|
PR LIGATION OF SPERM DUCT
|
Professional
|
Both
|
$651.00
|
|
|
Service Code
|
HCPCS 55450
|
| Min. Negotiated Rate |
$260.40 |
| Max. Negotiated Rate |
$423.15 |
| Rate for Payer: Aetna Medicare |
$325.50
|
| Rate for Payer: BCBS Complete |
$260.40
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.15
|
|
|
PR LIG/BANDING ANGIOACCESS ARTERIOVENOUS FISTULA
|
Professional
|
Both
|
$1,098.00
|
|
|
Service Code
|
HCPCS 37607
|
| Min. Negotiated Rate |
$357.54 |
| Max. Negotiated Rate |
$713.70 |
| Rate for Payer: Aetna Commercial |
$479.10
|
| Rate for Payer: Aetna Medicare |
$357.54
|
| Rate for Payer: BCBS Complete |
$439.20
|
| Rate for Payer: BCBS MAPPO |
$357.54
|
| Rate for Payer: BCN Medicare Advantage |
$357.54
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cofinity Commercial |
$514.86
|
| Rate for Payer: Cofinity Commercial |
$479.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.54
|
| Rate for Payer: Healthscope Commercial |
$429.05
|
| Rate for Payer: Healthscope Whirlpool |
$429.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.42
|
| Rate for Payer: Nomi Health Commercial |
$429.05
|
| Rate for Payer: PACE SWMI |
$357.54
|
| Rate for Payer: PHP Medicare Advantage |
$357.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.70
|
| Rate for Payer: Priority Health Medicare |
$357.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.54
|
| Rate for Payer: UHC Medicare Advantage |
$357.54
|
| Rate for Payer: UHCCP DNSP |
$357.54
|
|
|
PR LIG&DIV&COMPL STRPG LONG/SHRT SAPHENOUS VN W/EXC
|
Facility
|
OP
|
$856.00
|
|
|
Service Code
|
CPT 37735
|
| Hospital Charge Code |
37735
|
| Min. Negotiated Rate |
$556.40 |
| Max. Negotiated Rate |
$4,758.02 |
| Rate for Payer: Aetna Commercial |
$770.40
|
| Rate for Payer: Aetna Medicare |
$3,069.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: ASR ASR |
$830.32
|
| Rate for Payer: ASR Commercial |
$830.32
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCBS Trust/PPO |
$700.98
|
| Rate for Payer: BCN Commercial |
$663.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Cofinity Commercial |
$804.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$684.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$856.00
|
| Rate for Payer: Healthscope Whirlpool |
$830.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,069.69
|
| Rate for Payer: Mclaren Commercial |
$770.40
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$727.60
|
| Rate for Payer: Nomi Health Commercial |
$701.92
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,376.66
|
| Rate for Payer: PHP Medicaid |
$1,645.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$556.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$750.03
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health Narrow Network |
$600.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$753.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$4,758.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP DNSP |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
PR LIG&DIV&COMPL STRPG LONG/SHRT SAPHENOUS VN W/EXC
|
Professional
|
Both
|
$855.78
|
|
|
Service Code
|
HCPCS 37735
|
| Hospital Charge Code |
37735
|
| Min. Negotiated Rate |
$342.31 |
| Max. Negotiated Rate |
$808.06 |
| Rate for Payer: Aetna Commercial |
$751.94
|
| Rate for Payer: Aetna Medicare |
$561.15
|
| Rate for Payer: BCBS Complete |
$342.31
|
| Rate for Payer: BCBS MAPPO |
$561.15
|
| Rate for Payer: BCN Medicare Advantage |
$561.15
|
| Rate for Payer: Cash Price |
$684.62
|
| Rate for Payer: Cash Price |
$684.62
|
| Rate for Payer: Cofinity Commercial |
$808.06
|
| Rate for Payer: Cofinity Commercial |
$751.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$561.15
|
| Rate for Payer: Healthscope Commercial |
$673.38
|
| Rate for Payer: Healthscope Whirlpool |
$673.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$589.21
|
| Rate for Payer: Nomi Health Commercial |
$673.38
|
| Rate for Payer: PACE SWMI |
$561.15
|
| Rate for Payer: PHP Medicare Advantage |
$561.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$556.26
|
| Rate for Payer: Priority Health Medicare |
$561.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$561.15
|
| Rate for Payer: UHC Medicare Advantage |
