|
PR PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 50436
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$205.59 |
| Rate for Payer: Aetna Commercial |
$191.31
|
| Rate for Payer: Aetna Medicare |
$148.48
|
| Rate for Payer: BCBS Complete |
$122.00
|
| Rate for Payer: BCBS MAPPO |
$142.77
|
| Rate for Payer: BCN Medicare Advantage |
$142.77
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$205.59
|
| Rate for Payer: Cofinity Commercial |
$191.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.91
|
| Rate for Payer: Nomi Health Commercial |
$171.32
|
| Rate for Payer: PACE SWMI |
$142.77
|
| Rate for Payer: PHP Medicare Advantage |
$142.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health Medicare |
$144.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.77
|
| Rate for Payer: UHC Exchange |
$142.77
|
| Rate for Payer: UHC Medicare Advantage |
$142.77
|
|
|
PR PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 50437
|
| Min. Negotiated Rate |
$238.20 |
| Max. Negotiated Rate |
$553.15 |
| Rate for Payer: Aetna Commercial |
$319.19
|
| Rate for Payer: Aetna Medicare |
$247.73
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS MAPPO |
$238.20
|
| Rate for Payer: BCN Medicare Advantage |
$238.20
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cofinity Commercial |
$343.01
|
| Rate for Payer: Cofinity Commercial |
$319.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.11
|
| Rate for Payer: Nomi Health Commercial |
$285.84
|
| Rate for Payer: PACE SWMI |
$238.20
|
| Rate for Payer: PHP Medicare Advantage |
$238.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.15
|
| Rate for Payer: Priority Health Medicare |
$240.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.20
|
| Rate for Payer: UHC Exchange |
$238.20
|
| Rate for Payer: UHC Medicare Advantage |
$238.20
|
|
|
PR PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING
|
Professional
|
Both
|
$984.00
|
|
|
Service Code
|
HCPCS 32557
|
| Min. Negotiated Rate |
$140.51 |
| Max. Negotiated Rate |
$639.60 |
| Rate for Payer: Aetna Commercial |
$188.28
|
| Rate for Payer: Aetna Medicare |
$146.13
|
| Rate for Payer: BCBS Complete |
$393.60
|
| Rate for Payer: BCBS MAPPO |
$140.51
|
| Rate for Payer: BCN Medicare Advantage |
$140.51
|
| Rate for Payer: Cash Price |
$787.20
|
| Rate for Payer: Cash Price |
$787.20
|
| Rate for Payer: Cofinity Commercial |
$202.33
|
| Rate for Payer: Cofinity Commercial |
$188.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.54
|
| Rate for Payer: Nomi Health Commercial |
$168.61
|
| Rate for Payer: PACE SWMI |
$140.51
|
| Rate for Payer: PHP Medicare Advantage |
$140.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$639.60
|
| Rate for Payer: Priority Health Medicare |
$141.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.51
|
| Rate for Payer: UHC Exchange |
$140.51
|
| Rate for Payer: UHC Medicare Advantage |
$140.51
|
|
|
PR PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
HCPCS 32556
|
| Min. Negotiated Rate |
$119.15 |
| Max. Negotiated Rate |
$574.60 |
| Rate for Payer: Aetna Commercial |
$159.66
|
| Rate for Payer: Aetna Medicare |
$123.92
|
| Rate for Payer: BCBS Complete |
$353.60
|
| Rate for Payer: BCBS MAPPO |
$119.15
|
| Rate for Payer: BCN Medicare Advantage |
$119.15
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cofinity Commercial |
$171.58
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.11
|
| Rate for Payer: Nomi Health Commercial |
$142.98
|
| Rate for Payer: PACE SWMI |
$119.15
|
| Rate for Payer: PHP Medicare Advantage |
$119.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.60
|
| Rate for Payer: Priority Health Medicare |
$120.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.15
|
| Rate for Payer: UHC Exchange |
$119.15
|
| Rate for Payer: UHC Medicare Advantage |
$119.15
|
|
|
PR PERQ NL/PL LITHOTRP COMPLEX >2 CM MLT LOCATIONS
|
Professional
|
Both
|
$2,448.00
|
|
|
Service Code
|
HCPCS 50081
|
| Min. Negotiated Rate |
$979.20 |
| Max. Negotiated Rate |
$1,591.20 |
