|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
43450
|
| Min. Negotiated Rate |
$77.90 |
| Max. Negotiated Rate |
$697.40 |
| Rate for Payer: Aetna Commercial |
$278.80
|
| Rate for Payer: Aetna Medicare |
$85.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.50
|
| Rate for Payer: BCBS Complete |
$697.40
|
| Rate for Payer: BCBS MAPPO |
$82.00
|
| Rate for Payer: BCBS Trust/PPO |
$269.65
|
| Rate for Payer: BCN Commercial |
$255.02
|
| Rate for Payer: BCN Medicare Advantage |
$82.00
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$282.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.00
|
| Rate for Payer: Healthscope Commercial |
$295.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.00
|
| Rate for Payer: Mclaren Medicaid |
$664.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.10
|
| Rate for Payer: Meridian Medicaid |
$697.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: Nomi Health Commercial |
$268.96
|
| Rate for Payer: PACE Senior Care Partners |
$77.90
|
| Rate for Payer: PACE SWMI |
$82.00
|
| Rate for Payer: PHP Commercial |
$278.80
|
| Rate for Payer: PHP Medicare Advantage |
$82.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$664.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO |
$285.36
|
| Rate for Payer: Priority Health Medicare |
$82.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.76
|
| Rate for Payer: Railroad Medicare Medicare |
$82.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.64
|
| Rate for Payer: UHC Core |
$273.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.00
|
| Rate for Payer: UHC Exchange |
$82.00
|
| Rate for Payer: UHC Medicare Advantage |
$82.00
|
| Rate for Payer: UHCCP Medicaid |
$664.15
|
| Rate for Payer: VA VA |
$82.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.00
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 43450
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$1,202.94 |
| Rate for Payer: Aetna Commercial |
$100.73
|
| Rate for Payer: Aetna Medicare |
$78.18
|
| Rate for Payer: BCBS Complete |
$53.22
|
| Rate for Payer: BCBS MAPPO |
$75.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.94
|
| Rate for Payer: BCN Commercial |
$275.61
|
| Rate for Payer: BCN Medicare Advantage |
$75.17
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$108.24
|
| Rate for Payer: Cofinity Commercial |
$100.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.17
|
| Rate for Payer: Mclaren Medicaid |
$50.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.93
|
| Rate for Payer: Meridian Medicaid |
$53.22
|
| Rate for Payer: Nomi Health Commercial |
$90.20
|
| Rate for Payer: PACE SWMI |
$75.17
|
| Rate for Payer: PHP Medicare Advantage |
$75.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO |
$141.39
|
| Rate for Payer: Priority Health Medicare |
$75.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.17
|
| Rate for Payer: UHC Exchange |
$75.17
|
| Rate for Payer: UHC Medicare Advantage |
$75.17
|
| Rate for Payer: UHCCP Medicaid |
$50.69
|
|
|
PR DILATION LACRIMAL PUNCTUM W/WO IRRGATION
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 68801
|
| Min. Negotiated Rate |
$50.48 |
| Max. Negotiated Rate |
$1,061.88 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Aetna Medicare |
$75.44
|
| Rate for Payer: BCBS Complete |
$53.00
|
| Rate for Payer: BCBS MAPPO |
$72.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.88
|
| Rate for Payer: BCN Commercial |
$112.30
|
| Rate for Payer: BCN Medicare Advantage |
$72.54
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$97.20
|
| Rate for Payer: Cofinity Commercial |
$104.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.54
|
| Rate for Payer: Mclaren Medicaid |
$50.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.17
|
| Rate for Payer: Meridian Medicaid |
$53.00
|
| Rate for Payer: Nomi Health Commercial |
$87.05
|
| Rate for Payer: PACE SWMI |
$72.54
|
| Rate for Payer: PHP Medicare Advantage |
$72.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health HMO/PPO |
$139.20
|
| Rate for Payer: Priority Health Medicare |
$73.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.54
|
| Rate for Payer: UHC Exchange |
$72.54
|
| Rate for Payer: UHC Medicare Advantage |
$72.54
|
| Rate for Payer: UHCCP Medicaid |
$50.48
|
|
|
PR DILATION SALIVARY DUCT
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 42650
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$619.17 |
