|
PR EXPLORATION EPIDIDYMIS W/WO BIOPSY
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
HCPCS 54865
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$497.23 |
| Rate for Payer: Aetna Commercial |
$462.70
|
| Rate for Payer: Aetna Medicare |
$359.11
|
| Rate for Payer: BCBS Complete |
$269.20
|
| Rate for Payer: BCBS MAPPO |
$345.30
|
| Rate for Payer: BCN Medicare Advantage |
$345.30
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cofinity Commercial |
$497.23
|
| Rate for Payer: Cofinity Commercial |
$462.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.56
|
| Rate for Payer: Nomi Health Commercial |
$414.36
|
| Rate for Payer: PACE SWMI |
$345.30
|
| Rate for Payer: PHP Medicare Advantage |
$345.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.45
|
| Rate for Payer: Priority Health Medicare |
$348.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$345.30
|
| Rate for Payer: UHC Exchange |
$345.30
|
| Rate for Payer: UHC Medicare Advantage |
$345.30
|
|
|
PR EXPLORATION, FEMORAL ARTERY
|
Professional
|
Both
|
$1,563.00
|
|
|
Service Code
|
HCPCS 35721
|
| Min. Negotiated Rate |
$625.20 |
| Max. Negotiated Rate |
$1,015.95 |
| Rate for Payer: Aetna Medicare |
$781.50
|
| Rate for Payer: BCBS Complete |
$625.20
|
| Rate for Payer: Cash Price |
$1,250.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,015.95
|
|
|
PR EXPLORATION N/FLWD SURG LOWER EXTREMITY ARTERY
|
Professional
|
Both
|
$871.00
|
|
|
Service Code
|
HCPCS 35703
|
| Min. Negotiated Rate |
$348.40 |
| Max. Negotiated Rate |
$577.30 |
| Rate for Payer: Aetna Commercial |
$537.21
|
| Rate for Payer: Aetna Medicare |
$416.94
|
| Rate for Payer: BCBS Complete |
$348.40
|
| Rate for Payer: BCBS MAPPO |
$400.90
|
| Rate for Payer: BCN Medicare Advantage |
$400.90
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Cofinity Commercial |
$577.30
|
| Rate for Payer: Cofinity Commercial |
$537.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$400.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$420.94
|
| Rate for Payer: Nomi Health Commercial |
$481.08
|
| Rate for Payer: PACE SWMI |
$400.90
|
| Rate for Payer: PHP Medicare Advantage |
$400.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.15
|
| Rate for Payer: Priority Health Medicare |
$404.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$400.90
|
| Rate for Payer: UHC Exchange |
$400.90
|
| Rate for Payer: UHC Medicare Advantage |
$400.90
|
|
|
PR EXPLORATION N/FLWD SURG NECK ARTERY
|
Professional
|
Both
|
$908.00
|
|
|
Service Code
|
HCPCS 35701
|
| Min. Negotiated Rate |
$363.20 |
| Max. Negotiated Rate |
$603.75 |
| Rate for Payer: Aetna Commercial |
$561.82
|
| Rate for Payer: Aetna Medicare |
$436.04
|
| Rate for Payer: BCBS Complete |
$363.20
|
| Rate for Payer: BCBS MAPPO |
$419.27
|
| Rate for Payer: BCN Medicare Advantage |
$419.27
|
| Rate for Payer: Cash Price |
$726.40
|
| Rate for Payer: Cash Price |
$726.40
|
| Rate for Payer: Cofinity Commercial |
$561.82
|
| Rate for Payer: Cofinity Commercial |
$603.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$419.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$440.23
|
| Rate for Payer: Nomi Health Commercial |
$503.12
|
| Rate for Payer: PACE SWMI |
$419.27
|
| Rate for Payer: PHP Medicare Advantage |
$419.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.20
|
| Rate for Payer: Priority Health Medicare |
$423.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$419.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$419.27
|
| Rate for Payer: UHC Exchange |
$419.27
|
| Rate for Payer: UHC Medicare Advantage |
$419.27
|
|
|
PR EXPLORATION N/FLWD SURG UPPER EXTREMITY ARTERY
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
HCPCS 35702
|
| Min. Negotiated Rate |
$362.00 |
| Max. Negotiated Rate |
$588.25 |
| Rate for Payer: Aetna Commercial |
$527.38
|
| Rate for Payer: Aetna Medicare |
$409.31
|
| Rate for Payer: BCBS Complete |
$362.00
|
| Rate for Payer: BCBS MAPPO |
$393.57
|
| Rate for Payer: BCN Medicare Advantage |
