|
PR EVASC RPR DPLMNT AORTO-AORTIC NDGFT
|
Professional
|
Both
|
$2,588.00
|
|
|
Service Code
|
HCPCS 34701
|
| Min. Negotiated Rate |
$1,035.20 |
| Max. Negotiated Rate |
$1,706.31 |
| Rate for Payer: Aetna Commercial |
$1,587.82
|
| Rate for Payer: Aetna Medicare |
$1,232.34
|
| Rate for Payer: BCBS Complete |
$1,035.20
|
| Rate for Payer: BCBS MAPPO |
$1,184.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,184.94
|
| Rate for Payer: Cash Price |
$2,070.40
|
| Rate for Payer: Cash Price |
$2,070.40
|
| Rate for Payer: Cofinity Commercial |
$1,706.31
|
| Rate for Payer: Cofinity Commercial |
$1,587.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,184.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,244.19
|
| Rate for Payer: Nomi Health Commercial |
$1,421.93
|
| Rate for Payer: PACE SWMI |
$1,184.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,184.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,682.20
|
| Rate for Payer: Priority Health Medicare |
$1,196.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,184.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,184.94
|
| Rate for Payer: UHC Exchange |
$1,184.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,184.94
|
|
|
PR EVASC RPR DPLMNT AORTO-AORTIC NDGFT RPT
|
Professional
|
Both
|
$3,913.00
|
|
|
Service Code
|
HCPCS 34702
|
| Min. Negotiated Rate |
$1,565.20 |
| Max. Negotiated Rate |
$2,543.45 |
| Rate for Payer: Aetna Commercial |
$2,315.02
|
| Rate for Payer: Aetna Medicare |
$1,796.74
|
| Rate for Payer: BCBS Complete |
$1,565.20
|
| Rate for Payer: BCBS MAPPO |
$1,727.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,727.63
|
| Rate for Payer: Cash Price |
$3,130.40
|
| Rate for Payer: Cash Price |
$3,130.40
|
| Rate for Payer: Cofinity Commercial |
$2,487.79
|
| Rate for Payer: Cofinity Commercial |
$2,315.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,727.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,814.01
|
| Rate for Payer: Nomi Health Commercial |
$2,073.16
|
| Rate for Payer: PACE SWMI |
$1,727.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,727.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,543.45
|
| Rate for Payer: Priority Health Medicare |
$1,744.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,727.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,727.63
|
| Rate for Payer: UHC Exchange |
$1,727.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,727.63
|
|
|
PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT
|
Professional
|
Both
|
$3,166.00
|
|
|
Service Code
|
HCPCS 34705
|
| Min. Negotiated Rate |
$1,266.40 |
| Max. Negotiated Rate |
$2,103.49 |
| Rate for Payer: Aetna Commercial |
$1,957.42
|
| Rate for Payer: Aetna Medicare |
$1,519.19
|
| Rate for Payer: BCBS Complete |
$1,266.40
|
| Rate for Payer: BCBS MAPPO |
$1,460.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,460.76
|
| Rate for Payer: Cash Price |
$2,532.80
|
| Rate for Payer: Cash Price |
$2,532.80
|
| Rate for Payer: Cofinity Commercial |
$2,103.49
|
| Rate for Payer: Cofinity Commercial |
$1,957.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,460.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,533.80
|
| Rate for Payer: Nomi Health Commercial |
$1,752.91
|
| Rate for Payer: PACE SWMI |
$1,460.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,460.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,057.90
|
| Rate for Payer: Priority Health Medicare |
$1,475.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,460.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,460.76
|
| Rate for Payer: UHC Exchange |
$1,460.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,460.76
|
|
|
PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT
|
Professional
|
Both
|
$4,840.00
|
|
|
Service Code
|
HCPCS 34706
|
| Min. Negotiated Rate |
$1,936.00 |
| Max. Negotiated Rate |
$3,147.51 |
| Rate for Payer: Aetna Commercial |
$2,928.93
|
| Rate for Payer: Aetna Medicare |
$2,273.20
|
| Rate for Payer: BCBS Complete |
$1,936.00
|
