|
PR PLMT FEM-FEM PROSTC GRF EVASC AORTIC ARYSM RPR
|
Professional
|
Both
|
$1,219.00
|
|
|
Service Code
|
HCPCS 34813
|
| Min. Negotiated Rate |
$225.47 |
| Max. Negotiated Rate |
$792.35 |
| Rate for Payer: Aetna Commercial |
$302.13
|
| Rate for Payer: Aetna Medicare |
$234.49
|
| Rate for Payer: BCBS Complete |
$487.60
|
| Rate for Payer: BCBS MAPPO |
$225.47
|
| Rate for Payer: BCN Medicare Advantage |
$225.47
|
| Rate for Payer: Cash Price |
$975.20
|
| Rate for Payer: Cash Price |
$975.20
|
| Rate for Payer: Cofinity Commercial |
$324.68
|
| Rate for Payer: Cofinity Commercial |
$302.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$236.74
|
| Rate for Payer: Nomi Health Commercial |
$270.56
|
| Rate for Payer: PACE SWMI |
$225.47
|
| Rate for Payer: PHP Medicare Advantage |
$225.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$792.35
|
| Rate for Payer: Priority Health Medicare |
$227.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.47
|
| Rate for Payer: UHC Exchange |
$225.47
|
| Rate for Payer: UHC Medicare Advantage |
$225.47
|
|
|
PR PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 55876
|
| Min. Negotiated Rate |
$96.89 |
| Max. Negotiated Rate |
$180.05 |
| Rate for Payer: Aetna Commercial |
$129.83
|
| Rate for Payer: Aetna Medicare |
$100.77
|
| Rate for Payer: BCBS Complete |
$110.80
|
| Rate for Payer: BCBS MAPPO |
$96.89
|
| Rate for Payer: BCN Medicare Advantage |
$96.89
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cofinity Commercial |
$139.52
|
| Rate for Payer: Cofinity Commercial |
$129.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.73
|
| Rate for Payer: Nomi Health Commercial |
$116.27
|
| Rate for Payer: PACE SWMI |
$96.89
|
| Rate for Payer: PHP Medicare Advantage |
$96.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.05
|
| Rate for Payer: Priority Health Medicare |
$97.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.89
|
| Rate for Payer: UHC Exchange |
$96.89
|
| Rate for Payer: UHC Medicare Advantage |
$96.89
|
|
|
PR PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I
|
Professional
|
Both
|
$1,616.00
|
|
|
Service Code
|
HCPCS 50432
|
| Min. Negotiated Rate |
$192.01 |
| Max. Negotiated Rate |
$1,050.40 |
| Rate for Payer: Aetna Commercial |
$257.29
|
| Rate for Payer: Aetna Medicare |
$199.69
|
| Rate for Payer: BCBS Complete |
$646.40
|
| Rate for Payer: BCBS MAPPO |
$192.01
|
| Rate for Payer: BCN Medicare Advantage |
$192.01
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cofinity Commercial |
$276.49
|
| Rate for Payer: Cofinity Commercial |
$257.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$192.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.61
|
| Rate for Payer: Nomi Health Commercial |
$230.41
|
| Rate for Payer: PACE SWMI |
$192.01
|
| Rate for Payer: PHP Medicare Advantage |
$192.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.40
|
| Rate for Payer: Priority Health Medicare |
$193.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$192.01
|
| Rate for Payer: UHC Exchange |
$192.01
|
| Rate for Payer: UHC Medicare Advantage |
$192.01
|
|
|
PR PLMT PROX XTN PROSTH EVASC RPR DTA 1ST XTN
|
Professional
|
Both
|
$2,278.00
|
|
|
Service Code
|
HCPCS 33883
|
| Min. Negotiated Rate |
$911.20 |
| Max. Negotiated Rate |
$1,528.99 |
| Rate for Payer: Aetna Commercial |
$1,422.81
|
| Rate for Payer: Aetna Medicare |
$1,104.27
|
| Rate for Payer: BCBS Complete |
$911.20
|
| Rate for Payer: BCBS MAPPO |
$1,061.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,061.80
|
| Rate for Payer: Cash Price |
$1,822.40
|
| Rate for Payer: Cash Price |
$1,822.40
|
| Rate for Payer: Cofinity Commercial |
$1,528.99
|
| Rate for Payer: Cofinity Commercial |
$1,422.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,061.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,114.89
|
| Rate for Payer: Nomi Health Commercial |
$1,274.16
|
| Rate for Payer: PACE SWMI |