$393.57
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cofinity Commercial |
$566.74
|
| Rate for Payer: Cofinity Commercial |
$527.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.25
|
| Rate for Payer: Nomi Health Commercial |
$472.28
|
| Rate for Payer: PACE SWMI |
$393.57
|
| Rate for Payer: PHP Medicare Advantage |
$393.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$588.25
|
| Rate for Payer: Priority Health Medicare |
$397.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$393.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.57
|
| Rate for Payer: UHC Exchange |
$393.57
|
| Rate for Payer: UHC Medicare Advantage |
$393.57
|
|
|
PR EXPLORATION OF ARTERY/VEIN
|
Professional
|
Both
|
$1,308.00
|
|
|
Service Code
|
HCPCS 35761
|
| Min. Negotiated Rate |
$523.20 |
| Max. Negotiated Rate |
$850.20 |
| Rate for Payer: Aetna Medicare |
$654.00
|
| Rate for Payer: BCBS Complete |
$523.20
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.20
|
|
|
PR EXPLORATION PENETRATING WOUND SPX CHEST
|
Professional
|
Both
|
$1,148.00
|
|
|
Service Code
|
HCPCS 20101
|
| Min. Negotiated Rate |
$202.78 |
| Max. Negotiated Rate |
$746.20 |
| Rate for Payer: Aetna Commercial |
$271.73
|
| Rate for Payer: Aetna Medicare |
$210.89
|
| Rate for Payer: BCBS Complete |
$459.20
|
| Rate for Payer: BCBS MAPPO |
$202.78
|
| Rate for Payer: BCN Medicare Advantage |
$202.78
|
| Rate for Payer: Cash Price |
$918.40
|
| Rate for Payer: Cash Price |
$918.40
|
| Rate for Payer: Cofinity Commercial |
$292.00
|
| Rate for Payer: Cofinity Commercial |
$271.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.92
|
| Rate for Payer: Nomi Health Commercial |
$243.34
|
| Rate for Payer: PACE SWMI |
$202.78
|
| Rate for Payer: PHP Medicare Advantage |
$202.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$746.20
|
| Rate for Payer: Priority Health Medicare |
$204.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.78
|
| Rate for Payer: UHC Exchange |
$202.78
|
| Rate for Payer: UHC Medicare Advantage |
$202.78
|
|
|
PR EXPLORATION PENETRATING WOUND SPX EXTREMITY
|
Professional
|
Both
|
$1,817.00
|
|
|
Service Code
|
HCPCS 20103
|
| Min. Negotiated Rate |
$330.90 |
| Max. Negotiated Rate |
$1,181.05 |
| Rate for Payer: Aetna Commercial |
$443.41
|
| Rate for Payer: Aetna Medicare |
$344.14
|
| Rate for Payer: BCBS Complete |
$726.80
|
| Rate for Payer: BCBS MAPPO |
$330.90
|
| Rate for Payer: BCN Medicare Advantage |
$330.90
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cofinity Commercial |
$476.50
|
| Rate for Payer: Cofinity Commercial |
$443.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$330.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$347.44
|
| Rate for Payer: Nomi Health Commercial |
$397.08
|
| Rate for Payer: PACE SWMI |
$330.90
|
| Rate for Payer: PHP Medicare Advantage |
$330.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,181.05
|
| Rate for Payer: Priority Health Medicare |
$334.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$330.90
|
| Rate for Payer: UHC Exchange |
$330.90
|
| Rate for Payer: UHC Medicare Advantage |
$330.90
|
|
|
PR EXPLORATION PENETRATING WOUND SPX NECK
|
Professional
|
Both
|
$1,939.00
|
|
|
Service Code
|
HCPCS 20100
|
| Min. Negotiated Rate |
$580.58 |
| Max. Negotiated Rate |
$1,260.35 |
| Rate for Payer: Aetna Commercial |
$777.98
|
| Rate for Payer: Aetna Medicare |
$603.80
|
| Rate for Payer: BCBS Complete |
$775.60
|
| Rate for Payer: BCBS MAPPO |
$580.58
|
| Rate for Payer: BCN Medicare Advantage |
$580.58
|
| Rate for Payer: Cash Price |
$1,551.20
|
| Rate for Payer: Cash Price |
$1,551.20
|
| Rate for Payer: Cofinity Commercial |
$836.04
|
| Rate for Payer: Cofinity Commercial |
$777.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$580.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$609.61
|
| Rate for Payer: Nomi Health Commercial |
$696.70
|
| Rate for Payer: PACE SWMI |
$580.58
|
| Rate for Payer: PHP Medicare Advantage |
