|
PR BYP OTH/THN VEIN AORTOBI-ILIAC
|
Professional
|
Both
|
$4,943.00
|
|
|
Service Code
|
HCPCS 35638
|
| Min. Negotiated Rate |
$1,675.27 |
| Max. Negotiated Rate |
$3,212.95 |
| Rate for Payer: Aetna Commercial |
$2,244.86
|
| Rate for Payer: Aetna Medicare |
$1,675.27
|
| Rate for Payer: BCBS Complete |
$1,977.20
|
| Rate for Payer: BCBS MAPPO |
$1,675.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,675.27
|
| Rate for Payer: Cash Price |
$3,954.40
|
| Rate for Payer: Cash Price |
$3,954.40
|
| Rate for Payer: Cofinity Commercial |
$2,412.39
|
| Rate for Payer: Cofinity Commercial |
$2,244.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,675.27
|
| Rate for Payer: Healthscope Commercial |
$2,010.32
|
| Rate for Payer: Healthscope Whirlpool |
$2,010.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,759.03
|
| Rate for Payer: Nomi Health Commercial |
$2,010.32
|
| Rate for Payer: PACE SWMI |
$1,675.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,675.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,212.95
|
| Rate for Payer: Priority Health Medicare |
$1,675.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,675.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,675.27
|
| Rate for Payer: UHCCP DNSP |
$1,675.27
|
|
|
PR BYP OTH/THN VEIN AORTOCELIAC AORTOMSN AORTORNL
|
Professional
|
Both
|
$5,066.00
|
|
|
Service Code
|
HCPCS 35631
|
| Min. Negotiated Rate |
$1,772.59 |
| Max. Negotiated Rate |
$3,292.90 |
| Rate for Payer: Aetna Commercial |
$2,375.27
|
| Rate for Payer: Aetna Medicare |
$1,772.59
|
| Rate for Payer: BCBS Complete |
$2,026.40
|
| Rate for Payer: BCBS MAPPO |
$1,772.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,772.59
|
| Rate for Payer: Cash Price |
$4,052.80
|
| Rate for Payer: Cash Price |
$4,052.80
|
| Rate for Payer: Cofinity Commercial |
$2,552.53
|
| Rate for Payer: Cofinity Commercial |
$2,375.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,772.59
|
| Rate for Payer: Healthscope Commercial |
$2,127.11
|
| Rate for Payer: Healthscope Whirlpool |
$2,127.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,861.22
|
| Rate for Payer: Nomi Health Commercial |
$2,127.11
|
| Rate for Payer: PACE SWMI |
$1,772.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,772.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,292.90
|
| Rate for Payer: Priority Health Medicare |
$1,772.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,772.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,772.59
|
| Rate for Payer: UHCCP DNSP |
$1,772.59
|
|
|
PR BYP OTH/THN VEIN AORTOFEMORAL
|
Professional
|
Both
|
$3,067.00
|
|
|
Service Code
|
HCPCS 35647
|
| Min. Negotiated Rate |
$1,226.80 |
| Max. Negotiated Rate |
$2,120.92 |
| Rate for Payer: Aetna Commercial |
$1,973.63
|
| Rate for Payer: Aetna Medicare |
$1,472.86
|
| Rate for Payer: BCBS Complete |
$1,226.80
|
| Rate for Payer: BCBS MAPPO |
$1,472.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,472.86
|
| Rate for Payer: Cash Price |
$2,453.60
|
| Rate for Payer: Cash Price |
$2,453.60
|
| Rate for Payer: Cofinity Commercial |
$2,120.92
|
| Rate for Payer: Cofinity Commercial |
$1,973.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,472.86
|
| Rate for Payer: Healthscope Commercial |
$1,767.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,767.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,546.50
|
| Rate for Payer: Nomi Health Commercial |
$1,767.43
|
| Rate for Payer: PACE SWMI |
$1,472.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,472.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,993.55
|
| Rate for Payer: Priority Health Medicare |