| Rate for Payer: BCBS MAPPO |
$2,185.77
|
| Rate for Payer: BCN Medicare Advantage |
$2,185.77
|
| Rate for Payer: Cash Price |
$3,872.00
|
| Rate for Payer: Cash Price |
$3,872.00
|
| Rate for Payer: Cofinity Commercial |
$3,147.51
|
| Rate for Payer: Cofinity Commercial |
$2,928.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,185.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,295.06
|
| Rate for Payer: Nomi Health Commercial |
$2,622.92
|
| Rate for Payer: PACE SWMI |
$2,185.77
|
| Rate for Payer: PHP Medicare Advantage |
$2,185.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,146.00
|
| Rate for Payer: Priority Health Medicare |
$2,207.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,185.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,185.77
|
| Rate for Payer: UHC Exchange |
$2,185.77
|
| Rate for Payer: UHC Medicare Advantage |
$2,185.77
|
|
|
PR EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT
|
Professional
|
Both
|
$2,917.00
|
|
|
Service Code
|
HCPCS 34703
|
| Min. Negotiated Rate |
$1,166.80 |
| Max. Negotiated Rate |
$1,896.05 |
| Rate for Payer: Aetna Commercial |
$1,761.51
|
| Rate for Payer: Aetna Medicare |
$1,367.14
|
| Rate for Payer: BCBS Complete |
$1,166.80
|
| Rate for Payer: BCBS MAPPO |
$1,314.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,314.56
|
| Rate for Payer: Cash Price |
$2,333.60
|
| Rate for Payer: Cash Price |
$2,333.60
|
| Rate for Payer: Cofinity Commercial |
$1,892.97
|
| Rate for Payer: Cofinity Commercial |
$1,761.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,314.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,380.29
|
| Rate for Payer: Nomi Health Commercial |
$1,577.47
|
| Rate for Payer: PACE SWMI |
$1,314.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,314.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,896.05
|
| Rate for Payer: Priority Health Medicare |
$1,327.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,314.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,314.56
|
| Rate for Payer: UHC Exchange |
$1,314.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,314.56
|
|
|
PR EVASC RPR DPLMNT ILIO-ILIAC NDGFT
|
Professional
|
Both
|
$2,414.00
|
|
|
Service Code
|
HCPCS 34707
|
| Min. Negotiated Rate |
$965.60 |
| Max. Negotiated Rate |
$1,602.56 |
| Rate for Payer: Aetna Commercial |
$1,491.27
|
| Rate for Payer: Aetna Medicare |
$1,157.41
|
| Rate for Payer: BCBS Complete |
$965.60
|
| Rate for Payer: BCBS MAPPO |
$1,112.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,112.89
|
| Rate for Payer: Cash Price |
$1,931.20
|
| Rate for Payer: Cash Price |
$1,931.20
|
| Rate for Payer: Cofinity Commercial |
$1,602.56
|
| Rate for Payer: Cofinity Commercial |
$1,491.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,112.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,168.53
|
| Rate for Payer: Nomi Health Commercial |
$1,335.47
|
| Rate for Payer: PACE SWMI |
$1,112.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,112.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,569.10
|
| Rate for Payer: Priority Health Medicare |
$1,124.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,112.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,112.89
|
| Rate for Payer: UHC Exchange |
$1,112.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,112.89
|
|
|
PR EVASC RPR DPLMNT ILIO-ILIAC NDGFT RPT
|
Professional
|
Both
|
$3,899.00
|
|
|
Service Code
|
HCPCS 34708
|
| Min. Negotiated Rate |
$1,559.60 |
| Max. Negotiated Rate |
$2,534.35 |
| Rate for Payer: Aetna Commercial |
$2,345.95
|
| Rate for Payer: Aetna Medicare |
$1,820.74
|
| Rate for Payer: BCBS Complete |
$1,559.60
|
| Rate for Payer: BCBS MAPPO |
$1,750.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,750.71
|
| Rate for Payer: Cash Price |
$3,119.20
|
| Rate for Payer: Cash Price |
$3,119.20
|
| Rate for Payer: Cofinity Commercial |
$2,521.02
|
| Rate for Payer: Cofinity Commercial |
$2,345.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,750.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,838.25
