|
PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT
|
Professional
|
Both
|
$3,104.00
|
|
|
Service Code
|
HCPCS 34705
|
| Min. Negotiated Rate |
$949.98 |
| Max. Negotiated Rate |
$2,747.37 |
| Rate for Payer: Aetna Commercial |
$2,012.47
|
| Rate for Payer: Aetna Medicare |
$1,501.84
|
| Rate for Payer: BCBS Complete |
$997.48
|
| Rate for Payer: BCBS MAPPO |
$1,501.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,747.37
|
| Rate for Payer: BCN Commercial |
$2,174.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,501.84
|
| Rate for Payer: Cash Price |
$2,483.20
|
| Rate for Payer: Cash Price |
$2,483.20
|
| Rate for Payer: Cofinity Commercial |
$2,162.65
|
| Rate for Payer: Cofinity Commercial |
$2,012.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,501.84
|
| Rate for Payer: Healthscope Commercial |
$1,802.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,802.21
|
| Rate for Payer: Meridian Medicaid |
$997.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,576.93
|
| Rate for Payer: PACE SWMI |
$1,501.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,501.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$949.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,172.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,367.21
|
| Rate for Payer: Priority Health Medicare |
$1,501.84
|
| Rate for Payer: Priority Health Narrow Network |
$2,367.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,546.90
|
|
|
PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT
|
Professional
|
Both
|
$4,745.00
|
|
|
Service Code
|
HCPCS 34706
|
| Min. Negotiated Rate |
$1,415.81 |
| Max. Negotiated Rate |
$3,526.88 |
| Rate for Payer: Aetna Commercial |
$3,004.70
|
| Rate for Payer: Aetna Medicare |
$2,242.31
|
| Rate for Payer: BCBS Complete |
$1,486.60
|
| Rate for Payer: BCBS MAPPO |
$2,242.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,686.93
|
| Rate for Payer: BCN Commercial |
$3,239.93
|
| Rate for Payer: BCN Medicare Advantage |
$2,242.31
|
| Rate for Payer: Cash Price |
$3,796.00
|
| Rate for Payer: Cash Price |
$3,796.00
|
| Rate for Payer: Cofinity Commercial |
$3,228.93
|
| Rate for Payer: Cofinity Commercial |
$3,004.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,242.31
|
| Rate for Payer: Healthscope Commercial |
$2,690.77
|
| Rate for Payer: Healthscope Whirlpool |
$2,690.77
|
| Rate for Payer: Meridian Medicaid |
$1,486.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,354.43
|
| Rate for Payer: PACE SWMI |
$2,242.31
|
| Rate for Payer: PHP Medicare Advantage |
$2,242.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,415.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,321.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,526.88
|
| Rate for Payer: Priority Health Medicare |
$2,242.31
|
| Rate for Payer: Priority Health Narrow Network |
$3,526.88
|
| Rate for Payer: UHC Medicare Advantage |
$2,309.58
|
|
|
PR EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT
|
Professional
|
Both
|
$2,860.00
|
|
|
Service Code
|
HCPCS 34703
|
| Min. Negotiated Rate |
$854.34 |
| Max. Negotiated Rate |
$2,308.14 |
| Rate for Payer: Aetna Commercial |
$1,814.04
|
| Rate for Payer: Aetna Medicare |
$1,353.76
|
| Rate for Payer: BCBS Complete |
$897.06
|
| Rate for Payer: BCBS MAPPO |
$1,353.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,308.14
|
| Rate for Payer: BCN Commercial |
$1,960.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,353.76
|
| Rate for Payer: Cash Price |
$2,288.00
|
| Rate for Payer: Cash Price |
$2,288.00
|
| Rate for Payer: Cofinity Commercial |
$1,814.04
|
| Rate for Payer: Cofinity Commercial |
$1,949.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,353.76
|
| Rate for Payer: Healthscope Commercial |
$1,624.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,624.51
|
| Rate for Payer: Meridian Medicaid |
$897.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,421.45
|
| Rate for Payer: PACE SWMI |