| Rate for Payer: Aetna Commercial |
$75.80
|
| Rate for Payer: Aetna Medicare |
$58.83
|
| Rate for Payer: BCBS Complete |
$40.48
|
| Rate for Payer: BCBS MAPPO |
$56.57
|
| Rate for Payer: BCBS Trust/PPO |
$619.17
|
| Rate for Payer: BCN Commercial |
$109.95
|
| Rate for Payer: BCN Medicare Advantage |
$56.57
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$81.46
|
| Rate for Payer: Cofinity Commercial |
$75.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.57
|
| Rate for Payer: Mclaren Medicaid |
$38.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.40
|
| Rate for Payer: Meridian Medicaid |
$40.48
|
| Rate for Payer: Nomi Health Commercial |
$67.88
|
| Rate for Payer: PACE SWMI |
$56.57
|
| Rate for Payer: PHP Medicare Advantage |
$56.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health HMO/PPO |
$106.19
|
| Rate for Payer: Priority Health Medicare |
$57.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.57
|
| Rate for Payer: UHC Exchange |
$56.57
|
| Rate for Payer: UHC Medicare Advantage |
$56.57
|
| Rate for Payer: UHCCP Medicaid |
$38.55
|
|
|
PR DILATION VAGINA W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 57400
|
| Min. Negotiated Rate |
$83.50 |
| Max. Negotiated Rate |
$1,877.58 |
| Rate for Payer: Aetna Commercial |
$167.97
|
| Rate for Payer: Aetna Medicare |
$130.36
|
| Rate for Payer: BCBS Complete |
$87.68
|
| Rate for Payer: BCBS MAPPO |
$125.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,877.58
|
| Rate for Payer: BCN Commercial |
$188.63
|
| Rate for Payer: BCN Medicare Advantage |
$125.35
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cofinity Commercial |
$180.50
|
| Rate for Payer: Cofinity Commercial |
$167.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.35
|
| Rate for Payer: Mclaren Medicaid |
$83.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.62
|
| Rate for Payer: Meridian Medicaid |
$87.68
|
| Rate for Payer: Nomi Health Commercial |
$150.42
|
| Rate for Payer: PACE SWMI |
$125.35
|
| Rate for Payer: PHP Medicare Advantage |
$125.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.50
|
| Rate for Payer: Priority Health HMO/PPO |
$193.95
|
| Rate for Payer: Priority Health Medicare |
$126.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.35
|
| Rate for Payer: UHC Exchange |
$125.35
|
| Rate for Payer: UHC Medicare Advantage |
$125.35
|
| Rate for Payer: UHCCP Medicaid |
$83.50
|
|
|
PR DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 45910
|
| Min. Negotiated Rate |
$125.03 |
| Max. Negotiated Rate |
$1,149.58 |
| Rate for Payer: Aetna Commercial |
$248.46
|
| Rate for Payer: Aetna Medicare |
$192.84
|
| Rate for Payer: BCBS Complete |
$131.28
|
| Rate for Payer: BCBS MAPPO |
$185.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,149.58
|
| Rate for Payer: BCN Commercial |
$281.97
|
| Rate for Payer: BCN Medicare Advantage |
$185.42
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cofinity Commercial |
$267.00
|
| Rate for Payer: Cofinity Commercial |
$248.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.42
|
| Rate for Payer: Mclaren Medicaid |
$125.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.69
|
| Rate for Payer: Meridian Medicaid |
$131.28
|
| Rate for Payer: Nomi Health Commercial |
$222.50
|
| Rate for Payer: PACE SWMI |
$185.42
|
| Rate for Payer: PHP Medicare Advantage |
$185.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$858.00
|
| Rate for Payer: Priority Health HMO/PPO |
$347.21
|
| Rate for Payer: Priority Health Medicare |
$187.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$347.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.42
|
| Rate for Payer: UHC Exchange |
$185.42
|
| Rate for Payer: UHC Medicare Advantage |
$185.42
|
| Rate for Payer: UHCCP Medicaid |
$125.03
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE 1ST
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 53600
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$549.43 |
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna Medicare |
$63.56
|
| Rate for Payer: BCBS Complete |
$42.71
|
| Rate for Payer: BCBS MAPPO |
$61.12
|
| Rate for Payer: BCBS Trust/PPO |
$549.43
|
| Rate for Payer: BCN Commercial |
$129.50
|
| Rate for Payer: BCN Medicare Advantage |
$61.12
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$88.01
|
| Rate for Payer: Cofinity Commercial |