|
| Rate for Payer: Nomi Health Commercial |
$2,100.85
|
| Rate for Payer: PACE SWMI |
$1,750.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,750.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,534.35
|
| Rate for Payer: Priority Health Medicare |
$1,768.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,750.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,750.71
|
| Rate for Payer: UHC Exchange |
$1,750.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,750.71
|
|
|
PR EVASC RPR DTA COVERAGE ART ORIGIN 1ST ENDOPROSTH
|
Professional
|
Both
|
$8,245.00
|
|
|
Service Code
|
HCPCS 33880
|
| Min. Negotiated Rate |
$1,710.21 |
| Max. Negotiated Rate |
$5,359.25 |
| Rate for Payer: Aetna Commercial |
$2,291.68
|
| Rate for Payer: Aetna Medicare |
$1,778.62
|
| Rate for Payer: BCBS Complete |
$3,298.00
|
| Rate for Payer: BCBS MAPPO |
$1,710.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,710.21
|
| Rate for Payer: Cash Price |
$6,596.00
|
| Rate for Payer: Cash Price |
$6,596.00
|
| Rate for Payer: Cofinity Commercial |
$2,462.70
|
| Rate for Payer: Cofinity Commercial |
$2,291.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,710.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,795.72
|
| Rate for Payer: Nomi Health Commercial |
$2,052.25
|
| Rate for Payer: PACE SWMI |
$1,710.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,710.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,359.25
|
| Rate for Payer: Priority Health Medicare |
$1,727.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,710.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,710.21
|
| Rate for Payer: UHC Exchange |
$1,710.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,710.21
|
|
|
PR EVASC RPR DTA EXP COVERAGE W/O ART ORIGIN
|
Professional
|
Both
|
$5,504.00
|
|
|
Service Code
|
HCPCS 33881
|
| Min. Negotiated Rate |
$1,468.63 |
| Max. Negotiated Rate |
$3,577.60 |
| Rate for Payer: Aetna Commercial |
$1,967.96
|
| Rate for Payer: Aetna Medicare |
$1,527.38
|
| Rate for Payer: BCBS Complete |
$2,201.60
|
| Rate for Payer: BCBS MAPPO |
$1,468.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,468.63
|
| Rate for Payer: Cash Price |
$4,403.20
|
| Rate for Payer: Cash Price |
$4,403.20
|
| Rate for Payer: Cofinity Commercial |
$2,114.83
|
| Rate for Payer: Cofinity Commercial |
$1,967.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,468.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,542.06
|
| Rate for Payer: Nomi Health Commercial |
$1,762.36
|
| Rate for Payer: PACE SWMI |
$1,468.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,468.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,577.60
|
| Rate for Payer: Priority Health Medicare |
$1,483.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,468.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,468.63
|
| Rate for Payer: UHC Exchange |
$1,468.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,468.63
|
|
|
PR EVASC RPR ILAC ART BIFUR ENDGRFT CATHJ RS&I UNI
|
Professional
|
Both
|
$959.00
|
|
|
Service Code
|
HCPCS 0254T
|
| Min. Negotiated Rate |
$383.60 |
| Max. Negotiated Rate |
$623.35 |
| Rate for Payer: Aetna Medicare |
$479.50
|
| Rate for Payer: BCBS Complete |
$383.60
|
| Rate for Payer: Cash Price |
$767.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.35
|
|
|
PR EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNI
|
Professional
|
Both
|
$2,162.00
|
|
|
Service Code
|
HCPCS 34718
|
| Min. Negotiated Rate |
$864.80 |
| Max. Negotiated Rate |
$1,706.00 |
| Rate for Payer: Aetna Commercial |
$1,587.52
|
| Rate for Payer: Aetna Medicare |
$1,232.11
|
| Rate for Payer: BCBS Complete |
$864.80
|
| Rate for Payer: BCBS MAPPO |
$1,184.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,184.72
|
| Rate for Payer: Cash Price |
$1,729.60
|
| Rate for Payer: Cash Price |
$1,729.60
|
| Rate for Payer: Cofinity Commercial |
$1,706.00
|
| Rate for Payer: Cofinity Commercial |