$1,353.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,353.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$854.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,002.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,134.21
|
| Rate for Payer: Priority Health Medicare |
$1,353.76
|
| Rate for Payer: Priority Health Narrow Network |
$2,134.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,394.37
|
|
|
PR EVASC RPR DPLMNT ILIO-ILIAC NDGFT
|
Professional
|
Both
|
$2,367.00
|
|
|
Service Code
|
HCPCS 34707
|
| Min. Negotiated Rate |
$722.50 |
| Max. Negotiated Rate |
$2,209.35 |
| Rate for Payer: Aetna Commercial |
$1,536.40
|
| Rate for Payer: Aetna Medicare |
$1,146.57
|
| Rate for Payer: BCBS Complete |
$758.62
|
| Rate for Payer: BCBS MAPPO |
$1,146.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,209.35
|
| Rate for Payer: BCN Commercial |
$1,662.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,146.57
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Cofinity Commercial |
$1,651.06
|
| Rate for Payer: Cofinity Commercial |
$1,536.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,146.57
|
| Rate for Payer: Healthscope Commercial |
$1,375.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,375.88
|
| Rate for Payer: Meridian Medicaid |
$758.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,203.90
|
| Rate for Payer: PACE SWMI |
$1,146.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,146.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$722.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,656.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,809.72
|
| Rate for Payer: Priority Health Medicare |
$1,146.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,809.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,180.97
|
|
|
PR EVASC RPR DPLMNT ILIO-ILIAC NDGFT RPT
|
Professional
|
Both
|
$3,823.00
|
|
|
Service Code
|
HCPCS 34708
|
| Min. Negotiated Rate |
$1,132.52 |
| Max. Negotiated Rate |
$2,816.72 |
| Rate for Payer: Aetna Commercial |
$2,404.30
|
| Rate for Payer: Aetna Medicare |
$1,794.25
|
| Rate for Payer: BCBS Complete |
$1,189.15
|
| Rate for Payer: BCBS MAPPO |
$1,794.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,929.88
|
| Rate for Payer: BCN Commercial |
$2,587.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,794.25
|
| Rate for Payer: Cash Price |
$3,058.40
|
| Rate for Payer: Cash Price |
$3,058.40
|
| Rate for Payer: Cofinity Commercial |
$2,583.72
|
| Rate for Payer: Cofinity Commercial |
$2,404.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,794.25
|
| Rate for Payer: Healthscope Commercial |
$2,153.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,153.10
|
| Rate for Payer: Meridian Medicaid |
$1,189.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,883.96
|
| Rate for Payer: PACE SWMI |
$1,794.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,794.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,132.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,676.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,816.72
|
| Rate for Payer: Priority Health Medicare |
$1,794.25
|
| Rate for Payer: Priority Health Narrow Network |
$2,816.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,848.08
|
|
|
PR EVASC RPR DTA COVERAGE ART ORIGIN 1ST ENDOPROSTH
|
Professional
|
Both
|
$8,083.00
|
|
|
Service Code
|
HCPCS 33880
|
| Min. Negotiated Rate |
$649.81 |
| Max. Negotiated Rate |
$5,658.10 |
| Rate for Payer: Aetna Commercial |
$2,361.63
|
| Rate for Payer: Aetna Medicare |
$1,762.41
|
| Rate for Payer: BCBS Complete |
$1,168.80
|
| Rate for Payer: BCBS MAPPO |
$1,762.41
|
| Rate for Payer: BCBS Trust/PPO |
$649.81
|
| Rate for Payer: BCN Commercial |
$2,552.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,762.41
|
| Rate for Payer: Cash Price |
$6,466.40
|
| Rate for Payer: Cash Price |
$6,466.40
|
| Rate for Payer: Cofinity Commercial |
$2,361.63
|
| Rate for Payer: Cofinity Commercial |
$2,537.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,762.41
