|
PR DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 45910
|
| Min. Negotiated Rate |
$185.42 |
| Max. Negotiated Rate |
$858.00 |
| Rate for Payer: Aetna Commercial |
$248.46
|
| Rate for Payer: Aetna Medicare |
$185.42
|
| Rate for Payer: BCBS Complete |
$528.00
|
| Rate for Payer: BCBS MAPPO |
$185.42
|
| Rate for Payer: BCN Medicare Advantage |
$185.42
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cofinity Commercial |
$267.00
|
| Rate for Payer: Cofinity Commercial |
$248.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.42
|
| Rate for Payer: Healthscope Commercial |
$222.50
|
| Rate for Payer: Healthscope Whirlpool |
$222.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.69
|
| Rate for Payer: Nomi Health Commercial |
$222.50
|
| Rate for Payer: PACE SWMI |
$185.42
|
| Rate for Payer: PHP Medicare Advantage |
$185.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$858.00
|
| Rate for Payer: Priority Health Medicare |
$185.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.42
|
| Rate for Payer: UHC Medicare Advantage |
$185.42
|
| Rate for Payer: UHCCP DNSP |
$185.42
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE 1ST
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 53600
|
| Min. Negotiated Rate |
$61.12 |
| Max. Negotiated Rate |
$111.80 |
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna Medicare |
$61.12
|
| Rate for Payer: BCBS Complete |
$68.80
|
| Rate for Payer: BCBS MAPPO |
$61.12
|
| Rate for Payer: BCN Medicare Advantage |
$61.12
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$88.01
|
| Rate for Payer: Cofinity Commercial |
$81.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.12
|
| Rate for Payer: Healthscope Commercial |
$73.34
|
| Rate for Payer: Healthscope Whirlpool |
$73.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.18
|
| Rate for Payer: Nomi Health Commercial |
$73.34
|
| Rate for Payer: PACE SWMI |
$61.12
|
| Rate for Payer: PHP Medicare Advantage |
$61.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.80
|
| Rate for Payer: Priority Health Medicare |
$61.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.12
|
| Rate for Payer: UHC Medicare Advantage |
$61.12
|
| Rate for Payer: UHCCP DNSP |
$61.12
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE SBSQ
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 53601
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$105.95 |
| Rate for Payer: Aetna Commercial |
$68.43
|
| Rate for Payer: Aetna Medicare |
$51.07
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: BCBS MAPPO |
$51.07
|
| Rate for Payer: BCN Medicare Advantage |
$51.07
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$73.54
|
| Rate for Payer: Cofinity Commercial |
$68.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.07
|
| Rate for Payer: Healthscope Commercial |
$61.28
|
| Rate for Payer: Healthscope Whirlpool |
$61.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.62
|
| Rate for Payer: Nomi Health Commercial |
$61.28
|
| Rate for Payer: PACE SWMI |
$51.07
|
| Rate for Payer: PHP Medicare Advantage |
$51.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health Medicare |
$51.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.07
|
| Rate for Payer: UHC Medicare Advantage |
$51.07
|
| Rate for Payer: UHCCP DNSP |
$51.07
|
|
|
PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 53620
|
| Min. Negotiated Rate |
$82.97 |
| Max. Negotiated Rate |
$169.65 |
| Rate for Payer: Aetna Commercial |
$111.18
|
| Rate for Payer: Aetna Medicare |
$82.97
|
| Rate for Payer: BCBS Complete |
$104.40
|
| Rate for Payer: BCBS MAPPO |
$82.97
|
| Rate for Payer: BCN Medicare Advantage |
$82.97
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$119.48
|
| Rate for Payer: Cofinity Commercial |
$111.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.97
|
| Rate for Payer: Healthscope Commercial |
$99.56
|
| Rate for Payer: Healthscope Whirlpool |
$99.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.12
|
| Rate for Payer: Nomi Health Commercial |
$99.56
|
| Rate for Payer: PACE SWMI |
$82.97
|
| Rate for Payer: PHP Medicare Advantage |
$82.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: Priority Health Medicare |