$1,061.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,061.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.70
|
| Rate for Payer: Priority Health Medicare |
$1,072.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,061.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,061.80
|
| Rate for Payer: UHC Exchange |
$1,061.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,061.80
|
|
|
PR PLMT PROX XTN PROSTH EVASC RPR DTA EA PROX XTN
|
Professional
|
Both
|
$877.00
|
|
|
Service Code
|
HCPCS 33884
|
| Min. Negotiated Rate |
$350.80 |
| Max. Negotiated Rate |
$570.05 |
| Rate for Payer: Aetna Commercial |
$510.25
|
| Rate for Payer: Aetna Medicare |
$396.01
|
| Rate for Payer: BCBS Complete |
$350.80
|
| Rate for Payer: BCBS MAPPO |
$380.78
|
| Rate for Payer: BCN Medicare Advantage |
$380.78
|
| Rate for Payer: Cash Price |
$701.60
|
| Rate for Payer: Cash Price |
$701.60
|
| Rate for Payer: Cofinity Commercial |
$548.32
|
| Rate for Payer: Cofinity Commercial |
$510.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$380.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$399.82
|
| Rate for Payer: Nomi Health Commercial |
$456.94
|
| Rate for Payer: PACE SWMI |
$380.78
|
| Rate for Payer: PHP Medicare Advantage |
$380.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.05
|
| Rate for Payer: Priority Health Medicare |
$384.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$380.78
|
| Rate for Payer: UHC Exchange |
$380.78
|
| Rate for Payer: UHC Medicare Advantage |
$380.78
|
|
|
PR PLMT SFT TISS LOCLZJ DEV PERQ 1ST LESION
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 10035
|
| Min. Negotiated Rate |
$79.33 |
| Max. Negotiated Rate |
$154.05 |
| Rate for Payer: Aetna Commercial |
$106.30
|
| Rate for Payer: Aetna Medicare |
$82.50
|
| Rate for Payer: BCBS Complete |
$94.80
|
| Rate for Payer: BCBS MAPPO |
$79.33
|
| Rate for Payer: BCN Medicare Advantage |
$79.33
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$114.24
|
| Rate for Payer: Cofinity Commercial |
$106.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.30
|
| Rate for Payer: Nomi Health Commercial |
$95.20
|
| Rate for Payer: PACE SWMI |
$79.33
|
| Rate for Payer: PHP Medicare Advantage |
$79.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.05
|
| Rate for Payer: Priority Health Medicare |
$80.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.33
|
| Rate for Payer: UHC Exchange |
$79.33
|
| Rate for Payer: UHC Medicare Advantage |
$79.33
|
|
|
PR PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 50693
|
| Min. Negotiated Rate |
$191.01 |
| Max. Negotiated Rate |
$365.95 |
| Rate for Payer: Aetna Commercial |
$255.95
|
| Rate for Payer: Aetna Medicare |
$198.65
|
| Rate for Payer: BCBS Complete |
$225.20
|
| Rate for Payer: BCBS MAPPO |
$191.01
|
| Rate for Payer: BCN Medicare Advantage |
$191.01
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cofinity Commercial |
$275.05
|
| Rate for Payer: Cofinity Commercial |
$255.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.56
|
| Rate for Payer: Nomi Health Commercial |
$229.21
|
| Rate for Payer: PACE SWMI |
$191.01
|
| Rate for Payer: PHP Medicare Advantage |
$191.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.95
|
| Rate for Payer: Priority Health Medicare |
$192.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.01
|
| Rate for Payer: UHC Exchange |
$191.01
|
| Rate for Payer: UHC Medicare Advantage |
$191.01
|
|
|
PR PLMT VEIN PATCH/CUFF DSTL ANAST BYP CONDUIT
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
HCPCS 35685
|
| Min. Negotiated Rate |
$177.20 |
| Max. Negotiated Rate |
$287.95 |
| Rate for Payer: Aetna Commercial |
$255.56
|
| Rate for Payer: Aetna Medicare |
$198.35
|
| Rate for Payer: BCBS Complete |
$177.20
|
| Rate for Payer: BCBS MAPPO |
$190.72
|
| Rate for Payer: BCN Medicare Advantage |
$190.72
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cofinity Commercial |
$274.64
|
| Rate for Payer: Cofinity Commercial |