|
| Rate for Payer: Healthscope Commercial |
$2,114.89
|
| Rate for Payer: Healthscope Whirlpool |
$2,114.89
|
| Rate for Payer: Meridian Medicaid |
$1,168.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,850.53
|
| Rate for Payer: PACE SWMI |
$1,762.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,762.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,113.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,658.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,778.95
|
| Rate for Payer: Priority Health Medicare |
$1,762.41
|
| Rate for Payer: Priority Health Narrow Network |
$2,778.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,815.28
|
|
|
PR EVASC RPR DTA EXP COVERAGE W/O ART ORIGIN
|
Professional
|
Both
|
$5,396.00
|
|
|
Service Code
|
HCPCS 33881
|
| Min. Negotiated Rate |
$924.53 |
| Max. Negotiated Rate |
$3,777.20 |
| Rate for Payer: Aetna Commercial |
$2,022.93
|
| Rate for Payer: Aetna Medicare |
$1,509.65
|
| Rate for Payer: BCBS Complete |
$1,003.97
|
| Rate for Payer: BCBS MAPPO |
$1,509.65
|
| Rate for Payer: BCBS Trust/PPO |
$924.53
|
| Rate for Payer: BCN Commercial |
$2,187.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,509.65
|
| Rate for Payer: Cash Price |
$4,316.80
|
| Rate for Payer: Cash Price |
$4,316.80
|
| Rate for Payer: Cofinity Commercial |
$2,022.93
|
| Rate for Payer: Cofinity Commercial |
$2,173.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,509.65
|
| Rate for Payer: Healthscope Commercial |
$1,811.58
|
| Rate for Payer: Healthscope Whirlpool |
$1,811.58
|
| Rate for Payer: Meridian Medicaid |
$1,003.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,585.13
|
| Rate for Payer: PACE SWMI |
$1,509.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,509.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,777.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,381.04
|
| Rate for Payer: Priority Health Medicare |
$1,509.65
|
| Rate for Payer: Priority Health Narrow Network |
$2,381.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,554.94
|
|
|
PR EVASC RPR ILAC ART BIFUR ENDGRFT CATHJ RS&I UNI
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
HCPCS 0254T
|
| Min. Negotiated Rate |
$376.00 |
| Max. Negotiated Rate |
$658.00 |
| Rate for Payer: BCBS Complete |
$376.00
|
| Rate for Payer: Cash Price |
$752.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$658.00
|
|
|
PR EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNI
|
Professional
|
Both
|
$2,120.00
|
|
|
Service Code
|
HCPCS 34718
|
| Min. Negotiated Rate |
$770.63 |
| Max. Negotiated Rate |
$1,914.51 |
| Rate for Payer: Aetna Commercial |
$1,627.99
|
| Rate for Payer: Aetna Medicare |
$1,214.92
|
| Rate for Payer: BCBS Complete |
$809.16
|
| Rate for Payer: BCBS MAPPO |
$1,214.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,579.62
|
| Rate for Payer: BCN Commercial |
$1,758.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,214.92
|
| Rate for Payer: Cash Price |
$1,696.00
|
| Rate for Payer: Cash Price |
$1,696.00
|
| Rate for Payer: Cofinity Commercial |
$1,749.48
|
| Rate for Payer: Cofinity Commercial |
$1,627.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,214.92
|
| Rate for Payer: Healthscope Commercial |
$1,457.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,457.90
|
| Rate for Payer: Meridian Medicaid |
$809.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,275.67
|
| Rate for Payer: PACE SWMI |
$1,214.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,214.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$770.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,484.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,914.51
|
| Rate for Payer: Priority Health Medicare |
$1,214.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,914.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,251.37
|
|
|
PR EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNI
|
Professional
|
Both
|
$793.00
|
|
|
Service Code
|
HCPCS 34717
|
| Min. Negotiated Rate |