$81.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.12
|
| Rate for Payer: Mclaren Medicaid |
$40.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.18
|
| Rate for Payer: Meridian Medicaid |
$42.71
|
| Rate for Payer: Nomi Health Commercial |
$73.34
|
| Rate for Payer: PACE SWMI |
$61.12
|
| Rate for Payer: PHP Medicare Advantage |
$61.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.80
|
| Rate for Payer: Priority Health HMO/PPO |
$100.13
|
| Rate for Payer: Priority Health Medicare |
$61.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.12
|
| Rate for Payer: UHC Exchange |
$61.12
|
| Rate for Payer: UHC Medicare Advantage |
$61.12
|
| Rate for Payer: UHCCP Medicaid |
$40.68
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE SBSQ
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 53601
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$244.07 |
| Rate for Payer: Aetna Commercial |
$68.43
|
| Rate for Payer: Aetna Medicare |
$53.11
|
| Rate for Payer: BCBS Complete |
$35.78
|
| Rate for Payer: BCBS MAPPO |
$51.07
|
| Rate for Payer: BCBS Trust/PPO |
$244.07
|
| Rate for Payer: BCN Commercial |
$124.13
|
| Rate for Payer: BCN Medicare Advantage |
$51.07
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$73.54
|
| Rate for Payer: Cofinity Commercial |
$68.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.07
|
| Rate for Payer: Mclaren Medicaid |
$34.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.62
|
| Rate for Payer: Meridian Medicaid |
$35.78
|
| Rate for Payer: Nomi Health Commercial |
$61.28
|
| Rate for Payer: PACE SWMI |
$51.07
|
| Rate for Payer: PHP Medicare Advantage |
$51.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health HMO/PPO |
$84.14
|
| Rate for Payer: Priority Health Medicare |
$51.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.07
|
| Rate for Payer: UHC Exchange |
$51.07
|
| Rate for Payer: UHC Medicare Advantage |
$51.07
|
| Rate for Payer: UHCCP Medicaid |
$34.08
|
|
|
PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 53620
|
| Min. Negotiated Rate |
$55.38 |
| Max. Negotiated Rate |
$1,543.16 |
| Rate for Payer: Aetna Commercial |
$111.18
|
| Rate for Payer: Aetna Medicare |
$86.29
|
| Rate for Payer: BCBS Complete |
$58.15
|
| Rate for Payer: BCBS MAPPO |
$82.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.16
|
| Rate for Payer: BCN Commercial |
$248.73
|
| Rate for Payer: BCN Medicare Advantage |
$82.97
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$119.48
|
| Rate for Payer: Cofinity Commercial |
$111.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.97
|
| Rate for Payer: Mclaren Medicaid |
$55.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.12
|
| Rate for Payer: Meridian Medicaid |
$58.15
|
| Rate for Payer: Nomi Health Commercial |
$99.56
|
| Rate for Payer: PACE SWMI |
$82.97
|
| Rate for Payer: PHP Medicare Advantage |
$82.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: Priority Health HMO/PPO |
$137.41
|
| Rate for Payer: Priority Health Medicare |
$83.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.97
|
| Rate for Payer: UHC Exchange |
$82.97
|
| Rate for Payer: UHC Medicare Advantage |
$82.97
|
| Rate for Payer: UHCCP Medicaid |
$55.38
|
|
|
PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE SBSQ
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 53621
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna Commercial |
$91.52
|
| Rate for Payer: Aetna Medicare |
$71.03
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS MAPPO |
$68.30
|
| Rate for Payer: BCBS Trust/PPO |
$924.00
|
| Rate for Payer: BCN Commercial |
$237.98
|
| Rate for Payer: BCN Medicare Advantage |
$68.30
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$98.35
|
| Rate for Payer: Cofinity Commercial |
$91.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.30
|
| Rate for Payer: Mclaren Medicaid |
$45.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.72
|
| Rate for Payer: Meridian Medicaid |
$47.86
|
| Rate for Payer: Nomi Health Commercial |
$81.96
|
| Rate for Payer: PACE SWMI |
$68.30
|
| Rate for Payer: PHP Medicare Advantage |
$68.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.90
|
| Rate for Payer: Priority Health HMO/PPO |
$113.44
|
| Rate for Payer: Priority Health Medicare |
$68.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.30
|
| Rate for Payer: UHC Exchange |
$68.30
|
| Rate for Payer: UHC Medicare Advantage |