$561.15
|
| Rate for Payer: UHCCP DNSP |
$561.15
|
|
|
PR LIG&DIV&COMPL STRPG LONG/SHRT SAPHENOUS VN W/EXC
|
Professional
|
Both
|
$855.78
|
|
|
Service Code
|
HCPCS 37735
|
| Min. Negotiated Rate |
$342.31 |
| Max. Negotiated Rate |
$808.06 |
| Rate for Payer: Aetna Commercial |
$751.94
|
| Rate for Payer: Aetna Medicare |
$561.15
|
| Rate for Payer: BCBS Complete |
$342.31
|
| Rate for Payer: BCBS MAPPO |
$561.15
|
| Rate for Payer: BCN Medicare Advantage |
$561.15
|
| Rate for Payer: Cash Price |
$684.62
|
| Rate for Payer: Cash Price |
$684.62
|
| Rate for Payer: Cofinity Commercial |
$808.06
|
| Rate for Payer: Cofinity Commercial |
$751.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$561.15
|
| Rate for Payer: Healthscope Commercial |
$673.38
|
| Rate for Payer: Healthscope Whirlpool |
$673.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$589.21
|
| Rate for Payer: Nomi Health Commercial |
$673.38
|
| Rate for Payer: PACE SWMI |
$561.15
|
| Rate for Payer: PHP Medicare Advantage |
$561.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$556.26
|
| Rate for Payer: Priority Health Medicare |
$561.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$561.15
|
| Rate for Payer: UHC Medicare Advantage |
$561.15
|
| Rate for Payer: UHCCP DNSP |
$561.15
|
|
|
PR LIG&DIV&COMPL STRPG LONG/SHRT SAPHENOUS VN W/EXC
|
Facility
|
IP
|
$856.00
|
|
|
Service Code
|
CPT 37735
|
| Hospital Charge Code |
37735
|
| Min. Negotiated Rate |
$556.40 |
| Max. Negotiated Rate |
$856.00 |
| Rate for Payer: Aetna Commercial |
$770.40
|
| Rate for Payer: ASR ASR |
$830.32
|
| Rate for Payer: ASR Commercial |
$830.32
|
| Rate for Payer: BCBS Trust/PPO |
$697.55
|
| Rate for Payer: BCN Commercial |
$663.66
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Cofinity Commercial |
$804.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$684.80
|
| Rate for Payer: Healthscope Commercial |
$856.00
|
| Rate for Payer: Healthscope Whirlpool |
$830.32
|
| Rate for Payer: Mclaren Commercial |
$770.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$727.60
|
| Rate for Payer: Nomi Health Commercial |
$701.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$556.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$753.28
|
|
|
PR LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 37700
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$337.08 |
| Rate for Payer: Aetna Commercial |
$313.67
|
| Rate for Payer: Aetna Medicare |
$234.08
|
| Rate for Payer: BCBS Complete |
$189.60
|
| Rate for Payer: BCBS MAPPO |
$234.08
|
| Rate for Payer: BCN Medicare Advantage |
$234.08
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cofinity Commercial |
$337.08
|
| Rate for Payer: Cofinity Commercial |
$313.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$234.08
|
| Rate for Payer: Healthscope Commercial |
$280.90
|
| Rate for Payer: Healthscope Whirlpool |
$280.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.78
|
| Rate for Payer: Nomi Health Commercial |
$280.90
|
| Rate for Payer: PACE SWMI |
$234.08
|
| Rate for Payer: PHP Medicare Advantage |
$234.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.10
|
| Rate for Payer: Priority Health Medicare |
$234.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$234.08
|
| Rate for Payer: UHC Medicare Advantage |
$234.08
|
| Rate for Payer: UHCCP DNSP |
$234.08
|
|
|
PR LIG DIV & STRIPPING SHORT SAPHENOUS VEIN
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
HCPCS 37718
|
| Min. Negotiated Rate |
$328.80 |
| Max. Negotiated Rate |
$546.78 |
| Rate for Payer: Aetna Commercial |
$508.81
|
| Rate for Payer: Aetna Medicare |
$379.71
|
| Rate for Payer: BCBS Complete |
$328.80
|
| Rate for Payer: BCBS MAPPO |
$379.71
|
| Rate for Payer: BCN Medicare Advantage |
$379.71
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cofinity Commercial |
$546.78
|
| Rate for Payer: Cofinity Commercial |
$508.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.71
|
| Rate for Payer: Healthscope Commercial |
$455.65
|
| Rate for Payer: Healthscope Whirlpool |
$455.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$398.70
|
| Rate for Payer: Nomi Health Commercial |
$455.65
|
| Rate for Payer: PACE SWMI |
$379.71
|
| Rate for Payer: PHP Medicare Advantage |