$580.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,260.35
|
| Rate for Payer: Priority Health Medicare |
$586.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$580.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$580.58
|
| Rate for Payer: UHC Exchange |
$580.58
|
| Rate for Payer: UHC Medicare Advantage |
$580.58
|
|
|
PR EXPLORATION POPLITEAL ARTERY
|
Professional
|
Both
|
$1,079.00
|
|
|
Service Code
|
HCPCS 35741
|
| Min. Negotiated Rate |
$431.60 |
| Max. Negotiated Rate |
$701.35 |
| Rate for Payer: Aetna Medicare |
$539.50
|
| Rate for Payer: BCBS Complete |
$431.60
|
| Rate for Payer: Cash Price |
$863.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$701.35
|
|
|
PR EXPLORATION SPINAL FUSION
|
Professional
|
Both
|
$5,175.00
|
|
|
Service Code
|
HCPCS 22830
|
| Min. Negotiated Rate |
$803.57 |
| Max. Negotiated Rate |
$3,363.75 |
| Rate for Payer: Aetna Commercial |
$1,076.78
|
| Rate for Payer: Aetna Medicare |
$835.71
|
| Rate for Payer: BCBS Complete |
$2,070.00
|
| Rate for Payer: BCBS MAPPO |
$803.57
|
| Rate for Payer: BCN Medicare Advantage |
$803.57
|
| Rate for Payer: Cash Price |
$4,140.00
|
| Rate for Payer: Cash Price |
$4,140.00
|
| Rate for Payer: Cofinity Commercial |
$1,157.14
|
| Rate for Payer: Cofinity Commercial |
$1,076.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$803.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$843.75
|
| Rate for Payer: Nomi Health Commercial |
$964.28
|
| Rate for Payer: PACE SWMI |
$803.57
|
| Rate for Payer: PHP Medicare Advantage |
$803.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,363.75
|
| Rate for Payer: Priority Health Medicare |
$811.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$803.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$803.57
|
| Rate for Payer: UHC Exchange |
$803.57
|
| Rate for Payer: UHC Medicare Advantage |
$803.57
|
|
|
PR EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX
|
Professional
|
Both
|
$2,353.00
|
|
|
Service Code
|
HCPCS 49000
|
| Min. Negotiated Rate |
$746.43 |
| Max. Negotiated Rate |
$1,529.45 |
| Rate for Payer: Aetna Commercial |
$1,000.22
|
| Rate for Payer: Aetna Medicare |
$776.29
|
| Rate for Payer: BCBS Complete |
$941.20
|
| Rate for Payer: BCBS MAPPO |
$746.43
|
| Rate for Payer: BCN Medicare Advantage |
$746.43
|
| Rate for Payer: Cash Price |
$1,882.40
|
| Rate for Payer: Cash Price |
$1,882.40
|
| Rate for Payer: Cofinity Commercial |
$1,000.22
|
| Rate for Payer: Cofinity Commercial |
$1,074.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$746.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$783.75
|
| Rate for Payer: Nomi Health Commercial |
$895.72
|
| Rate for Payer: PACE SWMI |
$746.43
|
| Rate for Payer: PHP Medicare Advantage |
$746.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,529.45
|
| Rate for Payer: Priority Health Medicare |
$753.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$746.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$746.43
|
| Rate for Payer: UHC Exchange |
$746.43
|
| Rate for Payer: UHC Medicare Advantage |
$746.43
|
|
|
PR EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK
|
Professional
|
Both
|
$2,034.00
|
|
|
Service Code
|
HCPCS 20102
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$1,322.10 |
| Rate for Payer: Aetna Commercial |
$331.65
|
| Rate for Payer: Aetna Medicare |
$257.40
|
| Rate for Payer: BCBS Complete |
$813.60
|
| Rate for Payer: BCBS MAPPO |
$247.50
|
| Rate for Payer: BCN Medicare Advantage |
$247.50
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cofinity Commercial |
$356.40
|
| Rate for Payer: Cofinity Commercial |
$331.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$247.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$259.88
|
| Rate for Payer: Nomi Health Commercial |
$297.00
|
| Rate for Payer: PACE SWMI |
$247.50
|
| Rate for Payer: PHP Medicare Advantage |
$247.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.10
|
| Rate for Payer: Priority Health Medicare |
$249.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$247.50