$1,587.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,184.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,243.96
|
| Rate for Payer: Nomi Health Commercial |
$1,421.66
|
| Rate for Payer: PACE SWMI |
$1,184.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,184.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,405.30
|
| Rate for Payer: Priority Health Medicare |
$1,196.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,184.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,184.72
|
| Rate for Payer: UHC Exchange |
$1,184.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,184.72
|
|
|
PR EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNI
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 34717
|
| Min. Negotiated Rate |
$323.60 |
| Max. Negotiated Rate |
$611.06 |
| Rate for Payer: Aetna Commercial |
$568.63
|
| Rate for Payer: Aetna Medicare |
$441.32
|
| Rate for Payer: BCBS Complete |
$323.60
|
| Rate for Payer: BCBS MAPPO |
$424.35
|
| Rate for Payer: BCN Medicare Advantage |
$424.35
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cofinity Commercial |
$568.63
|
| Rate for Payer: Cofinity Commercial |
$611.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$424.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$445.57
|
| Rate for Payer: Nomi Health Commercial |
$509.22
|
| Rate for Payer: PACE SWMI |
$424.35
|
| Rate for Payer: PHP Medicare Advantage |
$424.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.85
|
| Rate for Payer: Priority Health Medicare |
$428.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$424.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$424.35
|
| Rate for Payer: UHC Exchange |
$424.35
|
| Rate for Payer: UHC Medicare Advantage |
$424.35
|
|
|
PR EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK
|
Professional
|
Both
|
$3,336.00
|
|
|
Service Code
|
HCPCS 61623
|
| Min. Negotiated Rate |
$564.20 |
| Max. Negotiated Rate |
$2,168.40 |
| Rate for Payer: Aetna Commercial |
$756.03
|
| Rate for Payer: Aetna Medicare |
$586.77
|
| Rate for Payer: BCBS Complete |
$1,334.40
|
| Rate for Payer: BCBS MAPPO |
$564.20
|
| Rate for Payer: BCN Medicare Advantage |
$564.20
|
| Rate for Payer: Cash Price |
$2,668.80
|
| Rate for Payer: Cash Price |
$2,668.80
|
| Rate for Payer: Cofinity Commercial |
$812.45
|
| Rate for Payer: Cofinity Commercial |
$756.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.41
|
| Rate for Payer: Nomi Health Commercial |
$677.04
|
| Rate for Payer: PACE SWMI |
$564.20
|
| Rate for Payer: PHP Medicare Advantage |
$564.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,168.40
|
| Rate for Payer: Priority Health Medicare |
$569.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$564.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$564.20
|
| Rate for Payer: UHC Exchange |
$564.20
|
| Rate for Payer: UHC Medicare Advantage |
$564.20
|
|
|
PR EWHO RIGID W/O JNTS CF
|
Professional
|
Both
|
$699.00
|
|
|
Service Code
|
HCPCS L3763
|
| Min. Negotiated Rate |
$279.60 |
| Max. Negotiated Rate |
$1,181.64 |
| Rate for Payer: Aetna Commercial |
$1,099.58
|
| Rate for Payer: Aetna Medicare |
$853.40
|
| Rate for Payer: BCBS Complete |
$279.60
|
| Rate for Payer: BCBS MAPPO |
$820.58
|
| Rate for Payer: BCN Medicare Advantage |
$820.58
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cofinity Commercial |
$1,181.64
|
| Rate for Payer: Cofinity Commercial |
$1,099.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$820.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$861.61
|
| Rate for Payer: Nomi Health Commercial |
$984.70
|
| Rate for Payer: PACE SWMI |
$820.58
|
| Rate for Payer: PHP Medicare Advantage |
$820.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.35
|
| Rate for Payer: Priority Health Medicare |
$828.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$820.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$820.58
|
| Rate for Payer: UHC Exchange |
$820.58
|
| Rate for Payer: UHC Medicare Advantage |
$820.58
|
|
|
PR EWHO W/JOINT(S) CF
|
Professional
|
Both
|