$82.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.97
|
| Rate for Payer: UHC Medicare Advantage |
$82.97
|
| Rate for Payer: UHCCP DNSP |
$82.97
|
|
|
PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE SBSQ
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 53621
|
| Min. Negotiated Rate |
$68.30 |
| Max. Negotiated Rate |
$159.90 |
| Rate for Payer: Aetna Commercial |
$91.52
|
| Rate for Payer: Aetna Medicare |
$68.30
|
| Rate for Payer: BCBS Complete |
$98.40
|
| Rate for Payer: BCBS MAPPO |
$68.30
|
| Rate for Payer: BCN Medicare Advantage |
$68.30
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$98.35
|
| Rate for Payer: Cofinity Commercial |
$91.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.30
|
| Rate for Payer: Healthscope Commercial |
$81.96
|
| Rate for Payer: Healthscope Whirlpool |
$81.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.72
|
| Rate for Payer: Nomi Health Commercial |
$81.96
|
| Rate for Payer: PACE SWMI |
$68.30
|
| Rate for Payer: PHP Medicare Advantage |
$68.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.90
|
| Rate for Payer: Priority Health Medicare |
$68.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.30
|
| Rate for Payer: UHC Medicare Advantage |
$68.30
|
| Rate for Payer: UHCCP DNSP |
$68.30
|
|
|
PR DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 53605
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$87.88 |
| Rate for Payer: Aetna Commercial |
$81.78
|
| Rate for Payer: Aetna Medicare |
$61.03
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$61.03
|
| Rate for Payer: BCN Medicare Advantage |
$61.03
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$87.88
|
| Rate for Payer: Cofinity Commercial |
$81.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.03
|
| Rate for Payer: Healthscope Commercial |
$73.24
|
| Rate for Payer: Healthscope Whirlpool |
$73.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.08
|
| Rate for Payer: Nomi Health Commercial |
$73.24
|
| Rate for Payer: PACE SWMI |
$61.03
|
| Rate for Payer: PHP Medicare Advantage |
$61.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$61.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.03
|
| Rate for Payer: UHC Medicare Advantage |
$61.03
|
| Rate for Payer: UHCCP DNSP |
$61.03
|
|
|
PR DIPHENHYDRAMINE HCL INJECTIO
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J1200
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$1.02
|
| Rate for Payer: Aetna Medicare |
$0.76
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$0.76
|
| Rate for Payer: BCN Medicare Advantage |
$0.76
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$1.09
|
| Rate for Payer: Cofinity Commercial |
$1.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.76
|
| Rate for Payer: Healthscope Commercial |
$0.91
|
| Rate for Payer: Healthscope Whirlpool |
$0.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.80
|
| Rate for Payer: Nomi Health Commercial |
$0.91
|
| Rate for Payer: PACE SWMI |
$0.76
|
| Rate for Payer: PHP Medicare Advantage |
$0.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$0.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.76
|
| Rate for Payer: UHC Medicare Advantage |
$0.76
|
| Rate for Payer: UHCCP DNSP |
$0.76
|
|
|
PR DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 90700
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Medicare |
$24.00
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
|
|
PR DIR/PTCH CLS SINUS VENOSUS W/WO ANOM PUL VEN DRG
|
Professional
|
Both
|
$7,628.00
|
|
|
Service Code
|
HCPCS 33645
|
| Min. Negotiated Rate |
$1,662.30 |
| Max. Negotiated Rate |
$4,958.20 |
| Rate for Payer: Aetna Commercial |
$2,227.48
|
| Rate for Payer: Aetna Medicare |
$1,662.30
|
| Rate for Payer: BCBS Complete |
$3,051.20
|
| Rate for Payer: BCBS MAPPO |
$1,662.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,662.30
|
| Rate for Payer: Cash Price |
$6,102.40
|
| Rate for Payer: Cash Price |
$6,102.40
|
| Rate for Payer: Cofinity Commercial |
$2,393.71
|
| Rate for Payer: Cofinity Commercial |
$2,227.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,662.30
|