$68.30
|
| Rate for Payer: UHCCP Medicaid |
$45.58
|
|
|
PR DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 53605
|
| Min. Negotiated Rate |
$40.47 |
| Max. Negotiated Rate |
$1,411.09 |
| Rate for Payer: Aetna Commercial |
$81.78
|
| Rate for Payer: Aetna Medicare |
$63.47
|
| Rate for Payer: BCBS Complete |
$42.49
|
| Rate for Payer: BCBS MAPPO |
$61.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,411.09
|
| Rate for Payer: BCN Commercial |
$92.36
|
| Rate for Payer: BCN Medicare Advantage |
$61.03
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$87.88
|
| Rate for Payer: Cofinity Commercial |
$81.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.03
|
| Rate for Payer: Mclaren Medicaid |
$40.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.08
|
| Rate for Payer: Meridian Medicaid |
$42.49
|
| Rate for Payer: Nomi Health Commercial |
$73.24
|
| Rate for Payer: PACE SWMI |
$61.03
|
| Rate for Payer: PHP Medicare Advantage |
$61.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health HMO/PPO |
$100.66
|
| Rate for Payer: Priority Health Medicare |
$61.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.03
|
| Rate for Payer: UHC Exchange |
$61.03
|
| Rate for Payer: UHC Medicare Advantage |
$61.03
|
| Rate for Payer: UHCCP Medicaid |
$40.47
|
|
|
PR DIPHENHYDRAMINE HCL INJECTIO
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J1200
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$1.21
|
| Rate for Payer: Aetna Medicare |
$0.94
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$0.90
|
| Rate for Payer: BCBS Trust/PPO |
$0.39
|
| Rate for Payer: BCN Commercial |
$0.58
|
| Rate for Payer: BCN Medicare Advantage |
$0.90
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$1.30
|
| Rate for Payer: Cofinity Commercial |
$1.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.95
|
| Rate for Payer: Nomi Health Commercial |
$1.08
|
| Rate for Payer: PACE SWMI |
$0.90
|
| Rate for Payer: PHP Medicare Advantage |
$0.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$0.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.90
|
| Rate for Payer: UHC Exchange |
$0.90
|
| Rate for Payer: UHC Medicare Advantage |
$0.90
|
|
|
PR DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 90700
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$34.91 |
| Rate for Payer: Aetna Commercial |
$29.53
|
| Rate for Payer: Aetna Medicare |
$24.00
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS Trust/PPO |
$34.91
|
| Rate for Payer: BCN Commercial |
$34.91
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
|
|
PR DIR/PTCH CLS SINUS VENOSUS W/WO ANOM PUL VEN DRG
|
Professional
|
Both
|
$7,628.00
|
|
|
Service Code
|
HCPCS 33645
|
| Min. Negotiated Rate |
$1,089.50 |
| Max. Negotiated Rate |
$4,958.20 |
| Rate for Payer: Aetna Commercial |
$2,227.48
|
| Rate for Payer: Aetna Medicare |
$1,728.79
|
| Rate for Payer: BCBS Complete |
$1,143.98
|
| Rate for Payer: BCBS MAPPO |
$1,662.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,139.01
|
| Rate for Payer: BCN Commercial |
$2,482.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,662.30
|
| Rate for Payer: Cash Price |
$6,102.40
|
| Rate for Payer: Cash Price |
$6,102.40
|
| Rate for Payer: Cofinity Commercial |
$2,227.48
|
| Rate for Payer: Cofinity Commercial |
$2,393.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,662.30
|
| Rate for Payer: Mclaren Medicaid |
$1,089.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,745.42
|
| Rate for Payer: Meridian Medicaid |
$1,143.98
|
| Rate for Payer: Nomi Health Commercial |
$1,994.76
|
| Rate for Payer: PACE SWMI |
$1,662.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,662.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,958.20
|
| Rate for Payer: Priority Health HMO/PPO |
$2,712.30
|
| Rate for Payer: Priority Health Medicare |
$1,678.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,712.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,662.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,662.30
|
| Rate for Payer: UHC Exchange |
$1,662.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,662.30
|
| Rate for Payer: UHCCP Medicaid |
$1,089.50
|
|
|
PR DIR RPR ANEURYSM ABDOM AORTA W/ILIAC VESSELS
|
Professional
|
Both
|
$3,721.00
|
|
|
Service Code
|
HCPCS 35102
|
| Min. Negotiated Rate |
$1,172.57 |
| Max. Negotiated Rate |
$2,929.82 |