| Rate for Payer: Aetna Commercial |
$1,436.71
|
| Rate for Payer: Aetna Medicare |
$1,115.06
|
| Rate for Payer: BCBS Complete |
$979.20
|
| Rate for Payer: BCBS MAPPO |
$1,072.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,072.17
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cofinity Commercial |
$1,543.92
|
| Rate for Payer: Cofinity Commercial |
$1,436.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,072.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,125.78
|
| Rate for Payer: Nomi Health Commercial |
$1,286.60
|
| Rate for Payer: PACE SWMI |
$1,072.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,072.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,591.20
|
| Rate for Payer: Priority Health Medicare |
$1,082.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,072.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,072.17
|
| Rate for Payer: UHC Exchange |
$1,072.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,072.17
|
|
|
PR PERQ NL/PL LITHOTRP SIMPLE UP TO 2 CM 1 LOCATION
|
Professional
|
Both
|
$1,664.00
|
|
|
Service Code
|
HCPCS 50080
|
| Min. Negotiated Rate |
$665.28 |
| Max. Negotiated Rate |
$1,081.60 |
| Rate for Payer: Aetna Commercial |
$891.48
|
| Rate for Payer: Aetna Medicare |
$691.89
|
| Rate for Payer: BCBS Complete |
$665.60
|
| Rate for Payer: BCBS MAPPO |
$665.28
|
| Rate for Payer: BCN Medicare Advantage |
$665.28
|
| Rate for Payer: Cash Price |
$1,331.20
|
| Rate for Payer: Cash Price |
$1,331.20
|
| Rate for Payer: Cofinity Commercial |
$958.00
|
| Rate for Payer: Cofinity Commercial |
$891.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$665.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$698.54
|
| Rate for Payer: Nomi Health Commercial |
$798.34
|
| Rate for Payer: PACE SWMI |
$665.28
|
| Rate for Payer: PHP Medicare Advantage |
$665.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,081.60
|
| Rate for Payer: Priority Health Medicare |
$671.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$665.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$665.28
|
| Rate for Payer: UHC Exchange |
$665.28
|
| Rate for Payer: UHC Medicare Advantage |
$665.28
|
|
|
PR PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
HCPCS 33017
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$339.25 |
| Rate for Payer: Aetna Commercial |
$315.69
|
| Rate for Payer: Aetna Medicare |
$245.01
|
| Rate for Payer: BCBS Complete |
$203.20
|
| Rate for Payer: BCBS MAPPO |
$235.59
|
| Rate for Payer: BCN Medicare Advantage |
$235.59
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Cofinity Commercial |
$339.25
|
| Rate for Payer: Cofinity Commercial |
$315.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.37
|
| Rate for Payer: Nomi Health Commercial |
$282.71
|
| Rate for Payer: PACE SWMI |
$235.59
|
| Rate for Payer: PHP Medicare Advantage |
$235.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.20
|
| Rate for Payer: Priority Health Medicare |
$237.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.59
|
| Rate for Payer: UHC Exchange |
$235.59
|
| Rate for Payer: UHC Medicare Advantage |
$235.59
|
|
|
PR PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 43762
|
| Min. Negotiated Rate |
$36.43 |
| Max. Negotiated Rate |
$280.15 |
| Rate for Payer: Aetna Commercial |
$48.82
|
| Rate for Payer: Aetna Medicare |
$37.89
|
| Rate for Payer: BCBS Complete |
$172.40
|
| Rate for Payer: BCBS MAPPO |
$36.43
|
| Rate for Payer: BCN Medicare Advantage |
$36.43
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Cofinity Commercial |
$48.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.25
|
| Rate for Payer: Nomi Health Commercial |
$43.72
|
| Rate for Payer: PACE SWMI |
$36.43
|
| Rate for Payer: PHP Medicare Advantage |
$36.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.15
|
| Rate for Payer: Priority Health Medicare |
$36.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.43
|
| Rate for Payer: UHC Exchange |
$36.43
|
| Rate for Payer: UHC Medicare Advantage |
$36.43