| Rate for Payer: Healthscope Commercial |
$1,994.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,994.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,745.41
|
| Rate for Payer: Nomi Health Commercial |
$1,994.76
|
| Rate for Payer: PACE SWMI |
$1,662.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,662.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,958.20
|
| Rate for Payer: Priority Health Medicare |
$1,662.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,662.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,662.30
|
| Rate for Payer: UHCCP DNSP |
$1,662.30
|
|
|
PR DIR RPR ANEURYSM ABDOM AORTA W/ILIAC VESSELS
|
Professional
|
Both
|
$3,721.00
|
|
|
Service Code
|
HCPCS 35102
|
| Min. Negotiated Rate |
$1,488.40 |
| Max. Negotiated Rate |
$2,596.98 |
| Rate for Payer: Aetna Commercial |
$2,416.64
|
| Rate for Payer: Aetna Medicare |
$1,803.46
|
| Rate for Payer: BCBS Complete |
$1,488.40
|
| Rate for Payer: BCBS MAPPO |
$1,803.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,803.46
|
| Rate for Payer: Cash Price |
$2,976.80
|
| Rate for Payer: Cash Price |
$2,976.80
|
| Rate for Payer: Cofinity Commercial |
$2,596.98
|
| Rate for Payer: Cofinity Commercial |
$2,416.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,803.46
|
| Rate for Payer: Healthscope Commercial |
$2,164.15
|
| Rate for Payer: Healthscope Whirlpool |
$2,164.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,893.63
|
| Rate for Payer: Nomi Health Commercial |
$2,164.15
|
| Rate for Payer: PACE SWMI |
$1,803.46
|
| Rate for Payer: PHP Medicare Advantage |
$1,803.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,418.65
|
| Rate for Payer: Priority Health Medicare |
$1,803.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,803.46
|
| Rate for Payer: UHC Medicare Advantage |
$1,803.46
|
| Rate for Payer: UHCCP DNSP |
$1,803.46
|
|
|
PR DIR RPR ANEURYSM ABDOM AORTA W/VISCERAL VESSELS
|
Professional
|
Both
|
$3,573.00
|
|
|
Service Code
|
HCPCS 35091
|
| Min. Negotiated Rate |
$1,429.20 |
| Max. Negotiated Rate |
$2,466.10 |
| Rate for Payer: Aetna Commercial |
$2,294.84
|
| Rate for Payer: Aetna Medicare |
$1,712.57
|
| Rate for Payer: BCBS Complete |
$1,429.20
|
| Rate for Payer: BCBS MAPPO |
$1,712.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,712.57
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cofinity Commercial |
$2,466.10
|
| Rate for Payer: Cofinity Commercial |
$2,294.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,712.57
|
| Rate for Payer: Healthscope Commercial |
$2,055.08
|
| Rate for Payer: Healthscope Whirlpool |
$2,055.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,798.20
|
| Rate for Payer: Nomi Health Commercial |
$2,055.08
|
| Rate for Payer: PACE SWMI |
$1,712.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,712.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,322.45
|
| Rate for Payer: Priority Health Medicare |
$1,712.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,712.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,712.57
|
| Rate for Payer: UHCCP DNSP |
$1,712.57
|
|
|
PR DIR RPR ANEURYSM ABDOMINAL AORTA
|
Professional
|
Both
|
$5,682.00
|
|
|
Service Code
|
HCPCS 35081
|
| Min. Negotiated Rate |
$1,659.06 |
| Max. Negotiated Rate |
$3,693.30 |
| Rate for Payer: Aetna Commercial |
$2,223.14
|
| Rate for Payer: Aetna Medicare |
$1,659.06
|
| Rate for Payer: BCBS Complete |
$2,272.80
|
| Rate for Payer: BCBS MAPPO |
$1,659.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,659.06
|
| Rate for Payer: Cash Price |
$4,545.60
|
| Rate for Payer: Cash Price |
$4,545.60
|
| Rate for Payer: Cofinity Commercial |
$2,389.05
|
| Rate for Payer: Cofinity Commercial |
$2,223.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,659.06
|
| Rate for Payer: Healthscope Commercial |
$1,990.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,990.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,742.01
|
| Rate for Payer: Nomi Health Commercial |
$1,990.87
|
| Rate for Payer: PACE SWMI |
$1,659.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,659.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,693.30
|
| Rate for Payer: Priority Health Medicare |