$1,472.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,472.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,472.86
|
| Rate for Payer: UHCCP DNSP |
$1,472.86
|
|
|
PR BYP OTH/THN VEIN AORTOILIAC
|
Professional
|
Both
|
$3,635.00
|
|
|
Service Code
|
HCPCS 35637
|
| Min. Negotiated Rate |
$1,454.00 |
| Max. Negotiated Rate |
$2,362.75 |
| Rate for Payer: Aetna Commercial |
$2,141.75
|
| Rate for Payer: Aetna Medicare |
$1,598.32
|
| Rate for Payer: BCBS Complete |
$1,454.00
|
| Rate for Payer: BCBS MAPPO |
$1,598.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,598.32
|
| Rate for Payer: Cash Price |
$2,908.00
|
| Rate for Payer: Cash Price |
$2,908.00
|
| Rate for Payer: Cofinity Commercial |
$2,301.58
|
| Rate for Payer: Cofinity Commercial |
$2,141.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,598.32
|
| Rate for Payer: Healthscope Commercial |
$1,917.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,917.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,678.24
|
| Rate for Payer: Nomi Health Commercial |
$1,917.98
|
| Rate for Payer: PACE SWMI |
$1,598.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,598.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,362.75
|
| Rate for Payer: Priority Health Medicare |
$1,598.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,598.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,598.32
|
| Rate for Payer: UHCCP DNSP |
$1,598.32
|
|
|
PR BYP OTH/THN VEIN AXILLARY-AXILLARY
|
Professional
|
Both
|
$2,215.00
|
|
|
Service Code
|
HCPCS 35650
|
| Min. Negotiated Rate |
$886.00 |
| Max. Negotiated Rate |
$1,439.75 |
| Rate for Payer: Aetna Commercial |
$1,319.48
|
| Rate for Payer: Aetna Medicare |
$984.69
|
| Rate for Payer: BCBS Complete |
$886.00
|
| Rate for Payer: BCBS MAPPO |
$984.69
|
| Rate for Payer: BCN Medicare Advantage |
$984.69
|
| Rate for Payer: Cash Price |
$1,772.00
|
| Rate for Payer: Cash Price |
$1,772.00
|
| Rate for Payer: Cofinity Commercial |
$1,417.95
|
| Rate for Payer: Cofinity Commercial |
$1,319.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$984.69
|
| Rate for Payer: Healthscope Commercial |
$1,181.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,181.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,033.92
|
| Rate for Payer: Nomi Health Commercial |
$1,181.63
|
| Rate for Payer: PACE SWMI |
$984.69
|
| Rate for Payer: PHP Medicare Advantage |
$984.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,439.75
|
| Rate for Payer: Priority Health Medicare |
$984.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$984.69
|
| Rate for Payer: UHC Medicare Advantage |
$984.69
|
| Rate for Payer: UHCCP DNSP |
$984.69
|
|
|
PR BYP OTH/THN VEIN AXILLARY-FEMORAL
|
Professional
|
Both
|
$4,190.00
|
|
|
Service Code
|
HCPCS 35621
|
| Min. Negotiated Rate |
$1,050.35 |
| Max. Negotiated Rate |
$2,723.50 |
| Rate for Payer: Aetna Commercial |
$1,407.47
|
| Rate for Payer: Aetna Medicare |
$1,050.35
|
| Rate for Payer: BCBS Complete |
$1,676.00
|
| Rate for Payer: BCBS MAPPO |
$1,050.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,050.35
|
| Rate for Payer: Cash Price |
$3,352.00
|
| Rate for Payer: Cash Price |
$3,352.00
|
| Rate for Payer: Cofinity Commercial |
$1,512.50
|
| Rate for Payer: Cofinity Commercial |
$1,407.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,050.35
|
| Rate for Payer: Healthscope Commercial |
$1,260.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,260.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,102.87
|
| Rate for Payer: Nomi Health Commercial |
$1,260.42
|
| Rate for Payer: PACE SWMI |