|
|
|
PR PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC
|
Professional
|
Both
|
$643.00
|
|
|
Service Code
|
HCPCS 43763
|
| Min. Negotiated Rate |
$83.93 |
| Max. Negotiated Rate |
$417.95 |
| Rate for Payer: Aetna Commercial |
$112.47
|
| Rate for Payer: Aetna Medicare |
$87.29
|
| Rate for Payer: BCBS Complete |
$257.20
|
| Rate for Payer: BCBS MAPPO |
$83.93
|
| Rate for Payer: BCN Medicare Advantage |
$83.93
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Cofinity Commercial |
$120.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.13
|
| Rate for Payer: Nomi Health Commercial |
$100.72
|
| Rate for Payer: PACE SWMI |
$83.93
|
| Rate for Payer: PHP Medicare Advantage |
$83.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.95
|
| Rate for Payer: Priority Health Medicare |
$84.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.93
|
| Rate for Payer: UHC Exchange |
$83.93
|
| Rate for Payer: UHC Medicare Advantage |
$83.93
|
|
|
PR PERQ SAC AGMNTJ BI W/WO BALO/MCHNL DEV 2/> NDLS
|
Professional
|
Both
|
$2,444.00
|
|
|
Service Code
|
HCPCS 0201T
|
| Min. Negotiated Rate |
$977.60 |
| Max. Negotiated Rate |
$1,588.60 |
| Rate for Payer: Aetna Medicare |
$1,222.00
|
| Rate for Payer: BCBS Complete |
$977.60
|
| Rate for Payer: Cash Price |
$1,955.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,588.60
|
|
|
PR PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> NDL
|
Professional
|
Both
|
$2,317.00
|
|
|
Service Code
|
HCPCS 0200T
|
| Min. Negotiated Rate |
$926.80 |
| Max. Negotiated Rate |
$1,506.05 |
| Rate for Payer: Aetna Medicare |
$1,158.50
|
| Rate for Payer: BCBS Complete |
$926.80
|
| Rate for Payer: Cash Price |
$1,853.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,506.05
|
|
|
PR PERQ SKELETAL FIXATION PST PELVIC BONE FX&/DIS
|
Professional
|
Both
|
$3,172.00
|
|
|
Service Code
|
HCPCS 27216
|
| Min. Negotiated Rate |
$1,268.80 |
| Max. Negotiated Rate |
$2,061.80 |
| Rate for Payer: Aetna Medicare |
$1,586.00
|
| Rate for Payer: BCBS Complete |
$1,268.80
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.80
|
|
|
PR PERQ SKELETAL FIXATION ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 25651
|
| Min. Negotiated Rate |
$346.80 |
| Max. Negotiated Rate |
$684.17 |
| Rate for Payer: Aetna Commercial |
$636.66
|
| Rate for Payer: Aetna Medicare |
$494.12
|
| Rate for Payer: BCBS Complete |
$346.80
|
| Rate for Payer: BCBS MAPPO |
$475.12
|
| Rate for Payer: BCN Medicare Advantage |
$475.12
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$684.17
|
| Rate for Payer: Cofinity Commercial |
$636.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$475.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$498.88
|
| Rate for Payer: Nomi Health Commercial |
$570.14
|
| Rate for Payer: PACE SWMI |
$475.12
|
| Rate for Payer: PHP Medicare Advantage |
$475.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.55
|
| Rate for Payer: Priority Health Medicare |
$479.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$475.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$475.12
|
| Rate for Payer: UHC Exchange |
$475.12
|
| Rate for Payer: UHC Medicare Advantage |
$475.12
|
|
|
PR PERQ SKELETAL FIXJ DISTAL RADIOULNAR DISLOCATION
|
Professional
|
Both
|
$1,428.00
|
|
|
Service Code
|
HCPCS 25671
|
| Min. Negotiated Rate |
$519.45 |
| Max. Negotiated Rate |
$928.20 |
| Rate for Payer: Aetna Commercial |
$696.06
|
| Rate for Payer: Aetna Medicare |
$540.23
|
| Rate for Payer: BCBS Complete |
$571.20
|
| Rate for Payer: BCBS MAPPO |
$519.45
|
| Rate for Payer: BCN Medicare Advantage |
$519.45
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cofinity Commercial |
$748.01
|
| Rate for Payer: Cofinity Commercial |
$696.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.42
|
| Rate for Payer: Nomi Health Commercial |
$623.34
|
| Rate for Payer: PACE SWMI |
$519.45
|
| Rate for Payer: PHP Medicare Advantage |
$519.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.20
|
| Rate for Payer: Priority Health Medicare |