$1,659.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,659.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,659.06
|
| Rate for Payer: UHCCP DNSP |
$1,659.06
|
|
|
PR DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION
|
Professional
|
Both
|
$3,720.00
|
|
|
Service Code
|
HCPCS 35011
|
| Min. Negotiated Rate |
$966.02 |
| Max. Negotiated Rate |
$2,418.00 |
| Rate for Payer: Aetna Commercial |
$1,294.47
|
| Rate for Payer: Aetna Medicare |
$966.02
|
| Rate for Payer: BCBS Complete |
$1,488.00
|
| Rate for Payer: BCBS MAPPO |
$966.02
|
| Rate for Payer: BCN Medicare Advantage |
$966.02
|
| Rate for Payer: Cash Price |
$2,976.00
|
| Rate for Payer: Cash Price |
$2,976.00
|
| Rate for Payer: Cofinity Commercial |
$1,391.07
|
| Rate for Payer: Cofinity Commercial |
$1,294.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$966.02
|
| Rate for Payer: Healthscope Commercial |
$1,159.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,159.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,014.32
|
| Rate for Payer: Nomi Health Commercial |
$1,159.22
|
| Rate for Payer: PACE SWMI |
$966.02
|
| Rate for Payer: PHP Medicare Advantage |
$966.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,418.00
|
| Rate for Payer: Priority Health Medicare |
$966.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$966.02
|
| Rate for Payer: UHC Medicare Advantage |
$966.02
|
| Rate for Payer: UHCCP DNSP |
$966.02
|
|
|
PR DIR RPR ANEURYSM CAROTID-SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$2,213.00
|
|
|
Service Code
|
HCPCS 35001
|
| Min. Negotiated Rate |
$885.20 |
| Max. Negotiated Rate |
$1,531.05 |
| Rate for Payer: Aetna Commercial |
$1,424.73
|
| Rate for Payer: Aetna Medicare |
$1,063.23
|
| Rate for Payer: BCBS Complete |
$885.20
|
| Rate for Payer: BCBS MAPPO |
$1,063.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,063.23
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cofinity Commercial |
$1,531.05
|
| Rate for Payer: Cofinity Commercial |
$1,424.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,063.23
|
| Rate for Payer: Healthscope Commercial |
$1,275.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,275.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,116.39
|
| Rate for Payer: Nomi Health Commercial |
$1,275.88
|
| Rate for Payer: PACE SWMI |
$1,063.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,063.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,438.45
|
| Rate for Payer: Priority Health Medicare |
$1,063.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,063.23
|
| Rate for Payer: UHC Medicare Advantage |
$1,063.23
|
| Rate for Payer: UHCCP DNSP |
$1,063.23
|
|
|
PR DIR RPR ANEURYSM & GRAFT COMMON FEMORAL ARTERY
|
Professional
|
Both
|
$2,176.00
|
|
|
Service Code
|
HCPCS 35141
|
| Min. Negotiated Rate |
$870.40 |
| Max. Negotiated Rate |
$1,508.86 |
| Rate for Payer: Aetna Commercial |
$1,404.08
|
| Rate for Payer: Aetna Medicare |
$1,047.82
|
| Rate for Payer: BCBS Complete |
$870.40
|
| Rate for Payer: BCBS MAPPO |
$1,047.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,047.82
|
| Rate for Payer: Cash Price |
$1,740.80
|
| Rate for Payer: Cash Price |
$1,740.80
|
| Rate for Payer: Cofinity Commercial |
$1,508.86
|
| Rate for Payer: Cofinity Commercial |
$1,404.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,047.82
|
| Rate for Payer: Healthscope Commercial |
$1,257.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,257.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,100.21
|
| Rate for Payer: Nomi Health Commercial |
$1,257.38
|
| Rate for Payer: PACE SWMI |
$1,047.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,047.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.40
|
| Rate for Payer: Priority Health Medicare |
$1,047.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,047.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,047.82
|
| Rate for Payer: UHCCP DNSP |
$1,047.82
|
|
|
PR DIR RPR ANEURYSM & GRAFT ILIAC ARTERY
|
Professional
|
Both
|
$4,955.00
|
|
|
Service Code
|
HCPCS 35131
|
| Min. Negotiated Rate |
$1,329.03 |
| Max. Negotiated Rate |
$3,220.75 |
| Rate for Payer: Aetna Commercial |