|
| Rate for Payer: UHC Exchange |
$247.50
|
| Rate for Payer: UHC Medicare Advantage |
$247.50
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD
|
Professional
|
Both
|
$2,353.00
|
|
|
Service Code
|
HCPCS 35840
|
| Min. Negotiated Rate |
$941.20 |
| Max. Negotiated Rate |
$1,695.97 |
| Rate for Payer: Aetna Commercial |
$1,578.20
|
| Rate for Payer: Aetna Medicare |
$1,224.87
|
| Rate for Payer: BCBS Complete |
$941.20
|
| Rate for Payer: BCBS MAPPO |
$1,177.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,177.76
|
| Rate for Payer: Cash Price |
$1,882.40
|
| Rate for Payer: Cash Price |
$1,882.40
|
| Rate for Payer: Cofinity Commercial |
$1,695.97
|
| Rate for Payer: Cofinity Commercial |
$1,578.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,177.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,236.65
|
| Rate for Payer: Nomi Health Commercial |
$1,413.31
|
| Rate for Payer: PACE SWMI |
$1,177.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,177.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,529.45
|
| Rate for Payer: Priority Health Medicare |
$1,189.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,177.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,177.76
|
| Rate for Payer: UHC Exchange |
$1,177.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,177.76
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ CH
|
Professional
|
Both
|
$5,591.00
|
|
|
Service Code
|
HCPCS 35820
|
| Min. Negotiated Rate |
$1,932.79 |
| Max. Negotiated Rate |
$3,634.15 |
| Rate for Payer: Aetna Commercial |
$2,589.94
|
| Rate for Payer: Aetna Medicare |
$2,010.10
|
| Rate for Payer: BCBS Complete |
$2,236.40
|
| Rate for Payer: BCBS MAPPO |
$1,932.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,932.79
|
| Rate for Payer: Cash Price |
$4,472.80
|
| Rate for Payer: Cash Price |
$4,472.80
|
| Rate for Payer: Cofinity Commercial |
$2,783.22
|
| Rate for Payer: Cofinity Commercial |
$2,589.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,932.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,029.43
|
| Rate for Payer: Nomi Health Commercial |
$2,319.35
|
| Rate for Payer: PACE SWMI |
$1,932.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,932.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,634.15
|
| Rate for Payer: Priority Health Medicare |
$1,952.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,932.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,932.79
|
| Rate for Payer: UHC Exchange |
$1,932.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,932.79
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ NCK
|
Professional
|
Both
|
$1,513.00
|
|
|
Service Code
|
HCPCS 35800
|
| Min. Negotiated Rate |
$605.20 |
| Max. Negotiated Rate |
$1,013.36 |
| Rate for Payer: Aetna Commercial |
$942.98
|
| Rate for Payer: Aetna Medicare |
$731.87
|
| Rate for Payer: BCBS Complete |
$605.20
|
| Rate for Payer: BCBS MAPPO |
$703.72
|
| Rate for Payer: BCN Medicare Advantage |
$703.72
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cofinity Commercial |
$942.98
|
| Rate for Payer: Cofinity Commercial |
$1,013.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.91
|
| Rate for Payer: Nomi Health Commercial |
$844.46
|
| Rate for Payer: PACE SWMI |
$703.72
|
| Rate for Payer: PHP Medicare Advantage |
$703.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$983.45
|
| Rate for Payer: Priority Health Medicare |
$710.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$703.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$703.72
|
| Rate for Payer: UHC Exchange |
$703.72
|
| Rate for Payer: UHC Medicare Advantage |
$703.72
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR
|
Professional
|
Both
|
$1,524.00
|
|
|
Service Code
|
HCPCS 35860
|
| Min. Negotiated Rate |
$609.60 |
| Max. Negotiated Rate |
$1,166.72 |
| Rate for Payer: Aetna Commercial |
$1,085.69
|
| Rate for Payer: Aetna Medicare |
$842.63
|
| Rate for Payer: BCBS Complete |
$609.60
|