$1,050.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,050.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,723.50
|
| Rate for Payer: Priority Health Medicare |
$1,050.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,050.35
|
| Rate for Payer: UHC Medicare Advantage |
$1,050.35
|
| Rate for Payer: UHCCP DNSP |
$1,050.35
|
|
|
PR BYP OTH/THN VEIN AXILLARY-FEMORAL-FEMORAL
|
Professional
|
Both
|
$4,922.00
|
|
|
Service Code
|
HCPCS 35654
|
| Min. Negotiated Rate |
$1,310.50 |
| Max. Negotiated Rate |
$3,199.30 |
| Rate for Payer: Aetna Commercial |
$1,756.07
|
| Rate for Payer: Aetna Medicare |
$1,310.50
|
| Rate for Payer: BCBS Complete |
$1,968.80
|
| Rate for Payer: BCBS MAPPO |
$1,310.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,310.50
|
| Rate for Payer: Cash Price |
$3,937.60
|
| Rate for Payer: Cash Price |
$3,937.60
|
| Rate for Payer: Cofinity Commercial |
$1,887.12
|
| Rate for Payer: Cofinity Commercial |
$1,756.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,310.50
|
| Rate for Payer: Healthscope Commercial |
$1,572.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,572.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,376.03
|
| Rate for Payer: Nomi Health Commercial |
$1,572.60
|
| Rate for Payer: PACE SWMI |
$1,310.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,310.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,199.30
|
| Rate for Payer: Priority Health Medicare |
$1,310.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,310.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,310.50
|
| Rate for Payer: UHCCP DNSP |
$1,310.50
|
|
|
PR BYP OTH/THN VEIN CAROTID-SUBCLAVIAN
|
Professional
|
Both
|
$2,324.00
|
|
|
Service Code
|
HCPCS 35606
|
| Min. Negotiated Rate |
$929.60 |
| Max. Negotiated Rate |
$1,621.64 |
| Rate for Payer: Aetna Commercial |
$1,509.03
|
| Rate for Payer: Aetna Medicare |
$1,126.14
|
| Rate for Payer: BCBS Complete |
$929.60
|
| Rate for Payer: BCBS MAPPO |
$1,126.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,126.14
|
| Rate for Payer: Cash Price |
$1,859.20
|
| Rate for Payer: Cash Price |
$1,859.20
|
| Rate for Payer: Cofinity Commercial |
$1,621.64
|
| Rate for Payer: Cofinity Commercial |
$1,509.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,126.14
|
| Rate for Payer: Healthscope Commercial |
$1,351.37
|
| Rate for Payer: Healthscope Whirlpool |
$1,351.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,182.45
|
| Rate for Payer: Nomi Health Commercial |
$1,351.37
|
| Rate for Payer: PACE SWMI |
$1,126.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,126.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,510.60
|
| Rate for Payer: Priority Health Medicare |
$1,126.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,126.14
|
| Rate for Payer: UHC Medicare Advantage |
$1,126.14
|
| Rate for Payer: UHCCP DNSP |
$1,126.14
|
|
|
PR BYP OTH/THN VEIN COMMON-IPSILATERAL CAROTID
|
Professional
|
Both
|
$2,942.00
|
|
|
Service Code
|
HCPCS 35601
|
| Min. Negotiated Rate |
$1,176.80 |
| Max. Negotiated Rate |
$1,944.81 |
| Rate for Payer: Aetna Commercial |
$1,809.75
|
| Rate for Payer: Aetna Medicare |
$1,350.56
|
| Rate for Payer: BCBS Complete |
$1,176.80
|
| Rate for Payer: BCBS MAPPO |
$1,350.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,350.56
|
| Rate for Payer: Cash Price |
$2,353.60
|
| Rate for Payer: Cash Price |
$2,353.60
|
| Rate for Payer: Cofinity Commercial |
$1,944.81
|
| Rate for Payer: Cofinity Commercial |
$1,809.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,350.56
|
| Rate for Payer: Healthscope Commercial |
$1,620.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,620.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,418.09