$1,780.90
|
| Rate for Payer: Aetna Medicare |
$1,329.03
|
| Rate for Payer: BCBS Complete |
$1,982.00
|
| Rate for Payer: BCBS MAPPO |
$1,329.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,329.03
|
| Rate for Payer: Cash Price |
$3,964.00
|
| Rate for Payer: Cash Price |
$3,964.00
|
| Rate for Payer: Cofinity Commercial |
$1,913.80
|
| Rate for Payer: Cofinity Commercial |
$1,780.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,329.03
|
| Rate for Payer: Healthscope Commercial |
$1,594.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,594.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,395.48
|
| Rate for Payer: Nomi Health Commercial |
$1,594.84
|
| Rate for Payer: PACE SWMI |
$1,329.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,329.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,220.75
|
| Rate for Payer: Priority Health Medicare |
$1,329.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,329.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,329.03
|
| Rate for Payer: UHCCP DNSP |
$1,329.03
|
|
|
PR DIR RPR ANEURYSM & GRAFT POPLITEAL ARTERY
|
Professional
|
Both
|
$2,457.00
|
|
|
Service Code
|
HCPCS 35151
|
| Min. Negotiated Rate |
$982.80 |
| Max. Negotiated Rate |
$1,710.23 |
| Rate for Payer: Aetna Commercial |
$1,591.46
|
| Rate for Payer: Aetna Medicare |
$1,187.66
|
| Rate for Payer: BCBS Complete |
$982.80
|
| Rate for Payer: BCBS MAPPO |
$1,187.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,187.66
|
| Rate for Payer: Cash Price |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,965.60
|
| Rate for Payer: Cofinity Commercial |
$1,710.23
|
| Rate for Payer: Cofinity Commercial |
$1,591.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,187.66
|
| Rate for Payer: Healthscope Commercial |
$1,425.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,425.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,247.04
|
| Rate for Payer: Nomi Health Commercial |
$1,425.19
|
| Rate for Payer: PACE SWMI |
$1,187.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,187.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,597.05
|
| Rate for Payer: Priority Health Medicare |
$1,187.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,187.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,187.66
|
| Rate for Payer: UHCCP DNSP |
$1,187.66
|
|
|
PR DIR RPR ANEURYSM HEPATIC/CELIAC/RENAL/MESENTERIC
|
Professional
|
Both
|
$3,196.00
|
|
|
Service Code
|
HCPCS 35121
|
| Min. Negotiated Rate |
$1,278.40 |
| Max. Negotiated Rate |
$2,194.40 |
| Rate for Payer: Aetna Commercial |
$2,042.01
|
| Rate for Payer: Aetna Medicare |
$1,523.89
|
| Rate for Payer: BCBS Complete |
$1,278.40
|
| Rate for Payer: BCBS MAPPO |
$1,523.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,523.89
|
| Rate for Payer: Cash Price |
$2,556.80
|
| Rate for Payer: Cash Price |
$2,556.80
|
| Rate for Payer: Cofinity Commercial |
$2,194.40
|
| Rate for Payer: Cofinity Commercial |
$2,042.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,523.89
|
| Rate for Payer: Healthscope Commercial |
$1,828.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,828.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,600.08
|
| Rate for Payer: Nomi Health Commercial |
$1,828.67
|
| Rate for Payer: PACE SWMI |
$1,523.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,523.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,077.40
|
| Rate for Payer: Priority Health Medicare |
$1,523.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,523.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,523.89
|
| Rate for Payer: UHCCP DNSP |
$1,523.89
|
|
|
PR DIR RPR ANEURYSM SPLENIC ARTERY
|
Professional
|
Both
|
$2,774.00
|
|
|
Service Code
|
HCPCS 35111
|
| Min. Negotiated Rate |
$1,109.60 |
| Max. Negotiated Rate |
$1,844.74 |
| Rate for Payer: Aetna Commercial |
$1,716.63
|
| Rate for Payer: Aetna Medicare |
$1,281.07
|
| Rate for Payer: BCBS Complete |
$1,109.60
|
| Rate for Payer: BCBS MAPPO |
$1,281.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,281.07
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Cofinity Commercial |
$1,844.74
|
| Rate for Payer: Cofinity Commercial |