$274.98 |
| Max. Negotiated Rate |
$1,145.35 |
| Rate for Payer: Aetna Commercial |
$584.92
|
| Rate for Payer: Aetna Medicare |
$436.51
|
| Rate for Payer: BCBS Complete |
$288.73
|
| Rate for Payer: BCBS MAPPO |
$436.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,145.35
|
| Rate for Payer: BCN Commercial |
$629.42
|
| Rate for Payer: BCN Medicare Advantage |
$436.51
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cofinity Commercial |
$584.92
|
| Rate for Payer: Cofinity Commercial |
$628.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$436.51
|
| Rate for Payer: Healthscope Commercial |
$523.81
|
| Rate for Payer: Healthscope Whirlpool |
$523.81
|
| Rate for Payer: Meridian Medicaid |
$288.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$458.34
|
| Rate for Payer: PACE SWMI |
$436.51
|
| Rate for Payer: PHP Medicare Advantage |
$436.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$685.17
|
| Rate for Payer: Priority Health Medicare |
$436.51
|
| Rate for Payer: Priority Health Narrow Network |
$685.17
|
| Rate for Payer: UHC Medicare Advantage |
$449.61
|
|
|
PR EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK
|
Professional
|
Both
|
$3,271.00
|
|
|
Service Code
|
HCPCS 61623
|
| Min. Negotiated Rate |
$124.15 |
| Max. Negotiated Rate |
$2,289.70 |
| Rate for Payer: Aetna Commercial |
$772.03
|
| Rate for Payer: Aetna Medicare |
$576.14
|
| Rate for Payer: BCBS Complete |
$385.57
|
| Rate for Payer: BCBS MAPPO |
$576.14
|
| Rate for Payer: BCBS Trust/PPO |
$124.15
|
| Rate for Payer: BCN Commercial |
$838.57
|
| Rate for Payer: BCN Medicare Advantage |
$576.14
|
| Rate for Payer: Cash Price |
$2,616.80
|
| Rate for Payer: Cash Price |
$2,616.80
|
| Rate for Payer: Cofinity Commercial |
$829.64
|
| Rate for Payer: Cofinity Commercial |
$772.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$576.14
|
| Rate for Payer: Healthscope Commercial |
$691.37
|
| Rate for Payer: Healthscope Whirlpool |
$691.37
|
| Rate for Payer: Meridian Medicaid |
$385.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$604.95
|
| Rate for Payer: PACE SWMI |
$576.14
|
| Rate for Payer: PHP Medicare Advantage |
$576.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,289.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$971.63
|
| Rate for Payer: Priority Health Medicare |
$576.14
|
| Rate for Payer: Priority Health Narrow Network |
$971.63
|
| Rate for Payer: UHC Medicare Advantage |
$593.42
|
|
|
PR EWHO RIGID W/O JNTS CF
|
Professional
|
Both
|
$685.00
|
|
|
Service Code
|
HCPCS L3763
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$646.68 |
| Rate for Payer: Aetna Commercial |
$410.20
|
| Rate for Payer: BCBS Complete |
$274.00
|
| Rate for Payer: BCN Commercial |
$646.68
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.50
|
|
|
PR EWHO W/JOINT(S) CF
|
Professional
|
Both
|
$717.00
|
|
|
Service Code
|
HCPCS L3764
|
| Min. Negotiated Rate |
$286.80 |
| Max. Negotiated Rate |
$676.76 |
| Rate for Payer: Aetna Commercial |
$429.28
|
| Rate for Payer: BCBS Complete |
$286.80
|
| Rate for Payer: BCN Commercial |
$676.76
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.90
|
|
|
PR EXC 1/> SMALL/LARGE LESIONS INTESTINE ENTEROTOM
|
Professional
|
Both
|
$2,332.00
|
|
|
Service Code
|
HCPCS 44110
|
| Min. Negotiated Rate |
$543.79 |
| Max. Negotiated Rate |
$1,643.01 |
| Rate for Payer: Aetna Commercial |
$1,123.90
|
| Rate for Payer: Aetna Medicare |
$838.73
|
| Rate for Payer: BCBS Complete |
$570.98
|
| Rate for Payer: BCBS MAPPO |
$838.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,643.01
|
| Rate for Payer: BCN Commercial |
$1,234.88
|
| Rate for Payer: BCN Medicare Advantage |
$838.73
|
| Rate for Payer: Cash Price |
$1,865.60
|
| Rate for Payer: Cash Price |
$1,865.60
|
| Rate for Payer: Cofinity Commercial |
$1,123.90
|
| Rate for Payer: Cofinity Commercial |
$1,207.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$838.73
|
| Rate for Payer: Healthscope Commercial |