|
| Rate for Payer: Nomi Health Commercial |
$1,620.67
|
| Rate for Payer: PACE SWMI |
$1,350.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,350.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,912.30
|
| Rate for Payer: Priority Health Medicare |
$1,350.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,350.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,350.56
|
| Rate for Payer: UHCCP DNSP |
$1,350.56
|
|
|
PR BYP OTH/THN VEIN FEM-ANT TIBL PST TIBL/PRONEAL
|
Professional
|
Both
|
$4,208.00
|
|
|
Service Code
|
HCPCS 35666
|
| Min. Negotiated Rate |
$1,227.19 |
| Max. Negotiated Rate |
$2,735.20 |
| Rate for Payer: Aetna Commercial |
$1,644.43
|
| Rate for Payer: Aetna Medicare |
$1,227.19
|
| Rate for Payer: BCBS Complete |
$1,683.20
|
| Rate for Payer: BCBS MAPPO |
$1,227.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,227.19
|
| Rate for Payer: Cash Price |
$3,366.40
|
| Rate for Payer: Cash Price |
$3,366.40
|
| Rate for Payer: Cofinity Commercial |
$1,767.15
|
| Rate for Payer: Cofinity Commercial |
$1,644.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,227.19
|
| Rate for Payer: Healthscope Commercial |
$1,472.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,472.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,288.55
|
| Rate for Payer: Nomi Health Commercial |
$1,472.63
|
| Rate for Payer: PACE SWMI |
$1,227.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,227.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,735.20
|
| Rate for Payer: Priority Health Medicare |
$1,227.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,227.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,227.19
|
| Rate for Payer: UHCCP DNSP |
$1,227.19
|
|
|
PR BYP OTH/THN VEIN FEMORAL-FEMORAL
|
Professional
|
Both
|
$2,253.00
|
|
|
Service Code
|
HCPCS 35661
|
| Min. Negotiated Rate |
$901.20 |
| Max. Negotiated Rate |
$1,493.06 |
| Rate for Payer: Aetna Commercial |
$1,389.38
|
| Rate for Payer: Aetna Medicare |
$1,036.85
|
| Rate for Payer: BCBS Complete |
$901.20
|
| Rate for Payer: BCBS MAPPO |
$1,036.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,036.85
|
| Rate for Payer: Cash Price |
$1,802.40
|
| Rate for Payer: Cash Price |
$1,802.40
|
| Rate for Payer: Cofinity Commercial |
$1,493.06
|
| Rate for Payer: Cofinity Commercial |
$1,389.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,036.85
|
| Rate for Payer: Healthscope Commercial |
$1,244.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,244.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,088.69
|
| Rate for Payer: Nomi Health Commercial |
$1,244.22
|
| Rate for Payer: PACE SWMI |
$1,036.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,036.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,464.45
|
| Rate for Payer: Priority Health Medicare |
$1,036.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,036.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,036.85
|
| Rate for Payer: UHCCP DNSP |
$1,036.85
|
|
|
PR BYP OTH/THN VEIN FEMORAL-POPLITEAL
|
Professional
|
Both
|
$2,278.00
|
|
|
Service Code
|
HCPCS 35656
|
| Min. Negotiated Rate |
$911.20 |
| Max. Negotiated Rate |
$1,480.70 |
| Rate for Payer: Aetna Commercial |
$1,375.97
|
| Rate for Payer: Aetna Medicare |
$1,026.84
|
| Rate for Payer: BCBS Complete |
$911.20
|
| Rate for Payer: BCBS MAPPO |
$1,026.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,026.84
|
| Rate for Payer: Cash Price |
$1,822.40
|
| Rate for Payer: Cash Price |
$1,822.40
|
| Rate for Payer: Cofinity Commercial |
$1,478.65
|
| Rate for Payer: Cofinity Commercial |