$524.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.45
|
| Rate for Payer: UHC Exchange |
$519.45
|
| Rate for Payer: UHC Medicare Advantage |
$519.45
|
|
|
PR PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP
|
Professional
|
Both
|
$1,944.00
|
|
|
Service Code
|
HCPCS 25606
|
| Min. Negotiated Rate |
$647.59 |
| Max. Negotiated Rate |
$1,263.60 |
| Rate for Payer: Aetna Commercial |
$867.77
|
| Rate for Payer: Aetna Medicare |
$673.49
|
| Rate for Payer: BCBS Complete |
$777.60
|
| Rate for Payer: BCBS MAPPO |
$647.59
|
| Rate for Payer: BCN Medicare Advantage |
$647.59
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cofinity Commercial |
$932.53
|
| Rate for Payer: Cofinity Commercial |
$867.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.97
|
| Rate for Payer: Nomi Health Commercial |
$777.11
|
| Rate for Payer: PACE SWMI |
$647.59
|
| Rate for Payer: PHP Medicare Advantage |
$647.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.60
|
| Rate for Payer: Priority Health Medicare |
$654.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.59
|
| Rate for Payer: UHC Exchange |
$647.59
|
| Rate for Payer: UHC Medicare Advantage |
$647.59
|
|
|
PR PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT
|
Professional
|
Both
|
$1,542.00
|
|
|
Service Code
|
HCPCS 36906
|
| Min. Negotiated Rate |
$482.07 |
| Max. Negotiated Rate |
$1,002.30 |
| Rate for Payer: Aetna Commercial |
$645.97
|
| Rate for Payer: Aetna Medicare |
$501.35
|
| Rate for Payer: BCBS Complete |
$616.80
|
| Rate for Payer: BCBS MAPPO |
$482.07
|
| Rate for Payer: BCN Medicare Advantage |
$482.07
|
| Rate for Payer: Cash Price |
$1,233.60
|
| Rate for Payer: Cash Price |
$1,233.60
|
| Rate for Payer: Cofinity Commercial |
$694.18
|
| Rate for Payer: Cofinity Commercial |
$645.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$482.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$506.17
|
| Rate for Payer: Nomi Health Commercial |
$578.48
|
| Rate for Payer: PACE SWMI |
$482.07
|
| Rate for Payer: PHP Medicare Advantage |
$482.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,002.30
|
| Rate for Payer: Priority Health Medicare |
$486.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$482.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$482.07
|
| Rate for Payer: UHC Exchange |
$482.07
|
| Rate for Payer: UHC Medicare Advantage |
$482.07
|
|
|
PR PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
HCPCS 36905
|
| Min. Negotiated Rate |
$418.19 |
| Max. Negotiated Rate |
$859.30 |
| Rate for Payer: Aetna Commercial |
$560.37
|
| Rate for Payer: Aetna Medicare |
$434.92
|
| Rate for Payer: BCBS Complete |
$528.80
|
| Rate for Payer: BCBS MAPPO |
$418.19
|
| Rate for Payer: BCN Medicare Advantage |
$418.19
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cofinity Commercial |
$602.19
|
| Rate for Payer: Cofinity Commercial |
$560.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$418.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$439.10
|
| Rate for Payer: Nomi Health Commercial |
$501.83
|
| Rate for Payer: PACE SWMI |
$418.19
|
| Rate for Payer: PHP Medicare Advantage |
$418.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.30
|
| Rate for Payer: Priority Health Medicare |
$422.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$418.19
|
| Rate for Payer: UHC Exchange |
$418.19
|
| Rate for Payer: UHC Medicare Advantage |
$418.19
|
|
|
PR PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH
|
Professional
|
Both
|
$887.00
|
|
|
Service Code
|
HCPCS 36904
|
| Min. Negotiated Rate |
$347.99 |
| Max. Negotiated Rate |
$576.55 |
| Rate for Payer: Aetna Commercial |
$466.31
|
| Rate for Payer: Aetna Medicare |
$361.91
|
| Rate for Payer: BCBS Complete |
$354.80
|
| Rate for Payer: BCBS MAPPO |
$347.99
|
| Rate for Payer: BCN Medicare Advantage |
$347.99
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Cofinity Commercial |
$501.11
|
| Rate for Payer: Cofinity Commercial |
$466.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.39