$1,006.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,006.48
|
| Rate for Payer: Meridian Medicaid |
$570.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$880.67
|
| Rate for Payer: PACE SWMI |
$838.73
|
| Rate for Payer: PHP Medicare Advantage |
$838.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$543.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,632.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,485.81
|
| Rate for Payer: Priority Health Medicare |
$838.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,485.81
|
| Rate for Payer: UHC Medicare Advantage |
$863.89
|
|
|
PR EXC 1/> SM/LG LESIONS INTESTNE MULT ENTEROTOMIE
|
Professional
|
Both
|
$3,534.00
|
|
|
Service Code
|
HCPCS 44111
|
| Min. Negotiated Rate |
$266.79 |
| Max. Negotiated Rate |
$2,473.80 |
| Rate for Payer: Aetna Commercial |
$1,308.18
|
| Rate for Payer: Aetna Medicare |
$976.25
|
| Rate for Payer: BCBS Complete |
$655.52
|
| Rate for Payer: BCBS MAPPO |
$976.25
|
| Rate for Payer: BCBS Trust/PPO |
$266.79
|
| Rate for Payer: BCN Commercial |
$1,435.25
|
| Rate for Payer: BCN Medicare Advantage |
$976.25
|
| Rate for Payer: Cash Price |
$2,827.20
|
| Rate for Payer: Cash Price |
$2,827.20
|
| Rate for Payer: Cofinity Commercial |
$1,405.80
|
| Rate for Payer: Cofinity Commercial |
$1,308.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$976.25
|
| Rate for Payer: Healthscope Commercial |
$1,171.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,171.50
|
| Rate for Payer: Meridian Medicaid |
$655.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,025.06
|
| Rate for Payer: PACE SWMI |
$976.25
|
| Rate for Payer: PHP Medicare Advantage |
$976.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$624.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,473.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,726.88
|
| Rate for Payer: Priority Health Medicare |
$976.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,726.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,005.54
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
11440
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$169.24 |
| Rate for Payer: Aetna Commercial |
$136.20
|
| Rate for Payer: Aetna Medicare |
$101.64
|
| Rate for Payer: BCBS Complete |
$72.46
|
| Rate for Payer: BCBS MAPPO |
$101.64
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$169.24
|
| Rate for Payer: BCN Medicare Advantage |
$101.64
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$146.36
|
| Rate for Payer: Cofinity Commercial |
$136.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.64
|
| Rate for Payer: Healthscope Commercial |
$121.97
|
| Rate for Payer: Healthscope Whirlpool |
$121.97
|
| Rate for Payer: Meridian Medicaid |
$72.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$106.72
|
| Rate for Payer: PACE SWMI |
$101.64
|
| Rate for Payer: PHP Medicare Advantage |
$101.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.30
|
| Rate for Payer: Priority Health Medicare |
$101.64
|
| Rate for Payer: Priority Health Narrow Network |
$130.30
|
| Rate for Payer: UHC Medicare Advantage |
$104.69
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 11440
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$169.24 |
| Rate for Payer: Aetna Commercial |
$136.20
|
| Rate for Payer: Aetna Medicare |
$101.64
|
| Rate for Payer: BCBS Complete |
$72.46
|
| Rate for Payer: BCBS MAPPO |
$101.64
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$169.24
|
| Rate for Payer: BCN Medicare Advantage |
$101.64
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$146.36
|
| Rate for Payer: Cofinity Commercial |
$136.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.64
|
| Rate for Payer: Healthscope Commercial |
$121.97
|
| Rate for Payer: Healthscope Whirlpool |
$121.97
|
| Rate for Payer: Meridian Medicaid |
$72.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$106.72
|
| Rate for Payer: PACE SWMI |
$101.64
|
| Rate for Payer: PHP Medicare Advantage |