$255.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.26
|
| Rate for Payer: Nomi Health Commercial |
$228.86
|
| Rate for Payer: PACE SWMI |
$190.72
|
| Rate for Payer: PHP Medicare Advantage |
$190.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.95
|
| Rate for Payer: Priority Health Medicare |
$192.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.72
|
| Rate for Payer: UHC Exchange |
$190.72
|
| Rate for Payer: UHC Medicare Advantage |
$190.72
|
|
|
PR PLNNING PT SPEC FENEST VISCERAL AORTIC GRAFT
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 34839
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
|
|
PR PL REJUV/PERFECT
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 00071
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
|
|
PR PLSTC RPR CL LIP/NSL DFRM SEC RECRTJ DFCT & RECL
|
Professional
|
Both
|
$1,883.00
|
|
|
Service Code
|
HCPCS 40720
|
| Min. Negotiated Rate |
$753.20 |
| Max. Negotiated Rate |
$1,413.40 |
| Rate for Payer: Aetna Commercial |
$1,315.25
|
| Rate for Payer: Aetna Medicare |
$1,020.79
|
| Rate for Payer: BCBS Complete |
$753.20
|
| Rate for Payer: BCBS MAPPO |
$981.53
|
| Rate for Payer: BCN Medicare Advantage |
$981.53
|
| Rate for Payer: Cash Price |
$1,506.40
|
| Rate for Payer: Cash Price |
$1,506.40
|
| Rate for Payer: Cofinity Commercial |
$1,315.25
|
| Rate for Payer: Cofinity Commercial |
$1,413.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$981.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,030.61
|
| Rate for Payer: Nomi Health Commercial |
$1,177.84
|
| Rate for Payer: PACE SWMI |
$981.53
|
| Rate for Payer: PHP Medicare Advantage |
$981.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,223.95
|
| Rate for Payer: Priority Health Medicare |
$991.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$981.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$981.53
|
| Rate for Payer: UHC Exchange |
$981.53
|
| Rate for Payer: UHC Medicare Advantage |
$981.53
|
|
|
PR PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 42500
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$566.80 |
| Rate for Payer: Aetna Commercial |
$438.98
|
| Rate for Payer: Aetna Medicare |
$340.70
|
| Rate for Payer: BCBS Complete |
$348.80
|
| Rate for Payer: BCBS MAPPO |
$327.60
|
| Rate for Payer: BCN Medicare Advantage |
$327.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cofinity Commercial |
$471.74
|
| Rate for Payer: Cofinity Commercial |
$438.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.98
|
| Rate for Payer: Nomi Health Commercial |
$393.12
|
| Rate for Payer: PACE SWMI |
$327.60
|
| Rate for Payer: PHP Medicare Advantage |
$327.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.80
|
| Rate for Payer: Priority Health Medicare |
$330.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.60
|
| Rate for Payer: UHC Exchange |
$327.60
|
| Rate for Payer: UHC Medicare Advantage |
$327.60
|
|
|
PR PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY SEC/COMP
|
Professional
|
Both
|
$1,112.00
|
|
|
Service Code
|
HCPCS 42505
|
| Min. Negotiated Rate |
$435.25 |
| Max. Negotiated Rate |
$722.80 |
| Rate for Payer: Aetna Commercial |
$583.24
|
| Rate for Payer: Aetna Medicare |
$452.66
|
| Rate for Payer: BCBS Complete |
$444.80
|
| Rate for Payer: BCBS MAPPO |
$435.25
|
| Rate for Payer: BCN Medicare Advantage |
$435.25
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cofinity Commercial |
$626.76
|
| Rate for Payer: Cofinity Commercial |
$583.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$435.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$457.01
|
| Rate for Payer: Nomi Health Commercial |
$522.30
|
| Rate for Payer: PACE SWMI |
$435.25
|
| Rate for Payer: PHP Medicare Advantage |
$435.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.80
|
| Rate for Payer: Priority Health Medicare |
$439.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$435.25
|
| Rate for Payer: UHC Exchange |