| Rate for Payer: Aetna Commercial |
$2,416.64
|
| Rate for Payer: Aetna Medicare |
$1,875.60
|
| Rate for Payer: BCBS Complete |
$1,231.20
|
| Rate for Payer: BCBS MAPPO |
$1,803.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,938.33
|
| Rate for Payer: BCN Commercial |
$2,674.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,803.46
|
| Rate for Payer: Cash Price |
$2,976.80
|
| Rate for Payer: Cash Price |
$2,976.80
|
| Rate for Payer: Cofinity Commercial |
$2,596.98
|
| Rate for Payer: Cofinity Commercial |
$2,416.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,803.46
|
| Rate for Payer: Mclaren Medicaid |
$1,172.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,893.63
|
| Rate for Payer: Meridian Medicaid |
$1,231.20
|
| Rate for Payer: Nomi Health Commercial |
$2,164.15
|
| Rate for Payer: PACE SWMI |
$1,803.46
|
| Rate for Payer: PHP Medicare Advantage |
$1,803.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,172.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,418.65
|
| Rate for Payer: Priority Health HMO/PPO |
$2,929.82
|
| Rate for Payer: Priority Health Medicare |
$1,821.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,929.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,803.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,803.46
|
| Rate for Payer: UHC Exchange |
$1,803.46
|
| Rate for Payer: UHC Medicare Advantage |
$1,803.46
|
| Rate for Payer: UHCCP Medicaid |
$1,172.57
|
|
|
PR DIR RPR ANEURYSM ABDOM AORTA W/VISCERAL VESSELS
|
Professional
|
Both
|
$3,573.00
|
|
|
Service Code
|
HCPCS 35091
|
| Min. Negotiated Rate |
$1,111.22 |
| Max. Negotiated Rate |
$2,767.61 |
| Rate for Payer: Aetna Commercial |
$2,294.84
|
| Rate for Payer: Aetna Medicare |
$1,781.07
|
| Rate for Payer: BCBS Complete |
$1,166.78
|
| Rate for Payer: BCBS MAPPO |
$1,712.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.81
|
| Rate for Payer: BCN Commercial |
$2,536.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,712.57
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cofinity Commercial |
$2,466.10
|
| Rate for Payer: Cofinity Commercial |
$2,294.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,712.57
|
| Rate for Payer: Mclaren Medicaid |
$1,111.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,798.20
|
| Rate for Payer: Meridian Medicaid |
$1,166.78
|
| Rate for Payer: Nomi Health Commercial |
$2,055.08
|
| Rate for Payer: PACE SWMI |
$1,712.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,712.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,111.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,322.45
|
| Rate for Payer: Priority Health HMO/PPO |
$2,767.61
|
| Rate for Payer: Priority Health Medicare |
$1,729.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,767.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,712.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,712.57
|
| Rate for Payer: UHC Exchange |
$1,712.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,712.57
|
| Rate for Payer: UHCCP Medicaid |
$1,111.22
|
|
|
PR DIR RPR ANEURYSM ABDOMINAL AORTA
|
Professional
|
Both
|
$5,682.00
|
|
|
Service Code
|
HCPCS 35081
|
| Min. Negotiated Rate |
$1,079.27 |
| Max. Negotiated Rate |
$3,693.30 |
| Rate for Payer: Aetna Commercial |
$2,223.14
|
| Rate for Payer: Aetna Medicare |
$1,725.42
|
| Rate for Payer: BCBS Complete |
$1,133.23
|
| Rate for Payer: BCBS MAPPO |
$1,659.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,076.67
|
| Rate for Payer: BCN Commercial |
$2,467.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,659.06
|
| Rate for Payer: Cash Price |
$4,545.60
|
| Rate for Payer: Cash Price |
$4,545.60
|
| Rate for Payer: Cofinity Commercial |
$2,389.05
|
| Rate for Payer: Cofinity Commercial |
$2,223.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,659.06
|
| Rate for Payer: Mclaren Medicaid |
$1,079.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,742.01
|
| Rate for Payer: Meridian Medicaid |
$1,133.23
|
| Rate for Payer: Nomi Health Commercial |
$1,990.87
|
| Rate for Payer: PACE SWMI |
$1,659.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,659.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,079.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,693.30
|
| Rate for Payer: Priority Health HMO/PPO |
$2,694.76
|
| Rate for Payer: Priority Health Medicare |