$101.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.30
|
| Rate for Payer: Priority Health Medicare |
$101.64
|
| Rate for Payer: Priority Health Narrow Network |
$130.30
|
| Rate for Payer: UHC Medicare Advantage |
$104.69
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
11440
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: ASR ASR |
$213.40
|
| Rate for Payer: BCBS Trust/PPO |
$170.57
|
| Rate for Payer: BCN Commercial |
$170.57
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$206.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.00
|
| Rate for Payer: Healthscope Commercial |
$220.00
|
| Rate for Payer: Healthscope Whirlpool |
$213.40
|
| Rate for Payer: Mclaren Commercial |
$198.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.60
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
11440
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$781.74 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Aetna Medicare |
$625.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: ASR ASR |
$213.40
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$170.57
|
| Rate for Payer: BCN Commercial |
$170.57
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$206.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$220.00
|
| Rate for Payer: Healthscope Whirlpool |
$213.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.39
|
| Rate for Payer: Mclaren Commercial |
$198.00
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.00
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$687.93
|
| Rate for Payer: PHP Medicaid |
$342.09
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.20
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$156.20
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.60
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM
|
Professional
|
Both
|
$810.00
|
|
|
Service Code
|
HCPCS 11446
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna Commercial |
$413.54
|
| Rate for Payer: Aetna Medicare |
$308.61
|
| Rate for Payer: BCBS Complete |
$213.14
|
| Rate for Payer: BCBS MAPPO |
$308.61
|
| Rate for Payer: BCBS Trust/PPO |
$150.00
|
| Rate for Payer: BCN Commercial |
$449.99
|
| Rate for Payer: BCN Medicare Advantage |
$308.61
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cofinity Commercial |
$444.40
|
| Rate for Payer: Cofinity Commercial |
$413.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.61
|
| Rate for Payer: Healthscope Commercial |
$370.33
|
| Rate for Payer: Healthscope Whirlpool |
$370.33
|
| Rate for Payer: Meridian Medicaid |
$213.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$324.04
|
| Rate for Payer: PACE SWMI |
$308.61
|
| Rate for Payer: PHP Medicare Advantage |
$308.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$386.79
|
| Rate for Payer: Priority Health Medicare |
$308.61
|
| Rate for Payer: Priority Health Narrow Network |
$386.79
|
| Rate for Payer: UHC Medicare Advantage |
$317.87
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
HCPCS 11420
|
| Min. Negotiated Rate |
$52.82 |
| Max. Negotiated Rate |
$150.39 |
| Rate for Payer: Aetna Commercial |
$106.34
|
| Rate for Payer: Aetna Medicare |
$79.36
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCBS MAPPO |
$79.36
|
| Rate for Payer: BCBS Trust/PPO |
$100.72
|
| Rate for Payer: BCN Commercial |
$150.39
|
| Rate for Payer: BCN Medicare Advantage |
$79.36
|
| Rate for Payer: Cash Price |
$159.20
|
| Rate for Payer: Cash Price |
$159.20
|
| Rate for Payer: Cofinity Commercial |
$114.28
|
| Rate for Payer: Cofinity Commercial |
$106.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.36
|
| Rate for Payer: Healthscope Commercial |
$95.23
|
| Rate for Payer: Healthscope Whirlpool |
$95.23
|
| Rate for Payer: Meridian Medicaid |
$55.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.33
|
| Rate for Payer: PACE SWMI |
$79.36
|
| Rate for Payer: PHP Medicare Advantage |
$79.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.70
|
| Rate for Payer: Priority Health Medicare |