$1,375.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,026.84
|
| Rate for Payer: Healthscope Commercial |
$1,232.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,232.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,078.18
|
| Rate for Payer: Nomi Health Commercial |
$1,232.21
|
| Rate for Payer: PACE SWMI |
$1,026.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,026.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.70
|
| Rate for Payer: Priority Health Medicare |
$1,026.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,026.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,026.84
|
| Rate for Payer: UHCCP DNSP |
$1,026.84
|
|
|
PR BYP OTH/THN VEIN ILIOFEMORAL
|
Professional
|
Both
|
$4,582.00
|
|
|
Service Code
|
HCPCS 35665
|
| Min. Negotiated Rate |
$1,123.50 |
| Max. Negotiated Rate |
$2,978.30 |
| Rate for Payer: Aetna Commercial |
$1,505.49
|
| Rate for Payer: Aetna Medicare |
$1,123.50
|
| Rate for Payer: BCBS Complete |
$1,832.80
|
| Rate for Payer: BCBS MAPPO |
$1,123.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,123.50
|
| Rate for Payer: Cash Price |
$3,665.60
|
| Rate for Payer: Cash Price |
$3,665.60
|
| Rate for Payer: Cofinity Commercial |
$1,617.84
|
| Rate for Payer: Cofinity Commercial |
$1,505.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,123.50
|
| Rate for Payer: Healthscope Commercial |
$1,348.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,348.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,179.67
|
| Rate for Payer: Nomi Health Commercial |
$1,348.20
|
| Rate for Payer: PACE SWMI |
$1,123.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,123.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,978.30
|
| Rate for Payer: Priority Health Medicare |
$1,123.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,123.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,123.50
|
| Rate for Payer: UHCCP DNSP |
$1,123.50
|
|
|
PR BYP OTH/THN VEIN POPLITEAL-TIBIAL/-PERONEAL ART
|
Professional
|
Both
|
$2,203.00
|
|
|
Service Code
|
HCPCS 35671
|
| Min. Negotiated Rate |
$881.20 |
| Max. Negotiated Rate |
$1,550.22 |
| Rate for Payer: Aetna Commercial |
$1,442.56
|
| Rate for Payer: Aetna Medicare |
$1,076.54
|
| Rate for Payer: BCBS Complete |
$881.20
|
| Rate for Payer: BCBS MAPPO |
$1,076.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,076.54
|
| Rate for Payer: Cash Price |
$1,762.40
|
| Rate for Payer: Cash Price |
$1,762.40
|
| Rate for Payer: Cofinity Commercial |
$1,550.22
|
| Rate for Payer: Cofinity Commercial |
$1,442.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,076.54
|
| Rate for Payer: Healthscope Commercial |
$1,291.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,291.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,130.37
|
| Rate for Payer: Nomi Health Commercial |
$1,291.85
|
| Rate for Payer: PACE SWMI |
$1,076.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,076.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,431.95
|
| Rate for Payer: Priority Health Medicare |
$1,076.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,076.54
|
| Rate for Payer: UHC Medicare Advantage |
$1,076.54
|
| Rate for Payer: UHCCP DNSP |
$1,076.54
|
|
|
PR BYP OTH/THN VEIN SUBCLAVIAN-SUBCLAVIAN
|
Professional
|
Both
|
$2,244.00
|
|
|
Service Code
|
HCPCS 35612
|
| Min. Negotiated Rate |
$897.60 |
| Max. Negotiated Rate |
$1,458.60 |
| Rate for Payer: Aetna Commercial |
$1,350.12
|
| Rate for Payer: Aetna Medicare |
$1,007.55
|
| Rate for Payer: BCBS Complete |
$897.60
|
| Rate for Payer: BCBS MAPPO |
$1,007.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,007.55
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cofinity Commercial |