$1,675.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,694.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,659.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,659.06
|
| Rate for Payer: UHC Exchange |
$1,659.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,659.06
|
| Rate for Payer: UHCCP Medicaid |
$1,079.27
|
|
|
PR DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION
|
Professional
|
Both
|
$3,720.00
|
|
|
Service Code
|
HCPCS 35011
|
| Min. Negotiated Rate |
$631.55 |
| Max. Negotiated Rate |
$2,418.00 |
| Rate for Payer: Aetna Commercial |
$1,294.47
|
| Rate for Payer: Aetna Medicare |
$1,004.66
|
| Rate for Payer: BCBS Complete |
$663.13
|
| Rate for Payer: BCBS MAPPO |
$966.02
|
| Rate for Payer: BCBS Trust/PPO |
$767.09
|
| Rate for Payer: BCN Commercial |
$1,445.02
|
| Rate for Payer: BCN Medicare Advantage |
$966.02
|
| Rate for Payer: Cash Price |
$2,976.00
|
| Rate for Payer: Cash Price |
$2,976.00
|
| Rate for Payer: Cofinity Commercial |
$1,391.07
|
| Rate for Payer: Cofinity Commercial |
$1,294.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$966.02
|
| Rate for Payer: Mclaren Medicaid |
$631.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,014.32
|
| Rate for Payer: Meridian Medicaid |
$663.13
|
| Rate for Payer: Nomi Health Commercial |
$1,159.22
|
| Rate for Payer: PACE SWMI |
$966.02
|
| Rate for Payer: PHP Medicare Advantage |
$966.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$631.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,418.00
|
| Rate for Payer: Priority Health HMO/PPO |
$1,578.45
|
| Rate for Payer: Priority Health Medicare |
$975.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,578.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$966.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$966.02
|
| Rate for Payer: UHC Exchange |
$966.02
|
| Rate for Payer: UHC Medicare Advantage |
$966.02
|
| Rate for Payer: UHCCP Medicaid |
$631.55
|
|
|
PR DIR RPR ANEURYSM CAROTID-SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$2,213.00
|
|
|
Service Code
|
HCPCS 35001
|
| Min. Negotiated Rate |
$694.17 |
| Max. Negotiated Rate |
$2,601.88 |
| Rate for Payer: Aetna Commercial |
$1,424.73
|
| Rate for Payer: Aetna Medicare |
$1,105.76
|
| Rate for Payer: BCBS Complete |
$728.88
|
| Rate for Payer: BCBS MAPPO |
$1,063.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,601.88
|
| Rate for Payer: BCN Commercial |
$1,607.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,063.23
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cofinity Commercial |
$1,531.05
|
| Rate for Payer: Cofinity Commercial |
$1,424.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,063.23
|
| Rate for Payer: Mclaren Medicaid |
$694.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,116.39
|
| Rate for Payer: Meridian Medicaid |
$728.88
|
| Rate for Payer: Nomi Health Commercial |
$1,275.88
|
| Rate for Payer: PACE SWMI |
$1,063.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,063.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$694.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,438.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,751.30
|
| Rate for Payer: Priority Health Medicare |
$1,073.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,751.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,063.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,063.23
|
| Rate for Payer: UHC Exchange |
$1,063.23
|
| Rate for Payer: UHC Medicare Advantage |
$1,063.23
|
| Rate for Payer: UHCCP Medicaid |
$694.17
|
|
|
PR DIR RPR ANEURYSM & GRAFT COMMON FEMORAL ARTERY
|
Professional
|
Both
|
$2,176.00
|
|
|
Service Code
|
HCPCS 35141
|
| Min. Negotiated Rate |
$381.43 |
| Max. Negotiated Rate |
$1,701.84 |
| Rate for Payer: Aetna Commercial |
$1,404.08
|
| Rate for Payer: Aetna Medicare |
$1,089.73
|
| Rate for Payer: BCBS Complete |
$716.57
|
| Rate for Payer: BCBS MAPPO |
$1,047.82
|
| Rate for Payer: BCBS Trust/PPO |
$381.43
|
| Rate for Payer: BCN Commercial |
$1,560.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,047.82
|
| Rate for Payer: Cash Price |
$1,740.80
|
| Rate for Payer: Cash Price |
$1,740.80
|
| Rate for Payer: Cofinity Commercial |
$1,508.86
|
| Rate for Payer: Cofinity Commercial |
$1,404.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,047.82
|
| Rate for Payer: Mclaren Medicaid |
$682.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,100.21
|
| Rate for Payer: Meridian Medicaid |