$379.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$534.30
|
| Rate for Payer: Priority Health Medicare |
$379.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$379.71
|
| Rate for Payer: UHC Medicare Advantage |
$379.71
|
| Rate for Payer: UHCCP DNSP |
$379.71
|
|
|
PR LIG DIV&STRPG LONG SAPH SAPHFEM JUNCT KNE/BELW
|
Professional
|
Both
|
$948.00
|
|
|
Service Code
|
HCPCS 37722
|
| Min. Negotiated Rate |
$379.20 |
| Max. Negotiated Rate |
$634.48 |
| Rate for Payer: Aetna Commercial |
$590.42
|
| Rate for Payer: Aetna Medicare |
$440.61
|
| Rate for Payer: BCBS Complete |
$379.20
|
| Rate for Payer: BCBS MAPPO |
$440.61
|
| Rate for Payer: BCN Medicare Advantage |
$440.61
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Cofinity Commercial |
$634.48
|
| Rate for Payer: Cofinity Commercial |
$590.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$440.61
|
| Rate for Payer: Healthscope Commercial |
$528.73
|
| Rate for Payer: Healthscope Whirlpool |
$528.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$462.64
|
| Rate for Payer: Nomi Health Commercial |
$528.73
|
| Rate for Payer: PACE SWMI |
$440.61
|
| Rate for Payer: PHP Medicare Advantage |
$440.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.20
|
| Rate for Payer: Priority Health Medicare |
$440.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$440.61
|
| Rate for Payer: UHC Medicare Advantage |
$440.61
|
| Rate for Payer: UHCCP DNSP |
$440.61
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
CPT 37785
|
| Hospital Charge Code |
37785
|
| Min. Negotiated Rate |
$629.85 |
| Max. Negotiated Rate |
$4,758.02 |
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: Aetna Medicare |
$3,069.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: ASR ASR |
$939.93
|
| Rate for Payer: ASR Commercial |
$939.93
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCBS Trust/PPO |
$793.51
|
| Rate for Payer: BCN Commercial |
$751.27
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$910.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$969.00
|
| Rate for Payer: Healthscope Whirlpool |
$939.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,069.69
|
| Rate for Payer: Mclaren Commercial |
$872.10
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: Nomi Health Commercial |
$794.58
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,376.66
|
| Rate for Payer: PHP Medicaid |
$1,645.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$849.04
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health Narrow Network |
$679.27
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$852.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$4,758.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP DNSP |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 37785
|
| Hospital Charge Code |
37785
|
| Min. Negotiated Rate |
$240.37 |
| Max. Negotiated Rate |
$629.85 |
| Rate for Payer: Aetna Commercial |
$322.10
|
| Rate for Payer: Aetna Medicare |
$240.37
|
| Rate for Payer: BCBS Complete |
$387.60
|
| Rate for Payer: BCBS MAPPO |
$240.37
|
| Rate for Payer: BCN Medicare Advantage |
$240.37
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$346.13
|
| Rate for Payer: Cofinity Commercial |
$322.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.37
|
| Rate for Payer: Healthscope Commercial |
$288.44
|
| Rate for Payer: Healthscope Whirlpool |
$288.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$252.39
|
| Rate for Payer: Nomi Health Commercial |
$288.44
|
| Rate for Payer: PACE SWMI |
$240.37
|
| Rate for Payer: PHP Medicare Advantage |
$240.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health Medicare |
$240.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$240.37
|
| Rate for Payer: UHC Medicare Advantage |
$240.37
|
| Rate for Payer: UHCCP DNSP |
$240.37
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
CPT 37785
|
| Hospital Charge Code |
37785
|
| Min. Negotiated Rate |
$629.85 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: ASR ASR |
$939.93
|
| Rate for Payer: ASR Commercial |
$939.93
|
| Rate for Payer: BCBS Trust/PPO |
$789.64
|
| Rate for Payer: BCN Commercial |
$751.27