|
| Rate for Payer: Nomi Health Commercial |
$417.59
|
| Rate for Payer: PACE SWMI |
$347.99
|
| Rate for Payer: PHP Medicare Advantage |
$347.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.55
|
| Rate for Payer: Priority Health Medicare |
$351.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$347.99
|
| Rate for Payer: UHC Exchange |
$347.99
|
| Rate for Payer: UHC Medicare Advantage |
$347.99
|
|
|
PR PERQ TRANSLUMINAL ANGIOPLASTY NATIVE/RECR COA
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
HCPCS 33897
|
| Min. Negotiated Rate |
$497.60 |
| Max. Negotiated Rate |
$808.60 |
| Rate for Payer: Aetna Commercial |
$740.91
|
| Rate for Payer: Aetna Medicare |
$575.04
|
| Rate for Payer: BCBS Complete |
$497.60
|
| Rate for Payer: BCBS MAPPO |
$552.92
|
| Rate for Payer: BCN Medicare Advantage |
$552.92
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cofinity Commercial |
$796.20
|
| Rate for Payer: Cofinity Commercial |
$740.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$552.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$580.57
|
| Rate for Payer: Nomi Health Commercial |
$663.50
|
| Rate for Payer: PACE SWMI |
$552.92
|
| Rate for Payer: PHP Medicare Advantage |
$552.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$808.60
|
| Rate for Payer: Priority Health Medicare |
$558.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$552.92
|
| Rate for Payer: UHC Exchange |
$552.92
|
| Rate for Payer: UHC Medicare Advantage |
$552.92
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION
|
Professional
|
Both
|
$1,546.00
|
|
|
Service Code
|
HCPCS 22513
|
| Min. Negotiated Rate |
$487.67 |
| Max. Negotiated Rate |
$1,004.90 |
| Rate for Payer: Aetna Commercial |
$653.48
|
| Rate for Payer: Aetna Medicare |
$507.18
|
| Rate for Payer: BCBS Complete |
$618.40
|
| Rate for Payer: BCBS MAPPO |
$487.67
|
| Rate for Payer: BCN Medicare Advantage |
$487.67
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cofinity Commercial |
$702.24
|
| Rate for Payer: Cofinity Commercial |
$653.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$487.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$512.05
|
| Rate for Payer: Nomi Health Commercial |
$585.20
|
| Rate for Payer: PACE SWMI |
$487.67
|
| Rate for Payer: PHP Medicare Advantage |
$487.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,004.90
|
| Rate for Payer: Priority Health Medicare |
$492.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$487.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$487.67
|
| Rate for Payer: UHC Exchange |
$487.67
|
| Rate for Payer: UHC Medicare Advantage |
$487.67
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH
|
Professional
|
Both
|
$806.00
|
|
|
Service Code
|
HCPCS 22515
|
| Min. Negotiated Rate |
$209.25 |
| Max. Negotiated Rate |
$523.90 |
| Rate for Payer: Aetna Commercial |
$280.39
|
| Rate for Payer: Aetna Medicare |
$217.62
|
| Rate for Payer: BCBS Complete |
$322.40
|
| Rate for Payer: BCBS MAPPO |
$209.25
|
| Rate for Payer: BCN Medicare Advantage |
$209.25
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Cofinity Commercial |
$280.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$219.71
|
| Rate for Payer: Nomi Health Commercial |
$251.10
|
| Rate for Payer: PACE SWMI |
$209.25
|
| Rate for Payer: PHP Medicare Advantage |
$209.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.90
|
| Rate for Payer: Priority Health Medicare |
$211.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.25
|
| Rate for Payer: UHC Exchange |
$209.25
|
| Rate for Payer: UHC Medicare Advantage |
$209.25
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR
|
Professional
|
Both
|
$1,444.00
|
|
|
Service Code
|
HCPCS 22514
|
| Min. Negotiated Rate |
$455.37 |
| Max. Negotiated Rate |
$938.60 |
| Rate for Payer: Aetna Commercial |
$610.20
|
| Rate for Payer: Aetna Medicare |
$473.58
|
| Rate for Payer: BCBS Complete |
$577.60
|
| Rate for Payer: BCBS MAPPO |
$455.37
|
| Rate for Payer: BCN Medicare Advantage |
$455.37
|