$716.57
|
| Rate for Payer: Nomi Health Commercial |
$1,257.38
|
| Rate for Payer: PACE SWMI |
$1,047.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,047.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$682.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,701.84
|
| Rate for Payer: Priority Health Medicare |
$1,058.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,701.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,047.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,047.82
|
| Rate for Payer: UHC Exchange |
$1,047.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,047.82
|
| Rate for Payer: UHCCP Medicaid |
$682.45
|
|
|
PR DIR RPR ANEURYSM & GRAFT ILIAC ARTERY
|
Professional
|
Both
|
$4,955.00
|
|
|
Service Code
|
HCPCS 35131
|
| Min. Negotiated Rate |
$866.27 |
| Max. Negotiated Rate |
$3,220.75 |
| Rate for Payer: Aetna Commercial |
$1,780.90
|
| Rate for Payer: Aetna Medicare |
$1,382.19
|
| Rate for Payer: BCBS Complete |
$909.58
|
| Rate for Payer: BCBS MAPPO |
$1,329.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,490.86
|
| Rate for Payer: BCN Commercial |
$1,965.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,329.03
|
| Rate for Payer: Cash Price |
$3,964.00
|
| Rate for Payer: Cash Price |
$3,964.00
|
| Rate for Payer: Cofinity Commercial |
$1,913.80
|
| Rate for Payer: Cofinity Commercial |
$1,780.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,329.03
|
| Rate for Payer: Mclaren Medicaid |
$866.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,395.48
|
| Rate for Payer: Meridian Medicaid |
$909.58
|
| Rate for Payer: Nomi Health Commercial |
$1,594.84
|
| Rate for Payer: PACE SWMI |
$1,329.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,329.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$866.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,220.75
|
| Rate for Payer: Priority Health HMO/PPO |
$2,152.83
|
| Rate for Payer: Priority Health Medicare |
$1,342.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,152.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,329.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,329.03
|
| Rate for Payer: UHC Exchange |
$1,329.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,329.03
|
| Rate for Payer: UHCCP Medicaid |
$866.27
|
|
|
PR DIR RPR ANEURYSM & GRAFT POPLITEAL ARTERY
|
Professional
|
Both
|
$2,457.00
|
|
|
Service Code
|
HCPCS 35151
|
| Min. Negotiated Rate |
$773.40 |
| Max. Negotiated Rate |
$1,934.78 |
| Rate for Payer: Aetna Commercial |
$1,591.46
|
| Rate for Payer: Aetna Medicare |
$1,235.17
|
| Rate for Payer: BCBS Complete |
$812.07
|
| Rate for Payer: BCBS MAPPO |
$1,187.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,760.30
|
| Rate for Payer: BCN Commercial |
$1,767.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,187.66
|
| Rate for Payer: Cash Price |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,965.60
|
| Rate for Payer: Cofinity Commercial |
$1,710.23
|
| Rate for Payer: Cofinity Commercial |
$1,591.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,187.66
|
| Rate for Payer: Mclaren Medicaid |
$773.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,247.04
|
| Rate for Payer: Meridian Medicaid |
$812.07
|
| Rate for Payer: Nomi Health Commercial |
$1,425.19
|
| Rate for Payer: PACE SWMI |
$1,187.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,187.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$773.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,597.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1,934.78
|
| Rate for Payer: Priority Health Medicare |
$1,199.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,934.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,187.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,187.66
|
| Rate for Payer: UHC Exchange |
$1,187.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,187.66
|
| Rate for Payer: UHCCP Medicaid |
$773.40
|
|
|
PR DIR RPR ANEURYSM HEPATIC/CELIAC/RENAL/MESENTERIC
|
Professional
|
Both
|
$3,196.00
|
|
|
Service Code
|
HCPCS 35121
|
| Min. Negotiated Rate |
$283.70 |
| Max. Negotiated Rate |
$2,461.29 |
| Rate for Payer: Aetna Commercial |
$2,042.01
|
| Rate for Payer: Aetna Medicare |
$1,584.85
|
| Rate for Payer: BCBS Complete |
$1,037.74
|
| Rate for Payer: BCBS MAPPO |
$1,523.89
|
| Rate for Payer: BCBS Trust/PPO |
$283.70
|
| Rate for Payer: BCN Commercial |