$435.25
|
| Rate for Payer: UHC Medicare Advantage |
$435.25
|
|
|
PR PL VITALIZE
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 00070
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
|
|
PR PNCRTECT DSTL STOT W/O PNCRTCOJEJUNOSTOMY
|
Professional
|
Both
|
$3,664.00
|
|
|
Service Code
|
HCPCS 48140
|
| Min. Negotiated Rate |
$1,465.60 |
| Max. Negotiated Rate |
$2,381.60 |
| Rate for Payer: Aetna Commercial |
$2,039.06
|
| Rate for Payer: Aetna Medicare |
$1,582.56
|
| Rate for Payer: BCBS Complete |
$1,465.60
|
| Rate for Payer: BCBS MAPPO |
$1,521.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,521.69
|
| Rate for Payer: Cash Price |
$2,931.20
|
| Rate for Payer: Cash Price |
$2,931.20
|
| Rate for Payer: Cofinity Commercial |
$2,191.23
|
| Rate for Payer: Cofinity Commercial |
$2,039.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,521.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,597.77
|
| Rate for Payer: Nomi Health Commercial |
$1,826.03
|
| Rate for Payer: PACE SWMI |
$1,521.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,521.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,381.60
|
| Rate for Payer: Priority Health Medicare |
$1,536.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,521.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,521.69
|
| Rate for Payer: UHC Exchange |
$1,521.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,521.69
|
|
|
PR PNCRTECT PROX STOT W/PANCREATOJEJUNOSTOMY
|
Professional
|
Both
|
$5,562.00
|
|
|
Service Code
|
HCPCS 48150
|
| Min. Negotiated Rate |
$2,224.80 |
| Max. Negotiated Rate |
$4,348.93 |
| Rate for Payer: Aetna Commercial |
$4,046.92
|
| Rate for Payer: Aetna Medicare |
$3,140.89
|
| Rate for Payer: BCBS Complete |
$2,224.80
|
| Rate for Payer: BCBS MAPPO |
$3,020.09
|
| Rate for Payer: BCN Medicare Advantage |
$3,020.09
|
| Rate for Payer: Cash Price |
$4,449.60
|
| Rate for Payer: Cash Price |
$4,449.60
|
| Rate for Payer: Cofinity Commercial |
$4,046.92
|
| Rate for Payer: Cofinity Commercial |
$4,348.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,020.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,171.09
|
| Rate for Payer: Nomi Health Commercial |
$3,624.11
|
| Rate for Payer: PACE SWMI |
$3,020.09
|
| Rate for Payer: PHP Medicare Advantage |
$3,020.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,615.30
|
| Rate for Payer: Priority Health Medicare |
$3,050.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,020.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,020.09
|
| Rate for Payer: UHC Exchange |
$3,020.09
|
| Rate for Payer: UHC Medicare Advantage |
$3,020.09
|
|
|
PR PNCRTECT W/PANCREATOJEJUNOSTOMY
|
Professional
|
Both
|
$8,303.00
|
|
|
Service Code
|
HCPCS 48153
|
| Min. Negotiated Rate |
$3,004.75 |
| Max. Negotiated Rate |
$5,396.95 |
| Rate for Payer: Aetna Commercial |
$4,026.36
|
| Rate for Payer: Aetna Medicare |
$3,124.94
|
| Rate for Payer: BCBS Complete |
$3,321.20
|
| Rate for Payer: BCBS MAPPO |
$3,004.75
|
| Rate for Payer: BCN Medicare Advantage |
$3,004.75
|
| Rate for Payer: Cash Price |
$6,642.40
|
| Rate for Payer: Cash Price |
$6,642.40
|
| Rate for Payer: Cofinity Commercial |
$4,326.84
|
| Rate for Payer: Cofinity Commercial |
$4,026.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,004.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,154.99
|
| Rate for Payer: Nomi Health Commercial |
$3,605.70
|
| Rate for Payer: PACE SWMI |
$3,004.75
|
| Rate for Payer: PHP Medicare Advantage |
$3,004.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,396.95
|
| Rate for Payer: Priority Health Medicare |
$3,034.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,004.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,004.75
|
| Rate for Payer: UHC Exchange |
$3,004.75
|
| Rate for Payer: UHC Medicare Advantage |
$3,004.75
|
|
|
PR PNEUMOCOCCAL CONJ VACCINE 7 VALENT IM
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 90669