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$910.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$969.00
|
| Rate for Payer: Healthscope Whirlpool |
$939.93
|
| Rate for Payer: Mclaren Commercial |
$872.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: Nomi Health Commercial |
$794.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$852.72
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 37785
|
| Min. Negotiated Rate |
$240.37 |
| Max. Negotiated Rate |
$629.85 |
| Rate for Payer: Aetna Commercial |
$322.10
|
| Rate for Payer: Aetna Medicare |
$240.37
|
| Rate for Payer: BCBS Complete |
$387.60
|
| Rate for Payer: BCBS MAPPO |
$240.37
|
| Rate for Payer: BCN Medicare Advantage |
$240.37
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$346.13
|
| Rate for Payer: Cofinity Commercial |
$322.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.37
|
| Rate for Payer: Healthscope Commercial |
$288.44
|
| Rate for Payer: Healthscope Whirlpool |
$288.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$252.39
|
| Rate for Payer: Nomi Health Commercial |
$288.44
|
| Rate for Payer: PACE SWMI |
$240.37
|
| Rate for Payer: PHP Medicare Advantage |
$240.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health Medicare |
$240.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$240.37
|
| Rate for Payer: UHC Medicare Advantage |
$240.37
|
| Rate for Payer: UHCCP DNSP |
$240.37
|
|
|
PR LIGJ & DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
HCPCS 37780
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$326.87 |
| Rate for Payer: Aetna Commercial |
$304.17
|
| Rate for Payer: Aetna Medicare |
$226.99
|
| Rate for Payer: BCBS Complete |
$193.20
|
| Rate for Payer: BCBS MAPPO |
$226.99
|
| Rate for Payer: BCN Medicare Advantage |
$226.99
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cofinity Commercial |
$326.87
|
| Rate for Payer: Cofinity Commercial |
$304.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.99
|
| Rate for Payer: Healthscope Commercial |
$272.39
|
| Rate for Payer: Healthscope Whirlpool |
$272.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$238.34
|
| Rate for Payer: Nomi Health Commercial |
$272.39
|
| Rate for Payer: PACE SWMI |
$226.99
|
| Rate for Payer: PHP Medicare Advantage |
$226.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.95
|
| Rate for Payer: Priority Health Medicare |
$226.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$226.99
|
| Rate for Payer: UHC Medicare Advantage |
$226.99
|
| Rate for Payer: UHCCP DNSP |
$226.99
|
|
|
PR LIGMOUS RCNSTJ AGMNTJ KNE INTRA-ARTICULAR XTR
|
Professional
|
Both
|
$2,234.00
|
|
|
Service Code
|
HCPCS 27429
|
| Min. Negotiated Rate |
$893.60 |
| Max. Negotiated Rate |
$1,749.79 |
| Rate for Payer: Aetna Commercial |
$1,628.27
|
| Rate for Payer: Aetna Medicare |
$1,215.13
|
| Rate for Payer: BCBS Complete |
$893.60
|
| Rate for Payer: BCBS MAPPO |
$1,215.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,215.13
|
| Rate for Payer: Cash Price |
$1,787.20
|
| Rate for Payer: Cash Price |
$1,787.20
|
| Rate for Payer: Cofinity Commercial |
$1,749.79
|
| Rate for Payer: Cofinity Commercial |
$1,628.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,215.13
|
| Rate for Payer: Healthscope Commercial |
$1,458.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,458.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,275.89
|
| Rate for Payer: Nomi Health Commercial |
$1,458.16
|
| Rate for Payer: PACE SWMI |
$1,215.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,215.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,452.10
|
| Rate for Payer: Priority Health Medicare |
$1,215.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,215.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,215.13
|
| Rate for Payer: UHCCP DNSP |
$1,215.13
|
|
|
PR LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG
|
Professional
|
Both
|
$1,126.00
|
|
|
Service Code
|
HCPCS 37761
|
| Min. Negotiated Rate |
$450.40 |
| Max. Negotiated Rate |
$734.54 |
| Rate for Payer: Aetna Commercial |
$683.53
|
| Rate for Payer: Aetna Medicare |
$510.10
|
| Rate for Payer: BCBS Complete |
$450.40
|
| Rate for Payer: BCBS MAPPO |
$510.10
|
| Rate for Payer: BCN Medicare Advantage |
$510.10
|
| Rate for Payer: Cash Price |