$1,450.87
|
| Rate for Payer: Cofinity Commercial |
$1,350.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,007.55
|
| Rate for Payer: Healthscope Commercial |
$1,209.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,209.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,057.93
|
| Rate for Payer: Nomi Health Commercial |
$1,209.06
|
| Rate for Payer: PACE SWMI |
$1,007.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,007.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,458.60
|
| Rate for Payer: Priority Health Medicare |
$1,007.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,007.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,007.55
|
| Rate for Payer: UHCCP DNSP |
$1,007.55
|
|
|
PR BYP TIBL-TIBL/PRONEAL-TIBL/TIBL/PRONEAL TRK-TIBL
|
Professional
|
Both
|
$2,798.00
|
|
|
Service Code
|
HCPCS 35570
|
| Min. Negotiated Rate |
$1,119.20 |
| Max. Negotiated Rate |
$2,044.01 |
| Rate for Payer: Aetna Commercial |
$1,902.06
|
| Rate for Payer: Aetna Medicare |
$1,419.45
|
| Rate for Payer: BCBS Complete |
$1,119.20
|
| Rate for Payer: BCBS MAPPO |
$1,419.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,419.45
|
| Rate for Payer: Cash Price |
$2,238.40
|
| Rate for Payer: Cash Price |
$2,238.40
|
| Rate for Payer: Cofinity Commercial |
$2,044.01
|
| Rate for Payer: Cofinity Commercial |
$1,902.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,419.45
|
| Rate for Payer: Healthscope Commercial |
$1,703.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,490.42
|
| Rate for Payer: Nomi Health Commercial |
$1,703.34
|
| Rate for Payer: PACE SWMI |
$1,419.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,419.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,818.70
|
| Rate for Payer: Priority Health Medicare |
$1,419.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,419.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,419.45
|
| Rate for Payer: UHCCP DNSP |
$1,419.45
|
|
|
PR BYP W/VEIN POP-TIBL-PRONEAL ART/OTH DSTL VSL
|
Professional
|
Both
|
$5,238.00
|
|
|
Service Code
|
HCPCS 35571
|
| Min. Negotiated Rate |
$1,269.45 |
| Max. Negotiated Rate |
$3,404.70 |
| Rate for Payer: Aetna Commercial |
$1,701.06
|
| Rate for Payer: Aetna Medicare |
$1,269.45
|
| Rate for Payer: BCBS Complete |
$2,095.20
|
| Rate for Payer: BCBS MAPPO |
$1,269.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,269.45
|
| Rate for Payer: Cash Price |
$4,190.40
|
| Rate for Payer: Cash Price |
$4,190.40
|
| Rate for Payer: Cofinity Commercial |
$1,828.01
|
| Rate for Payer: Cofinity Commercial |
$1,701.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,269.45
|
| Rate for Payer: Healthscope Commercial |
$1,523.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,523.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,332.92
|
| Rate for Payer: Nomi Health Commercial |
$1,523.34
|
| Rate for Payer: PACE SWMI |
$1,269.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,269.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,404.70
|
| Rate for Payer: Priority Health Medicare |
$1,269.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,269.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,269.45
|
| Rate for Payer: UHCCP DNSP |
$1,269.45
|
|
|
PR CABG W/ARTERIAL GRAFT FOUR/>ARTERIAL GRAFTS
|
Professional
|
Both
|
$5,502.00
|
|
|
Service Code
|
HCPCS 33536
|
| Min. Negotiated Rate |
$2,200.80 |
| Max. Negotiated Rate |
$3,638.79 |
| Rate for Payer: Aetna Commercial |
$3,386.10
|
| Rate for Payer: Aetna Medicare |
$2,526.94
|
| Rate for Payer: BCBS Complete |
$2,200.80
|
| Rate for Payer: BCBS MAPPO |
$2,526.94
|