$731.00
|
|
|
Service Code
|
HCPCS L3764
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$1,236.61 |
| Rate for Payer: Aetna Commercial |
$1,150.74
|
| Rate for Payer: Aetna Medicare |
$893.11
|
| Rate for Payer: BCBS Complete |
$292.40
|
| Rate for Payer: BCBS MAPPO |
$858.76
|
| Rate for Payer: BCN Medicare Advantage |
$858.76
|
| Rate for Payer: Cash Price |
$584.80
|
| Rate for Payer: Cash Price |
$584.80
|
| Rate for Payer: Cofinity Commercial |
$1,236.61
|
| Rate for Payer: Cofinity Commercial |
$1,150.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$901.70
|
| Rate for Payer: Nomi Health Commercial |
$1,030.51
|
| Rate for Payer: PACE SWMI |
$858.76
|
| Rate for Payer: PHP Medicare Advantage |
$858.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.15
|
| Rate for Payer: Priority Health Medicare |
$867.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$858.76
|
| Rate for Payer: UHC Exchange |
$858.76
|
| Rate for Payer: UHC Medicare Advantage |
$858.76
|
|
|
PR EXC 1/> SMALL/LARGE LESIONS INTESTINE ENTEROTOM
|
Professional
|
Both
|
$2,379.00
|
|
|
Service Code
|
HCPCS 44110
|
| Min. Negotiated Rate |
$821.23 |
| Max. Negotiated Rate |
$1,546.35 |
| Rate for Payer: Aetna Commercial |
$1,100.45
|
| Rate for Payer: Aetna Medicare |
$854.08
|
| Rate for Payer: BCBS Complete |
$951.60
|
| Rate for Payer: BCBS MAPPO |
$821.23
|
| Rate for Payer: BCN Medicare Advantage |
$821.23
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cofinity Commercial |
$1,182.57
|
| Rate for Payer: Cofinity Commercial |
$1,100.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$821.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$862.29
|
| Rate for Payer: Nomi Health Commercial |
$985.48
|
| Rate for Payer: PACE SWMI |
$821.23
|
| Rate for Payer: PHP Medicare Advantage |
$821.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,546.35
|
| Rate for Payer: Priority Health Medicare |
$829.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$821.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$821.23
|
| Rate for Payer: UHC Exchange |
$821.23
|
| Rate for Payer: UHC Medicare Advantage |
$821.23
|
|
|
PR EXC 1/> SM/LG LESIONS INTESTNE MULT ENTEROTOMIE
|
Professional
|
Both
|
$3,605.00
|
|
|
Service Code
|
HCPCS 44111
|
| Min. Negotiated Rate |
$945.42 |
| Max. Negotiated Rate |
$2,343.25 |
| Rate for Payer: Aetna Commercial |
$1,266.86
|
| Rate for Payer: Aetna Medicare |
$983.24
|
| Rate for Payer: BCBS Complete |
$1,442.00
|
| Rate for Payer: BCBS MAPPO |
$945.42
|
| Rate for Payer: BCN Medicare Advantage |
$945.42
|
| Rate for Payer: Cash Price |
$2,884.00
|
| Rate for Payer: Cash Price |
$2,884.00
|
| Rate for Payer: Cofinity Commercial |
$1,361.40
|
| Rate for Payer: Cofinity Commercial |
$1,266.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$945.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$992.69
|
| Rate for Payer: Nomi Health Commercial |
$1,134.50
|
| Rate for Payer: PACE SWMI |
$945.42
|
| Rate for Payer: PHP Medicare Advantage |
$945.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,343.25
|
| Rate for Payer: Priority Health Medicare |
$954.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$945.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$945.42
|
| Rate for Payer: UHC Exchange |
$945.42
|
| Rate for Payer: UHC Medicare Advantage |
$945.42
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 11440
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$145.60 |
| Rate for Payer: Aetna Commercial |
$134.13
|
| Rate for Payer: Aetna Medicare |
$104.10
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: BCBS MAPPO |
$100.10
|
| Rate for Payer: BCN Medicare Advantage |
$100.10
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$144.14
|
| Rate for Payer: Cofinity Commercial |
$134.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.11
|
| Rate for Payer: Nomi Health Commercial |
$120.12
|
| Rate for Payer: PACE SWMI |
$100.10
|
| Rate for Payer: PHP Medicare Advantage |
$100.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health Medicare |
