,633.60
|
| Rate for Payer: Cash Price |
$2,633.60
|
| Rate for Payer: Mclaren Medicaid |
$916.33
|
| Rate for Payer: Meridian Medicaid |
$962.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,469.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$916.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,484.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,484.80
|
| Rate for Payer: UHC Medicaid |
$916.33
|
| Rate for Payer: UHCCP Medicaid |
$916.33
|
|
|
PR DIR RPR ANEURYSM SPLENIC ARTERY
|
Professional
|
Both
|
$2,857.00
|
|
|
Service Code
|
HCPCS 35111
|
| Min. Negotiated Rate |
$770.63 |
| Max. Negotiated Rate |
$2,142.75 |
| Rate for Payer: Aetna Commercial |
$1,786.57
|
| Rate for Payer: Aetna Medicare |
$1,428.50
|
| Rate for Payer: BCBS Complete |
$809.16
|
| Rate for Payer: BCN Commercial |
$1,944.12
|
| Rate for Payer: Cash Price |
$2,285.60
|
| Rate for Payer: Cash Price |
$2,285.60
|
| Rate for Payer: Mclaren Medicaid |
$770.63
|
| Rate for Payer: Meridian Medicaid |
$809.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,142.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$770.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,090.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,090.66
|
| Rate for Payer: UHC Medicaid |
$770.63
|
| Rate for Payer: UHCCP Medicaid |
$770.63
|
|
|
PR DIR RPR RUPTD ANEURSM ABDOM AORTA W/VISCERA VSLS
|
Professional
|
Both
|
$5,663.00
|
|
|
Service Code
|
HCPCS 35092
|
| Min. Negotiated Rate |
$1,461.18 |
| Max. Negotiated Rate |
$4,247.25 |
| Rate for Payer: Aetna Commercial |
$3,485.74
|
| Rate for Payer: Aetna Medicare |
$2,831.50
|
| Rate for Payer: BCBS Complete |
$1,534.24
|
| Rate for Payer: BCN Commercial |
$3,786.15
|
| Rate for Payer: Cash Price |
$4,530.40
|
| Rate for Payer: Cash Price |
$4,530.40
|
| Rate for Payer: Mclaren Medicaid |
$1,461.18
|
| Rate for Payer: Meridian Medicaid |
$1,534.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,247.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,461.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,071.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,071.52
|
| Rate for Payer: UHC Medicaid |
$1,461.18
|
| Rate for Payer: UHCCP Medicaid |
$1,461.18
|
|
|
PR DIR RPR RUPTD ANEURSM HEPATIC/CELIAC/RENAL/MESEN
|
Professional
|
Both
|
$3,975.00
|
|
|
Service Code
|
HCPCS 35122
|
| Min. Negotiated Rate |
$1,094.61 |
| Max. Negotiated Rate |
$2,981.25 |
| Rate for Payer: Aetna Commercial |
$2,544.07
|
| Rate for Payer: Aetna Medicare |
$1,987.50
|
| Rate for Payer: BCBS Complete |
$1,149.34
|
| Rate for Payer: BCN Commercial |
$2,760.80
|
| Rate for Payer: Cash Price |
$3,180.00
|
| Rate for Payer: Cash Price |
$3,180.00
|
| Rate for Payer: Mclaren Medicaid |
$1,094.61
|
| Rate for Payer: Meridian Medicaid |
$1,149.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,981.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,094.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,968.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,968.90
|
| Rate for Payer: UHC Medicaid |
$1,094.61
|
| Rate for Payer: UHCCP Medicaid |
$1,094.61
|
|
|
PR DIR RPR RUPTD ANEURYSM ABDOM AORTA W/ILIAC VSLS
|
Professional
|
Both
|
$3,667.00
|
|
|
Service Code
|
HCPCS 35103
|
| Min. Negotiated Rate |
$1,253.93 |
| Max. Negotiated Rate |
$3,401.07 |
| Rate for Payer: Aetna Commercial |
$2,999.96
|
| Rate for Payer: Aetna Medicare |
$1,833.50
|
| Rate for Payer: BCBS Complete |
$1,316.63
|
| Rate for Payer: BCN Commercial |
$3,162.67
|
| Rate for Payer: Cash Price |
$2,933.60
|
| Rate for Payer: Cash Price |
$2,933.60
|
| Rate for Payer: Mclaren Medicaid |
$1,253.93
|
| Rate for Payer: Meridian Medicaid |
$1,316.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,750.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,253.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,401.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,401.07
|
| Rate for Payer: UHC Medicaid |
$1,253.93
|
| Rate for Payer: UHCCP Medicaid |
$1,253.93
|
|
|
PR DIR RPR RUPTD ANEURYSM ABDOMINAL AORTA
|
Professional
|
Both
|
$4,415.00
|
|
|
Service Code
|
HCPCS 35082
|
| Min. Negotiated Rate |
$1,246.90 |
| Max. Negotiated Rate |
$3,399.99 |
| Rate for Payer: Aetna Commercial |
$2,925.76
|
| Rate for Payer: Aetna Medicare |
$2,207.50
|
| Rate for Payer: BCBS Complete |
$1,309.24
|
| Rate for Payer: BCN Commercial |
$3,161.68
|
| Rate for Payer: Cash Price |
$3,532.00
|
| Rate for Payer: Cash Price |
$3,532.00
|
| Rate for Payer: Mclaren Medicaid |
$1,246.90
|
| Rate for Payer: Meridian Medicaid |
$1,309.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,311.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,246.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,399.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,399.99
|
| Rate for Payer: UHC Medicaid |
$1,246.90
|
| Rate for Payer: UHCCP Medicaid |
$1,246.90
|
|
|
PR DIR RPR RUPTD ANEURYSM AXIL-BRACHIAL ARM INCIS
|
Professional
|
Both
|
$4,045.00
|
|
|
Service Code
|
HCPCS 35013
|
| Min. Negotiated Rate |
$688.20 |
| Max. Negotiated Rate |
$3,033.75 |
| Rate for Payer: Aetna Commercial |
$1,693.49
|
| Rate for Payer: Aetna Medicare |
$2,022.50
|
| Rate for Payer: BCBS Complete |
$722.61
|
| Rate for Payer: BCN Commercial |
$1,734.47
|
| Rate for Payer: Cash Price |
$3,236.00
|
| Rate for Payer: Cash Price |
$3,236.00
|
| Rate for Payer: Mclaren Medicaid |
$688.20
|
| Rate for Payer: Meridian Medicaid |
$722.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,033.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$688.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,865.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,865.20
|
| Rate for Payer: UHC Medicaid |
$688.20
|
| Rate for Payer: UHCCP Medicaid |
$688.20
|
|
|
PR DIR RPR RUPTD ANEURYSM CAROTID-SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$2,618.00
|
|
|
Service Code
|
HCPCS 35002
|
| Min. Negotiated Rate |
$661.15 |
| Max. Negotiated Rate |
$1,963.50 |
| Rate for Payer: Aetna Commercial |
$1,529.14
|
| Rate for Payer: Aetna Medicare |
$1,309.00
|
| Rate for Payer: BCBS Complete |
$694.21
|
| Rate for Payer: BCN Commercial |
$1,666.74
|
| Rate for Payer: Cash Price |
$2,094.40
|
| Rate for Payer: Cash Price |
$2,094.40
|
| Rate for Payer: Mclaren Medicaid |
$661.15
|
| Rate for Payer: Meridian Medicaid |
$694.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,963.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$661.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,792.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,792.37
|
| Rate for Payer: UHC Medicaid |
$661.15
|
| Rate for Payer: UHCCP Medicaid |
$661.15
|
|