| Rate for Payer: BCBS MAPPO |
$810.22
|
| Rate for Payer: BCN Medicare Advantage |
$810.22
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cofinity Commercial |
$1,166.72
|
| Rate for Payer: Cofinity Commercial |
$1,085.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$850.73
|
| Rate for Payer: Nomi Health Commercial |
$972.26
|
| Rate for Payer: PACE SWMI |
$810.22
|
| Rate for Payer: PHP Medicare Advantage |
$810.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.60
|
| Rate for Payer: Priority Health Medicare |
$818.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$810.22
|
| Rate for Payer: UHC Exchange |
$810.22
|
| Rate for Payer: UHC Medicare Advantage |
$810.22
|
|
|
PR EXPL RETROPERITONEUM W/WO BX SPX
|
Professional
|
Both
|
$2,032.00
|
|
|
Service Code
|
HCPCS 49010
|
| Min. Negotiated Rate |
$812.80 |
| Max. Negotiated Rate |
$1,320.80 |
| Rate for Payer: Aetna Commercial |
$1,204.75
|
| Rate for Payer: Aetna Medicare |
$935.03
|
| Rate for Payer: BCBS Complete |
$812.80
|
| Rate for Payer: BCBS MAPPO |
$899.07
|
| Rate for Payer: BCN Medicare Advantage |
$899.07
|
| Rate for Payer: Cash Price |
$1,625.60
|
| Rate for Payer: Cash Price |
$1,625.60
|
| Rate for Payer: Cofinity Commercial |
$1,294.66
|
| Rate for Payer: Cofinity Commercial |
$1,204.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$899.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$944.02
|
| Rate for Payer: Nomi Health Commercial |
$1,078.88
|
| Rate for Payer: PACE SWMI |
$899.07
|
| Rate for Payer: PHP Medicare Advantage |
$899.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.80
|
| Rate for Payer: Priority Health Medicare |
$908.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$899.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$899.07
|
| Rate for Payer: UHC Exchange |
$899.07
|
| Rate for Payer: UHC Medicare Advantage |
$899.07
|
|
|
PR EXPL RPR & PRESACRAL DRG RECTAL INJURY
|
Professional
|
Both
|
$3,078.00
|
|
|
Service Code
|
HCPCS 45562
|
| Min. Negotiated Rate |
$1,133.14 |
| Max. Negotiated Rate |
$2,000.70 |
| Rate for Payer: Aetna Commercial |
$1,518.41
|
| Rate for Payer: Aetna Medicare |
$1,178.47
|
| Rate for Payer: BCBS Complete |
$1,231.20
|
| Rate for Payer: BCBS MAPPO |
$1,133.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,133.14
|
| Rate for Payer: Cash Price |
$2,462.40
|
| Rate for Payer: Cash Price |
$2,462.40
|
| Rate for Payer: Cofinity Commercial |
$1,631.72
|
| Rate for Payer: Cofinity Commercial |
$1,518.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,133.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,189.80
|
| Rate for Payer: Nomi Health Commercial |
$1,359.77
|
| Rate for Payer: PACE SWMI |
$1,133.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,133.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,000.70
|
| Rate for Payer: Priority Health Medicare |
$1,144.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,133.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,133.14
|
| Rate for Payer: UHC Exchange |
$1,133.14
|
| Rate for Payer: UHC Medicare Advantage |
$1,133.14
|
|
|
PR EXPL UNDESCENDED TESTIS W/ABDOMINAL EXPL
|
Professional
|
Both
|
$1,299.00
|
|
|
Service Code
|
HCPCS 54560
|
| Min. Negotiated Rate |
$519.60 |
| Max. Negotiated Rate |
$946.47 |
| Rate for Payer: Aetna Commercial |
$880.74
|
| Rate for Payer: Aetna Medicare |
$683.56
|
| Rate for Payer: BCBS Complete |
$519.60
|
| Rate for Payer: BCBS MAPPO |
$657.27
|
| Rate for Payer: BCN Medicare Advantage |
$657.27
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cofinity Commercial |
$946.47
|
| Rate for Payer: Cofinity Commercial |
$880.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$657.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$690.13
|
| Rate for Payer: Nomi Health Commercial |
$788.72
|
| Rate for Payer: PACE SWMI |
$657.27
|
| Rate for Payer: PHP Medicare Advantage |
$657.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.35
|
| Rate for Payer: Priority Health Medicare |