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$75.40 |
| Rate for Payer: Aetna Medicare |
$58.00
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.40
|
|
|
PR PNEUMONOLYSIS XTRPRIOSTEAL W/FILLING/PACKING PX
|
Professional
|
Both
|
$2,574.00
|
|
|
Service Code
|
HCPCS 32940
|
| Min. Negotiated Rate |
$1,029.60 |
| Max. Negotiated Rate |
$1,707.78 |
| Rate for Payer: Aetna Commercial |
$1,589.19
|
| Rate for Payer: Aetna Medicare |
$1,233.40
|
| Rate for Payer: BCBS Complete |
$1,029.60
|
| Rate for Payer: BCBS MAPPO |
$1,185.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,185.96
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cofinity Commercial |
$1,707.78
|
| Rate for Payer: Cofinity Commercial |
$1,589.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,185.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,245.26
|
| Rate for Payer: Nomi Health Commercial |
$1,423.15
|
| Rate for Payer: PACE SWMI |
$1,185.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,185.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,673.10
|
| Rate for Payer: Priority Health Medicare |
$1,197.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,185.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,185.96
|
| Rate for Payer: UHC Exchange |
$1,185.96
|
| Rate for Payer: UHC Medicare Advantage |
$1,185.96
|
|
|
PR PNEUMONOSTOMY W/OPEN DRAINAGE ABSCESS/CYST
|
Professional
|
Both
|
$2,729.00
|
|
|
Service Code
|
HCPCS 32200
|
| Min. Negotiated Rate |
$1,091.60 |
| Max. Negotiated Rate |
$1,773.85 |
| Rate for Payer: Aetna Commercial |
$1,468.76
|
| Rate for Payer: Aetna Medicare |
$1,139.93
|
| Rate for Payer: BCBS Complete |
$1,091.60
|
| Rate for Payer: BCBS MAPPO |
$1,096.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,096.09
|
| Rate for Payer: Cash Price |
$2,183.20
|
| Rate for Payer: Cash Price |
$2,183.20
|
| Rate for Payer: Cofinity Commercial |
$1,578.37
|
| Rate for Payer: Cofinity Commercial |
$1,468.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,096.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,150.89
|
| Rate for Payer: Nomi Health Commercial |
$1,315.31
|
| Rate for Payer: PACE SWMI |
$1,096.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,096.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,773.85
|
| Rate for Payer: Priority Health Medicare |
$1,107.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,096.09
|
| Rate for Payer: UHC Exchange |
$1,096.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,096.09
|
|
|
PR PNEUMOTHORAX THER INTRAPLEURAL INJECTION AIR
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
HCPCS 32960
|
| Min. Negotiated Rate |
$85.92 |
| Max. Negotiated Rate |
$200.85 |
| Rate for Payer: Aetna Commercial |
$115.13
|
| Rate for Payer: Aetna Medicare |
$89.36
|
| Rate for Payer: BCBS Complete |
$123.60
|
| Rate for Payer: BCBS MAPPO |
$85.92
|
| Rate for Payer: BCN Medicare Advantage |
$85.92
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cofinity Commercial |
$123.72
|
| Rate for Payer: Cofinity Commercial |
$115.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.22
|
| Rate for Payer: Nomi Health Commercial |
$103.10
|
| Rate for Payer: PACE SWMI |
$85.92
|
| Rate for Payer: PHP Medicare Advantage |
$85.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.85
|
| Rate for Payer: Priority Health Medicare |
$86.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.92
|
| Rate for Payer: UHC Exchange |
$85.92
|
| Rate for Payer: UHC Medicare Advantage |
$85.92
|
|
|
PR PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 55000
|
| Min. Negotiated Rate |
$80.41 |
| Max. Negotiated Rate |
$143.65 |
| Rate for Payer: Aetna Commercial |
$107.75
|
| Rate for Payer: Aetna Medicare |
$83.63
|
| Rate for Payer: BCBS Complete |
$88.40
|
| Rate for Payer: BCBS MAPPO |
$80.41
|
| Rate for Payer: BCN Medicare Advantage |
$80.41
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cofinity Commercial |