$1,716.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,281.07
|
| Rate for Payer: Healthscope Commercial |
$1,537.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,537.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,345.12
|
| Rate for Payer: Nomi Health Commercial |
$1,537.28
|
| Rate for Payer: PACE SWMI |
$1,281.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,281.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.10
|
| Rate for Payer: Priority Health Medicare |
$1,281.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,281.07
|
| Rate for Payer: UHC Medicare Advantage |
$1,281.07
|
| Rate for Payer: UHCCP DNSP |
$1,281.07
|
|
|
PR DIR RPR RUPTD ANEURSM ABDOM AORTA W/VISCERA VSLS
|
Professional
|
Both
|
$5,498.00
|
|
|
Service Code
|
HCPCS 35092
|
| Min. Negotiated Rate |
$2,199.20 |
| Max. Negotiated Rate |
$3,589.08 |
| Rate for Payer: Aetna Commercial |
$3,339.84
|
| Rate for Payer: Aetna Medicare |
$2,492.42
|
| Rate for Payer: BCBS Complete |
$2,199.20
|
| Rate for Payer: BCBS MAPPO |
$2,492.42
|
| Rate for Payer: BCN Medicare Advantage |
$2,492.42
|
| Rate for Payer: Cash Price |
$4,398.40
|
| Rate for Payer: Cash Price |
$4,398.40
|
| Rate for Payer: Cofinity Commercial |
$3,589.08
|
| Rate for Payer: Cofinity Commercial |
$3,339.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,492.42
|
| Rate for Payer: Healthscope Commercial |
$2,990.90
|
| Rate for Payer: Healthscope Whirlpool |
$2,990.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,617.04
|
| Rate for Payer: Nomi Health Commercial |
$2,990.90
|
| Rate for Payer: PACE SWMI |
$2,492.42
|
| Rate for Payer: PHP Medicare Advantage |
$2,492.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,573.70
|
| Rate for Payer: Priority Health Medicare |
$2,492.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,492.42
|
| Rate for Payer: UHC Medicare Advantage |
$2,492.42
|
| Rate for Payer: UHCCP DNSP |
$2,492.42
|
|
|
PR DIR RPR RUPTD ANEURSM HEPATIC/CELIAC/RENAL/MESEN
|
Professional
|
Both
|
$3,859.00
|
|
|
Service Code
|
HCPCS 35122
|
| Min. Negotiated Rate |
$1,543.60 |
| Max. Negotiated Rate |
$2,623.32 |
| Rate for Payer: Aetna Commercial |
$2,441.14
|
| Rate for Payer: Aetna Medicare |
$1,821.75
|
| Rate for Payer: BCBS Complete |
$1,543.60
|
| Rate for Payer: BCBS MAPPO |
$1,821.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,821.75
|
| Rate for Payer: Cash Price |
$3,087.20
|
| Rate for Payer: Cash Price |
$3,087.20
|
| Rate for Payer: Cofinity Commercial |
$2,623.32
|
| Rate for Payer: Cofinity Commercial |
$2,441.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,821.75
|
| Rate for Payer: Healthscope Commercial |
$2,186.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,186.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,912.84
|
| Rate for Payer: Nomi Health Commercial |
$2,186.10
|
| Rate for Payer: PACE SWMI |
$1,821.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,821.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,508.35
|
| Rate for Payer: Priority Health Medicare |
$1,821.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,821.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,821.75
|
| Rate for Payer: UHCCP DNSP |
$1,821.75
|
|
|
PR DIR RPR RUPTD ANEURYSM ABDOM AORTA W/ILIAC VSLS
|
Professional
|
Both
|
$3,560.00
|
|
|
Service Code
|
HCPCS 35103
|
| Min. Negotiated Rate |
$1,424.00 |
| Max. Negotiated Rate |
$3,006.85 |
| Rate for Payer: Aetna Commercial |
$2,798.04
|
| Rate for Payer: Aetna Medicare |
$2,088.09
|
| Rate for Payer: BCBS Complete |
$1,424.00
|
| Rate for Payer: BCBS MAPPO |
$2,088.09
|
| Rate for Payer: BCN Medicare Advantage |
$2,088.09
|
| Rate for Payer: Cash Price |
$2,848.00
|
| Rate for Payer: Cash Price |
$2,848.00
|
| Rate for Payer: Cofinity Commercial |
$3,006.85
|
| Rate for Payer: Cofinity Commercial |
$2,798.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,088.09
|
| Rate for Payer: Healthscope Commercial |
$2,505.71
|
| Rate for Payer: Healthscope Whirlpool |
$2,505.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,192.49
|
| Rate for Payer: Nomi Health Commercial |
$2,505.71
|
| Rate for Payer: PACE SWMI |