$79.36
|
| Rate for Payer: Priority Health Narrow Network |
$100.70
|
| Rate for Payer: UHC Medicare Advantage |
$81.74
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$179.20 |
| Max. Negotiated Rate |
$781.74 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Aetna Medicare |
$625.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: ASR ASR |
$248.32
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$198.48
|
| Rate for Payer: BCN Commercial |
$198.48
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cofinity Commercial |
$240.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$256.00
|
| Rate for Payer: Healthscope Whirlpool |
$248.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.39
|
| Rate for Payer: Mclaren Commercial |
$230.40
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.60
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$687.93
|
| Rate for Payer: PHP Medicaid |
$342.09
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.96
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$181.76
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.28
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 11421
|
| Hospital Charge Code |
11421
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$338.18 |
| Rate for Payer: Aetna Commercial |
$142.56
|
| Rate for Payer: Aetna Medicare |
$106.39
|
| Rate for Payer: BCBS Complete |
$73.58
|
| Rate for Payer: BCBS MAPPO |
$106.39
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: BCN Commercial |
$188.87
|
| Rate for Payer: BCN Medicare Advantage |
$106.39
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cofinity Commercial |
$142.56
|
| Rate for Payer: Cofinity Commercial |
$153.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.39
|
| Rate for Payer: Healthscope Commercial |
$127.67
|
| Rate for Payer: Healthscope Whirlpool |
$127.67
|
| Rate for Payer: Meridian Medicaid |
$73.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$111.71
|
| Rate for Payer: PACE SWMI |
$106.39
|
| Rate for Payer: PHP Medicare Advantage |
$106.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.41
|
| Rate for Payer: Priority Health Medicare |
$106.39
|
| Rate for Payer: Priority Health Narrow Network |
$134.41
|
| Rate for Payer: UHC Medicare Advantage |
$109.58
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 11421
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$338.18 |
| Rate for Payer: Aetna Commercial |
$142.56
|
| Rate for Payer: Aetna Medicare |
$106.39
|
| Rate for Payer: BCBS Complete |
$73.58
|
| Rate for Payer: BCBS MAPPO |
$106.39
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: BCN Commercial |
$188.87
|
| Rate for Payer: BCN Medicare Advantage |
$106.39
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cofinity Commercial |
$153.20
|
| Rate for Payer: Cofinity Commercial |
$142.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.39
|
| Rate for Payer: Healthscope Commercial |
$127.67
|
| Rate for Payer: Healthscope Whirlpool |
$127.67
|
| Rate for Payer: Meridian Medicaid |
$73.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$111.71
|
| Rate for Payer: PACE SWMI |
$106.39
|
| Rate for Payer: PHP Medicare Advantage |
$106.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.41
|
| Rate for Payer: Priority Health Medicare |
$106.39
|
| Rate for Payer: Priority Health Narrow Network |
$134.41
|
| Rate for Payer: UHC Medicare Advantage |
$109.58
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$179.20 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: ASR ASR |
$248.32
|
| Rate for Payer: BCBS Trust/PPO |
$198.48
|
| Rate for Payer: BCN Commercial |
$198.48
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cofinity Commercial |
$240.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.80
|
| Rate for Payer: Healthscope Commercial |
$256.00
|
| Rate for Payer: Healthscope Whirlpool |
$248.32
|
| Rate for Payer: Mclaren Commercial |
$230.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.28
|
|