| Rate for Payer: Cash Price |
$1,155.20
|
| Rate for Payer: Cash Price |
$1,155.20
|
| Rate for Payer: Cofinity Commercial |
$655.73
|
| Rate for Payer: Cofinity Commercial |
$610.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$455.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$478.14
|
| Rate for Payer: Nomi Health Commercial |
$546.44
|
| Rate for Payer: PACE SWMI |
$455.37
|
| Rate for Payer: PHP Medicare Advantage |
$455.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$938.60
|
| Rate for Payer: Priority Health Medicare |
$459.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$455.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$455.37
|
| Rate for Payer: UHC Exchange |
$455.37
|
| Rate for Payer: UHC Medicare Advantage |
$455.37
|
|
|
PR PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL
|
Professional
|
Both
|
$1,057.00
|
|
|
Service Code
|
HCPCS 22511
|
| Min. Negotiated Rate |
$388.54 |
| Max. Negotiated Rate |
$687.05 |
| Rate for Payer: Aetna Commercial |
$520.64
|
| Rate for Payer: Aetna Medicare |
$404.08
|
| Rate for Payer: BCBS Complete |
$422.80
|
| Rate for Payer: BCBS MAPPO |
$388.54
|
| Rate for Payer: BCN Medicare Advantage |
$388.54
|
| Rate for Payer: Cash Price |
$845.60
|
| Rate for Payer: Cash Price |
$845.60
|
| Rate for Payer: Cofinity Commercial |
$559.50
|
| Rate for Payer: Cofinity Commercial |
$520.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$388.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$407.97
|
| Rate for Payer: Nomi Health Commercial |
$466.25
|
| Rate for Payer: PACE SWMI |
$388.54
|
| Rate for Payer: PHP Medicare Advantage |
$388.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$687.05
|
| Rate for Payer: Priority Health Medicare |
$392.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$388.54
|
| Rate for Payer: UHC Exchange |
$388.54
|
| Rate for Payer: UHC Medicare Advantage |
$388.54
|
|
|
PR PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC
|
Professional
|
Both
|
$3,421.00
|
|
|
Service Code
|
HCPCS 22510
|
| Min. Negotiated Rate |
$413.04 |
| Max. Negotiated Rate |
$2,223.65 |
| Rate for Payer: Aetna Commercial |
$553.47
|
| Rate for Payer: Aetna Medicare |
$429.56
|
| Rate for Payer: BCBS Complete |
$1,368.40
|
| Rate for Payer: BCBS MAPPO |
$413.04
|
| Rate for Payer: BCN Medicare Advantage |
$413.04
|
| Rate for Payer: Cash Price |
$2,736.80
|
| Rate for Payer: Cash Price |
$2,736.80
|
| Rate for Payer: Cofinity Commercial |
$594.78
|
| Rate for Payer: Cofinity Commercial |
$553.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$413.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$433.69
|
| Rate for Payer: Nomi Health Commercial |
$495.65
|
| Rate for Payer: PACE SWMI |
$413.04
|
| Rate for Payer: PHP Medicare Advantage |
$413.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,223.65
|
| Rate for Payer: Priority Health Medicare |
$417.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$413.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$413.04
|
| Rate for Payer: UHC Exchange |
$413.04
|
| Rate for Payer: UHC Medicare Advantage |
$413.04
|
|
|
PR PESSARY REUSABLE NONRUBBER
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS A4562
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$102.46 |
| Rate for Payer: Aetna Commercial |
$95.34
|
| Rate for Payer: Aetna Medicare |
$74.00
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCBS MAPPO |
$71.15
|
| Rate for Payer: BCN Medicare Advantage |
$71.15
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$95.34
|
| Rate for Payer: Cofinity Commercial |
$102.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.71
|
| Rate for Payer: Nomi Health Commercial |
$85.38
|
| Rate for Payer: PACE SWMI |
$71.15
|
| Rate for Payer: PHP Medicare Advantage |
$71.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: Priority Health Medicare |
$71.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.15
|
| Rate for Payer: UHC Exchange |
$71.15
|
| Rate for Payer: UHC Medicare Advantage |
$71.15
|
|