$663.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$657.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$657.27
|
| Rate for Payer: UHC Exchange |
$657.27
|
| Rate for Payer: UHC Medicare Advantage |
$657.27
|
|
|
PR EXPL UNDESCENDED TSTIS INGUN/SCROTAL AREA
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 54550
|
| Min. Negotiated Rate |
$371.20 |
| Max. Negotiated Rate |
$677.87 |
| Rate for Payer: Aetna Commercial |
$630.79
|
| Rate for Payer: Aetna Medicare |
$489.57
|
| Rate for Payer: BCBS Complete |
$371.20
|
| Rate for Payer: BCBS MAPPO |
$470.74
|
| Rate for Payer: BCN Medicare Advantage |
$470.74
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cofinity Commercial |
$677.87
|
| Rate for Payer: Cofinity Commercial |
$630.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$470.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$494.28
|
| Rate for Payer: Nomi Health Commercial |
$564.89
|
| Rate for Payer: PACE SWMI |
$470.74
|
| Rate for Payer: PHP Medicare Advantage |
$470.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.20
|
| Rate for Payer: Priority Health Medicare |
$475.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$470.74
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$470.74
|
|
|
PR EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST
|
Professional
|
Both
|
$820.00
|
|
|
Service Code
|
HCPCS 25248
|
| Min. Negotiated Rate |
$328.00 |
| Max. Negotiated Rate |
$582.58 |
| Rate for Payer: Aetna Commercial |
$542.12
|
| Rate for Payer: Aetna Medicare |
$420.75
|
| Rate for Payer: BCBS Complete |
$328.00
|
| Rate for Payer: BCBS MAPPO |
$404.57
|
| Rate for Payer: BCN Medicare Advantage |
$404.57
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cofinity Commercial |
$582.58
|
| Rate for Payer: Cofinity Commercial |
$542.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$404.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$424.80
|
| Rate for Payer: Nomi Health Commercial |
$485.48
|
| Rate for Payer: PACE SWMI |
$404.57
|
| Rate for Payer: PHP Medicare Advantage |
$404.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.00
|
| Rate for Payer: Priority Health Medicare |
$408.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$404.57
|
| Rate for Payer: UHC Exchange |
$404.57
|
| Rate for Payer: UHC Medicare Advantage |
$404.57
|
|
|
PR EXPOS PROSTATE ANY APPROACH INSJ RADIOACT SUBST
|
Professional
|
Both
|
$1,673.00
|
|
|
Service Code
|
HCPCS 55860
|
| Min. Negotiated Rate |
$669.20 |
| Max. Negotiated Rate |
$1,202.43 |
| Rate for Payer: Aetna Commercial |
$1,118.93
|
| Rate for Payer: Aetna Medicare |
$868.42
|
| Rate for Payer: BCBS Complete |
$669.20
|
| Rate for Payer: BCBS MAPPO |
$835.02
|
| Rate for Payer: BCN Medicare Advantage |
$835.02
|
| Rate for Payer: Cash Price |
$1,338.40
|
| Rate for Payer: Cash Price |
$1,338.40
|
| Rate for Payer: Cofinity Commercial |
$1,118.93
|
| Rate for Payer: Cofinity Commercial |
$1,202.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$835.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$876.77
|
| Rate for Payer: Nomi Health Commercial |
$1,002.02
|
| Rate for Payer: PACE SWMI |
$835.02
|
| Rate for Payer: PHP Medicare Advantage |
$835.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,087.45
|
| Rate for Payer: Priority Health Medicare |
$843.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$835.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$835.02
|
| Rate for Payer: UHC Exchange |
$835.02
|
| Rate for Payer: UHC Medicare Advantage |
$835.02
|
|
|
PR EXPRESS FACIAL REFINEMENT OR RELAXATION
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 00126
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
|
PR EXT ECG > 48HR TO 21 DAY RCRD W/CONECT INTL RCRD
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 0296T
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$122.85 |
| Rate for Payer: Aetna Medicare |
$94.50
|
| Rate for Payer: BCBS Complete |
$75.60
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
|