$2,088.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,088.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,314.00
|
| Rate for Payer: Priority Health Medicare |
$2,088.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,088.09
|
| Rate for Payer: UHC Medicare Advantage |
$2,088.09
|
| Rate for Payer: UHCCP DNSP |
$2,088.09
|
|
|
PR DIR RPR RUPTD ANEURYSM ABDOMINAL AORTA
|
Professional
|
Both
|
$4,286.00
|
|
|
Service Code
|
HCPCS 35082
|
| Min. Negotiated Rate |
$1,714.40 |
| Max. Negotiated Rate |
$2,994.41 |
| Rate for Payer: Aetna Commercial |
$2,786.46
|
| Rate for Payer: Aetna Medicare |
$2,079.45
|
| Rate for Payer: BCBS Complete |
$1,714.40
|
| Rate for Payer: BCBS MAPPO |
$2,079.45
|
| Rate for Payer: BCN Medicare Advantage |
$2,079.45
|
| Rate for Payer: Cash Price |
$3,428.80
|
| Rate for Payer: Cash Price |
$3,428.80
|
| Rate for Payer: Cofinity Commercial |
$2,994.41
|
| Rate for Payer: Cofinity Commercial |
$2,786.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,079.45
|
| Rate for Payer: Healthscope Commercial |
$2,495.34
|
| Rate for Payer: Healthscope Whirlpool |
$2,495.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,183.42
|
| Rate for Payer: Nomi Health Commercial |
$2,495.34
|
| Rate for Payer: PACE SWMI |
$2,079.45
|
| Rate for Payer: PHP Medicare Advantage |
$2,079.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,785.90
|
| Rate for Payer: Priority Health Medicare |
$2,079.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,079.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,079.45
|
| Rate for Payer: UHCCP DNSP |
$2,079.45
|
|
|
PR DIR RPR RUPTD ANEURYSM AXIL-BRACHIAL ARM INCIS
|
Professional
|
Both
|
$3,927.00
|
|
|
Service Code
|
HCPCS 35013
|
| Min. Negotiated Rate |
$1,141.79 |
| Max. Negotiated Rate |
$2,552.55 |
| Rate for Payer: Aetna Commercial |
$1,530.00
|
| Rate for Payer: Aetna Medicare |
$1,141.79
|
| Rate for Payer: BCBS Complete |
$1,570.80
|
| Rate for Payer: BCBS MAPPO |
$1,141.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,141.79
|
| Rate for Payer: Cash Price |
$3,141.60
|
| Rate for Payer: Cash Price |
$3,141.60
|
| Rate for Payer: Cofinity Commercial |
$1,644.18
|
| Rate for Payer: Cofinity Commercial |
$1,530.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,141.79
|
| Rate for Payer: Healthscope Commercial |
$1,370.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,370.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,198.88
|
| Rate for Payer: Nomi Health Commercial |
$1,370.15
|
| Rate for Payer: PACE SWMI |
$1,141.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,141.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,552.55
|
| Rate for Payer: Priority Health Medicare |
$1,141.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,141.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,141.79
|
| Rate for Payer: UHCCP DNSP |
$1,141.79
|
|
|
PR DIR RPR RUPTD ANEURYSM CAROTID-SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$2,542.00
|
|
|
Service Code
|
HCPCS 35002
|
| Min. Negotiated Rate |
$1,016.80 |
| Max. Negotiated Rate |
$1,652.30 |
| Rate for Payer: Aetna Commercial |
$1,469.60
|
| Rate for Payer: Aetna Medicare |
$1,096.72
|
| Rate for Payer: BCBS Complete |
$1,016.80
|
| Rate for Payer: BCBS MAPPO |
$1,096.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,096.72
|
| Rate for Payer: Cash Price |
$2,033.60
|
| Rate for Payer: Cash Price |
$2,033.60
|
| Rate for Payer: Cofinity Commercial |
$1,579.28
|
| Rate for Payer: Cofinity Commercial |
$1,469.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,096.72
|
| Rate for Payer: Healthscope Commercial |
$1,316.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,316.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,151.56
|
| Rate for Payer: Nomi Health Commercial |
$1,316.06
|
| Rate for Payer: PACE SWMI |
$1,096.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,096.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,652.30
|
| Rate for Payer: Priority Health Medicare |
$1,096.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,096.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,096.72
|
| Rate for Payer: UHCCP DNSP |
$1,096.72
|
|