$101.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.10
|
| Rate for Payer: UHC Exchange |
$100.10
|
| Rate for Payer: UHC Medicare Advantage |
$100.10
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
11440
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$534.17 |
| Rate for Payer: Aetna Commercial |
$190.40
|
| Rate for Payer: Aetna Medicare |
$58.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.00
|
| Rate for Payer: BCBS Complete |
$534.17
|
| Rate for Payer: BCBS MAPPO |
$56.00
|
| Rate for Payer: BCBS Trust/PPO |
$184.15
|
| Rate for Payer: BCN Commercial |
$174.16
|
| Rate for Payer: BCN Medicare Advantage |
$56.00
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$192.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$201.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.00
|
| Rate for Payer: Mclaren Medicaid |
$508.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.80
|
| Rate for Payer: Meridian Medicaid |
$534.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.40
|
| Rate for Payer: Nomi Health Commercial |
$183.68
|
| Rate for Payer: PACE Senior Care Partners |
$53.20
|
| Rate for Payer: PACE SWMI |
$56.00
|
| Rate for Payer: PHP Commercial |
$190.40
|
| Rate for Payer: PHP Medicare Advantage |
$56.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO |
$194.88
|
| Rate for Payer: Priority Health Medicare |
$56.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.08
|
| Rate for Payer: Railroad Medicare Medicare |
$56.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.12
|
| Rate for Payer: UHC Core |
$187.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.00
|
| Rate for Payer: UHC Exchange |
$56.00
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: UHCCP Medicaid |
$508.70
|
| Rate for Payer: VA VA |
$56.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.00
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
11440
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$190.40
|
| Rate for Payer: BCBS Trust/PPO |
$182.85
|
| Rate for Payer: BCN Commercial |
$173.11
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$192.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.20
|
| Rate for Payer: Healthscope Commercial |
$201.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.40
|
| Rate for Payer: Nomi Health Commercial |
$183.68
|
| Rate for Payer: PHP Commercial |
$190.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO |
$194.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.12
|
| Rate for Payer: UHC Core |
$187.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.00
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
11440
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$145.60 |
| Rate for Payer: Aetna Commercial |
$134.13
|
| Rate for Payer: Aetna Medicare |
$104.10
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: BCBS MAPPO |
$100.10
|
| Rate for Payer: BCN Medicare Advantage |
$100.10
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$144.14
|
| Rate for Payer: Cofinity Commercial |
$134.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.11
|
| Rate for Payer: Nomi Health Commercial |
$120.12
|
| Rate for Payer: PACE SWMI |
$100.10
|
| Rate for Payer: PHP Medicare Advantage |
$100.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health Medicare |
$101.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.10
|
| Rate for Payer: UHC Exchange |
$100.10
|
| Rate for Payer: UHC Medicare Advantage |
$100.10
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM
|
Professional
|
Both
|
$826.00
|
|
|
Service Code
|
HCPCS 11446
|
| Min. Negotiated Rate |
$304.03 |
| Max. Negotiated Rate |
$536.90 |
| Rate for Payer: Aetna Commercial |
$407.40
|
| Rate for Payer: Aetna Medicare |
$316.19
|
| Rate for Payer: BCBS Complete |
$330.40
|
| Rate for Payer: BCBS MAPPO |
$304.03
|
| Rate for Payer: BCN Medicare Advantage |
$304.03
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cofinity Commercial |
$437.80
|
| Rate for Payer: Cofinity Commercial |