$115.79
|
| Rate for Payer: Cofinity Commercial |
$107.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.43
|
| Rate for Payer: Nomi Health Commercial |
$96.49
|
| Rate for Payer: PACE SWMI |
$80.41
|
| Rate for Payer: PHP Medicare Advantage |
$80.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.65
|
| Rate for Payer: Priority Health Medicare |
$81.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.41
|
| Rate for Payer: UHC Exchange |
$80.41
|
| Rate for Payer: UHC Medicare Advantage |
$80.41
|
|
|
PR POLIOVIRUS VACCINE INACTIVATED SUBQ/IM
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 90713
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$29.90 |
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
|
|
PR POLLICIZATION DIGIT
|
Professional
|
Both
|
$2,768.00
|
|
|
Service Code
|
HCPCS 26550
|
| Min. Negotiated Rate |
$1,107.20 |
| Max. Negotiated Rate |
$2,256.88 |
| Rate for Payer: Aetna Commercial |
$2,100.16
|
| Rate for Payer: Aetna Medicare |
$1,629.97
|
| Rate for Payer: BCBS Complete |
$1,107.20
|
| Rate for Payer: BCBS MAPPO |
$1,567.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,567.28
|
| Rate for Payer: Cash Price |
$2,214.40
|
| Rate for Payer: Cash Price |
$2,214.40
|
| Rate for Payer: Cofinity Commercial |
$2,256.88
|
| Rate for Payer: Cofinity Commercial |
$2,100.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,567.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,645.64
|
| Rate for Payer: Nomi Health Commercial |
$1,880.74
|
| Rate for Payer: PACE SWMI |
$1,567.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,567.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,799.20
|
| Rate for Payer: Priority Health Medicare |
$1,582.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,567.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,567.28
|
| Rate for Payer: UHC Exchange |
$1,567.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,567.28
|
|
|
PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 95810
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$811.47 |
| Rate for Payer: Aetna Commercial |
$755.12
|
| Rate for Payer: Aetna Commercial |
$755.12
|
| Rate for Payer: Aetna Medicare |
$586.06
|
| Rate for Payer: Aetna Medicare |
$586.06
|
| Rate for Payer: BCBS Complete |
$189.60
|
| Rate for Payer: BCBS Complete |
$398.80
|
| Rate for Payer: BCBS MAPPO |
$563.52
|
| Rate for Payer: BCBS MAPPO |
$563.52
|
| Rate for Payer: BCN Medicare Advantage |
$563.52
|
| Rate for Payer: BCN Medicare Advantage |
$563.52
|
| Rate for Payer: Cash Price |
$797.60
|
| Rate for Payer: Cash Price |
$797.60
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cofinity Commercial |
$811.47
|
| Rate for Payer: Cofinity Commercial |
$755.12
|
| Rate for Payer: Cofinity Commercial |
$811.47
|
| Rate for Payer: Cofinity Commercial |
$755.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$563.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$563.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$591.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$591.70
|
| Rate for Payer: Nomi Health Commercial |
$676.22
|
| Rate for Payer: Nomi Health Commercial |
$676.22
|
| Rate for Payer: PACE SWMI |
$563.52
|
| Rate for Payer: PACE SWMI |
$563.52
|
| Rate for Payer: PHP Medicare Advantage |
$563.52
|
| Rate for Payer: PHP Medicare Advantage |
$563.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.05
|
| Rate for Payer: Priority Health Medicare |
$569.16
|
| Rate for Payer: Priority Health Medicare |
$569.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$563.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$563.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$563.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$563.52
|
| Rate for Payer: UHC Exchange |
$563.52
|
| Rate for Payer: UHC Exchange |
$563.52
|
| Rate for Payer: UHC Medicare Advantage |
$563.52
|
| Rate for Payer: UHC Medicare Advantage |
$563.52
|
|