$2,251.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,523.89
|
| Rate for Payer: Cash Price |
$2,556.80
|
| Rate for Payer: Cash Price |
$2,556.80
|
| Rate for Payer: Cofinity Commercial |
$2,194.40
|
| Rate for Payer: Cofinity Commercial |
$2,042.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,523.89
|
| Rate for Payer: Mclaren Medicaid |
$988.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,600.08
|
| Rate for Payer: Meridian Medicaid |
$1,037.74
|
| Rate for Payer: Nomi Health Commercial |
$1,828.67
|
| Rate for Payer: PACE SWMI |
$1,523.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,523.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$988.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,077.40
|
| Rate for Payer: Priority Health HMO/PPO |
$2,461.29
|
| Rate for Payer: Priority Health Medicare |
$1,539.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,461.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,523.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,523.89
|
| Rate for Payer: UHC Exchange |
$1,523.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,523.89
|
| Rate for Payer: UHCCP Medicaid |
$988.32
|
|
|
PR DIR RPR ANEURYSM SPLENIC ARTERY
|
Professional
|
Both
|
$2,774.00
|
|
|
Service Code
|
HCPCS 35111
|
| Min. Negotiated Rate |
$831.55 |
| Max. Negotiated Rate |
$2,070.93 |
| Rate for Payer: Aetna Commercial |
$1,716.63
|
| Rate for Payer: Aetna Medicare |
$1,332.31
|
| Rate for Payer: BCBS Complete |
$873.13
|
| Rate for Payer: BCBS MAPPO |
$1,281.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.86
|
| Rate for Payer: BCN Commercial |
$1,895.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,281.07
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Cofinity Commercial |
$1,844.74
|
| Rate for Payer: Cofinity Commercial |
$1,716.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,281.07
|
| Rate for Payer: Mclaren Medicaid |
$831.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,345.12
|
| Rate for Payer: Meridian Medicaid |
$873.13
|
| Rate for Payer: Nomi Health Commercial |
$1,537.28
|
| Rate for Payer: PACE SWMI |
$1,281.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,281.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$831.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.10
|
| Rate for Payer: Priority Health HMO/PPO |
$2,070.93
|
| Rate for Payer: Priority Health Medicare |
$1,293.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,070.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,281.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,281.07
|
| Rate for Payer: UHC Exchange |
$1,281.07
|
| Rate for Payer: UHC Medicare Advantage |
$1,281.07
|
| Rate for Payer: UHCCP Medicaid |
$831.55
|
|
|
PR DIR RPR RUPTD ANEURSM ABDOM AORTA W/VISCERA VSLS
|
Professional
|
Both
|
$5,498.00
|
|
|
Service Code
|
HCPCS 35092
|
| Min. Negotiated Rate |
$1,619.44 |
| Max. Negotiated Rate |
$4,038.14 |
| Rate for Payer: Aetna Commercial |
$3,339.84
|
| Rate for Payer: Aetna Medicare |
$2,592.12
|
| Rate for Payer: BCBS Complete |
$1,700.41
|
| Rate for Payer: BCBS MAPPO |
$2,492.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,136.58
|
| Rate for Payer: BCN Commercial |
$3,681.69
|
| Rate for Payer: BCN Medicare Advantage |
$2,492.42
|
| Rate for Payer: Cash Price |
$4,398.40
|
| Rate for Payer: Cash Price |
$4,398.40
|
| Rate for Payer: Cofinity Commercial |
$3,589.08
|
| Rate for Payer: Cofinity Commercial |
$3,339.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,492.42
|
| Rate for Payer: Mclaren Medicaid |
$1,619.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,617.04
|
| Rate for Payer: Meridian Medicaid |
$1,700.41
|
| Rate for Payer: Nomi Health Commercial |
$2,990.90
|
| Rate for Payer: PACE SWMI |
$2,492.42
|
| Rate for Payer: PHP Medicare Advantage |
$2,492.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,619.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,573.70
|
| Rate for Payer: Priority Health HMO/PPO |
$4,038.14
|
| Rate for Payer: Priority Health Medicare |
$2,517.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,038.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,492.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,492.42
|
| Rate for Payer: UHC Exchange |
$2,492.42
|
| Rate for Payer: UHC Medicare Advantage |
$2,492.42
|
| Rate for Payer: UHCCP Medicaid |
$1,619.44
|
|