$407.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$304.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$319.23
|
| Rate for Payer: Nomi Health Commercial |
$364.84
|
| Rate for Payer: PACE SWMI |
$304.03
|
| Rate for Payer: PHP Medicare Advantage |
$304.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.90
|
| Rate for Payer: Priority Health Medicare |
$307.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$304.03
|
| Rate for Payer: UHC Exchange |
$304.03
|
| Rate for Payer: UHC Medicare Advantage |
$304.03
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 11420
|
| Min. Negotiated Rate |
$77.95 |
| Max. Negotiated Rate |
$131.95 |
| Rate for Payer: Aetna Commercial |
$104.45
|
| Rate for Payer: Aetna Medicare |
$81.07
|
| Rate for Payer: BCBS Complete |
$81.20
|
| Rate for Payer: BCBS MAPPO |
$77.95
|
| Rate for Payer: BCN Medicare Advantage |
$77.95
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cofinity Commercial |
$112.25
|
| Rate for Payer: Cofinity Commercial |
$104.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.85
|
| Rate for Payer: Nomi Health Commercial |
$93.54
|
| Rate for Payer: PACE SWMI |
$77.95
|
| Rate for Payer: PHP Medicare Advantage |
$77.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.95
|
| Rate for Payer: Priority Health Medicare |
$78.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.95
|
| Rate for Payer: UHC Exchange |
$77.95
|
| Rate for Payer: UHC Medicare Advantage |
$77.95
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$169.65 |
| Max. Negotiated Rate |
$234.90 |
| Rate for Payer: Aetna Commercial |
$221.85
|
| Rate for Payer: BCBS Trust/PPO |
$213.05
|
| Rate for Payer: BCN Commercial |
$201.70
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$224.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.80
|
| Rate for Payer: Healthscope Commercial |
$234.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.85
|
| Rate for Payer: Nomi Health Commercial |
$214.02
|
| Rate for Payer: PHP Commercial |
$221.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: Priority Health HMO/PPO |
$227.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.68
|
| Rate for Payer: UHC Core |
$217.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.75
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$61.99 |
| Max. Negotiated Rate |
$534.17 |
| Rate for Payer: Aetna Commercial |
$221.85
|
| Rate for Payer: Aetna Medicare |
$67.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.56
|
| Rate for Payer: BCBS Complete |
$534.17
|
| Rate for Payer: BCBS MAPPO |
$65.25
|
| Rate for Payer: BCBS Trust/PPO |
$214.57
|
| Rate for Payer: BCN Commercial |
$202.93
|
| Rate for Payer: BCN Medicare Advantage |
$65.25
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$224.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.25
|
| Rate for Payer: Healthscope Commercial |
$234.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.75
|
| Rate for Payer: Mclaren Medicaid |
$508.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.51
|
| Rate for Payer: Meridian Medicaid |
$534.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.85
|
| Rate for Payer: Nomi Health Commercial |
$214.02
|
| Rate for Payer: PACE Senior Care Partners |
$61.99
|
| Rate for Payer: PACE SWMI |
$65.25
|
| Rate for Payer: PHP Commercial |
$221.85
|
| Rate for Payer: PHP Medicare Advantage |
$65.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: Priority Health HMO/PPO |
$227.07
|
| Rate for Payer: Priority Health Medicare |
$65.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.87
|
| Rate for Payer: Railroad Medicare Medicare |
$65.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.68
|
| Rate for Payer: UHC Core |
$217.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.25
|
| Rate for Payer: UHC Exchange |
$65.25
|
| Rate for Payer: UHC Medicare Advantage |
$65.25
|
| Rate for Payer: UHCCP Medicaid |
$508.70
|
| Rate for Payer: VA VA |
$65.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.75
|
|