| Rate for Payer: BCN Medicare Advantage |
$2,526.94
|
| Rate for Payer: Cash Price |
$4,401.60
|
| Rate for Payer: Cash Price |
$4,401.60
|
| Rate for Payer: Cofinity Commercial |
$3,638.79
|
| Rate for Payer: Cofinity Commercial |
$3,386.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,526.94
|
| Rate for Payer: Healthscope Commercial |
$3,032.33
|
| Rate for Payer: Healthscope Whirlpool |
$3,032.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,653.29
|
| Rate for Payer: Nomi Health Commercial |
$3,032.33
|
| Rate for Payer: PACE SWMI |
$2,526.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,526.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,576.30
|
| Rate for Payer: Priority Health Medicare |
$2,526.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,526.94
|
| Rate for Payer: UHC Medicare Advantage |
$2,526.94
|
| Rate for Payer: UHCCP DNSP |
$2,526.94
|
|
|
PR CABG W/ARTERIAL GRAFT SINGLE ARTERIAL GRAFT
|
Professional
|
Both
|
$3,911.00
|
|
|
Service Code
|
HCPCS 33533
|
| Min. Negotiated Rate |
$1,564.40 |
| Max. Negotiated Rate |
$2,584.77 |
| Rate for Payer: Aetna Commercial |
$2,405.27
|
| Rate for Payer: Aetna Medicare |
$1,794.98
|
| Rate for Payer: BCBS Complete |
$1,564.40
|
| Rate for Payer: BCBS MAPPO |
$1,794.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,794.98
|
| Rate for Payer: Cash Price |
$3,128.80
|
| Rate for Payer: Cash Price |
$3,128.80
|
| Rate for Payer: Cofinity Commercial |
$2,584.77
|
| Rate for Payer: Cofinity Commercial |
$2,405.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,794.98
|
| Rate for Payer: Healthscope Commercial |
$2,153.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,153.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,884.73
|
| Rate for Payer: Nomi Health Commercial |
$2,153.98
|
| Rate for Payer: PACE SWMI |
$1,794.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,794.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,542.15
|
| Rate for Payer: Priority Health Medicare |
$1,794.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,794.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,794.98
|
| Rate for Payer: UHCCP DNSP |
$1,794.98
|
|
|
PR CABG W/ARTERIAL GRAFT THREE ARTERIAL GRAFTS
|
Professional
|
Both
|
$5,136.00
|
|
|
Service Code
|
HCPCS 33535
|
| Min. Negotiated Rate |
$2,054.40 |
| Max. Negotiated Rate |
$3,376.31 |
| Rate for Payer: Aetna Commercial |
$3,141.84
|
| Rate for Payer: Aetna Medicare |
$2,344.66
|
| Rate for Payer: BCBS Complete |
$2,054.40
|
| Rate for Payer: BCBS MAPPO |
$2,344.66
|
| Rate for Payer: BCN Medicare Advantage |
$2,344.66
|
| Rate for Payer: Cash Price |
$4,108.80
|
| Rate for Payer: Cash Price |
$4,108.80
|
| Rate for Payer: Cofinity Commercial |
$3,376.31
|
| Rate for Payer: Cofinity Commercial |
$3,141.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,344.66
|
| Rate for Payer: Healthscope Commercial |
$2,813.59
|
| Rate for Payer: Healthscope Whirlpool |
$2,813.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,461.89
|
| Rate for Payer: Nomi Health Commercial |
$2,813.59
|
| Rate for Payer: PACE SWMI |
$2,344.66
|
| Rate for Payer: PHP Medicare Advantage |
$2,344.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,338.40
|
| Rate for Payer: Priority Health Medicare |
$2,344.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,344.66
|
| Rate for Payer: UHC Medicare Advantage |
$2,344.66
|
| Rate for Payer: UHCCP DNSP |
$2,344.66
|
|
|
PR CABG W/ARTERIAL GRAFT TWO ARTERIAL GRAFTS
|
Professional
|
Both
|
$4,602.00
|
|
|
Service Code
|
HCPCS 33534
|
| Min. Negotiated Rate |
$1,840.80 |
| Max. Negotiated Rate |
$3,037.80 |
| Rate for Payer: Aetna Commercial |
$2,826.84
|
| Rate for Payer: Aetna Medicare |
$2,109.58
|
| Rate for Payer: BCBS Complete |
$1,840.80
|
| Rate for Payer: BCBS MAPPO |
$2,109.58
|
| Rate for Payer: BCN Medicare Advantage |
$2,109.58
|
| Rate for Payer: Cash Price |
$3,681.60
|
| Rate for Payer: Cash Price |
$3,681.60
|
| Rate for Payer: Cofinity Commercial |
$3,037.80
|
| Rate for Payer: Cofinity Commercial |
$2,826.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,109.58
|
| Rate for Payer: Healthscope Commercial |
$2,531.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,531.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,215.06
|
| Rate for Payer: Nomi Health Commercial |
$2,531.50
|
| Rate for Payer: PACE SWMI |
$2,109.58
|
| Rate for Payer: PHP Medicare Advantage |
$2,109.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,991.30
|
| Rate for Payer: Priority Health Medicare |
$2,109.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,109.58
|
| Rate for Payer: UHC Medicare Advantage |
$2,109.58
|
| Rate for Payer: UHCCP DNSP |
$2,109.58
|
|
|
PR CALIBRATED MICROCAP TUBE
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS A4651
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
|
|
PR CALORIC VESTIBULAR TEST, EACH IRRIGATION, WITH RECORDING
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS 92543
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Aetna Medicare |
$9.50
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.35
|
|
|
PR CANALITH REPOSITIONING PROCEDURE
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 95992
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$85.15 |
| Rate for Payer: Aetna Commercial |
$45.09
|
| Rate for Payer: Aetna Medicare |
$33.65
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$33.65
|
| Rate for Payer: BCN Medicare Advantage |
$33.65
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$48.46
|
| Rate for Payer: Cofinity Commercial |
$45.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.65
|
| Rate for Payer: Healthscope Commercial |
$40.38
|
| Rate for Payer: Healthscope Whirlpool |
$40.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.33
|
| Rate for Payer: Nomi Health Commercial |
$40.38
|
| Rate for Payer: PACE SWMI |
$33.65
|
| Rate for Payer: PHP Medicare Advantage |
$33.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$33.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.65
|
| Rate for Payer: UHC Medicare Advantage |
$33.65
|
| Rate for Payer: UHCCP DNSP |
$33.65
|
|
|
PR CANTHOPLASTY
|
Professional
|
Both
|
$1,146.00
|
|
|
Service Code
|
HCPCS 67950
|
| Min. Negotiated Rate |
$427.13 |
| Max. Negotiated Rate |
$744.90 |
| Rate for Payer: Aetna Commercial |
$572.35
|
| Rate for Payer: Aetna Medicare |
$427.13
|
| Rate for Payer: BCBS Complete |
$458.40
|
| Rate for Payer: BCBS MAPPO |
$427.13
|
| Rate for Payer: BCN Medicare Advantage |
$427.13
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Cofinity Commercial |
$615.07
|
| Rate for Payer: Cofinity Commercial |
$572.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$427.13
|
| Rate for Payer: Healthscope Commercial |
$512.56
|
| Rate for Payer: Healthscope Whirlpool |
$512.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$448.49
|
| Rate for Payer: Nomi Health Commercial |
$512.56
|
| Rate for Payer: PACE SWMI |
$427.13
|
| Rate for Payer: PHP Medicare Advantage |
$427.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.90
|
| Rate for Payer: Priority Health Medicare |
$427.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$427.13
|
| Rate for Payer: UHC Medicare Advantage |
$427.13
|
| Rate for Payer: UHCCP DNSP |
$427.13
|
|