$900.80
|
| Rate for Payer: Cash Price |
$900.80
|
| Rate for Payer: Cofinity Commercial |
$734.54
|
| Rate for Payer: Cofinity Commercial |
$683.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.10
|
| Rate for Payer: Healthscope Commercial |
$612.12
|
| Rate for Payer: Healthscope Whirlpool |
$612.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$535.61
|
| Rate for Payer: Nomi Health Commercial |
$612.12
|
| Rate for Payer: PACE SWMI |
$510.10
|
| Rate for Payer: PHP Medicare Advantage |
$510.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.90
|
| Rate for Payer: Priority Health Medicare |
$510.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.10
|
| Rate for Payer: UHC Medicare Advantage |
$510.10
|
| Rate for Payer: UHCCP DNSP |
$510.10
|
|
|
PR LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 58611
|
| Min. Negotiated Rate |
$72.51 |
| Max. Negotiated Rate |
$219.05 |
| Rate for Payer: Aetna Commercial |
$97.16
|
| Rate for Payer: Aetna Medicare |
$72.51
|
| Rate for Payer: BCBS Complete |
$134.80
|
| Rate for Payer: BCBS MAPPO |
$72.51
|
| Rate for Payer: BCN Medicare Advantage |
$72.51
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$97.16
|
| Rate for Payer: Cofinity Commercial |
$104.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.51
|
| Rate for Payer: Healthscope Commercial |
$87.01
|
| Rate for Payer: Healthscope Whirlpool |
$87.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.14
|
| Rate for Payer: Nomi Health Commercial |
$87.01
|
| Rate for Payer: PACE SWMI |
$72.51
|
| Rate for Payer: PHP Medicare Advantage |
$72.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health Medicare |
$72.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.51
|
| Rate for Payer: UHC Medicare Advantage |
$72.51
|
| Rate for Payer: UHCCP DNSP |
$72.51
|
|
|
PR LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 58600
|
| Min. Negotiated Rate |
$355.53 |
| Max. Negotiated Rate |
$835.25 |
| Rate for Payer: Aetna Commercial |
$476.41
|
| Rate for Payer: Aetna Medicare |
$355.53
|
| Rate for Payer: BCBS Complete |
$514.00
|
| Rate for Payer: BCBS MAPPO |
$355.53
|
| Rate for Payer: BCN Medicare Advantage |
$355.53
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cofinity Commercial |
$511.96
|
| Rate for Payer: Cofinity Commercial |
$476.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$355.53
|
| Rate for Payer: Healthscope Commercial |
$426.64
|
| Rate for Payer: Healthscope Whirlpool |
$426.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$373.31
|
| Rate for Payer: Nomi Health Commercial |
$426.64
|
| Rate for Payer: PACE SWMI |
$355.53
|
| Rate for Payer: PHP Medicare Advantage |
$355.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$835.25
|
| Rate for Payer: Priority Health Medicare |
$355.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$355.53
|
| Rate for Payer: UHC Medicare Advantage |
$355.53
|
| Rate for Payer: UHCCP DNSP |
$355.53
|
|
|
PR LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 58605
|
| Min. Negotiated Rate |
$322.34 |
| Max. Negotiated Rate |
$562.25 |
| Rate for Payer: Aetna Commercial |
$431.94
|
| Rate for Payer: Aetna Medicare |
$322.34
|
| Rate for Payer: BCBS Complete |
$346.00
|
| Rate for Payer: BCBS MAPPO |
$322.34
|
| Rate for Payer: BCN Medicare Advantage |
$322.34
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$464.17
|
| Rate for Payer: Cofinity Commercial |
$431.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.34
|
| Rate for Payer: Healthscope Commercial |
$386.81
|
| Rate for Payer: Healthscope Whirlpool |
$386.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.46
|
| Rate for Payer: Nomi Health Commercial |
$386.81
|
| Rate for Payer: PACE SWMI |
$322.34
|
| Rate for Payer: PHP Medicare Advantage |
$322.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health Medicare |
$322.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.34
|
| Rate for Payer: UHC Medicare Advantage |
$322.34
|
| Rate for Payer: UHCCP DNSP |
$322.34
|
|
|
PR LILETTA, 52 MG
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
HCPCS J7297
|
| Min. Negotiated Rate |
$352.00 |
| Max. Negotiated Rate |
$572.00 |
| Rate for Payer: Aetna Medicare |
$440.00
|
| Rate for Payer: BCBS Complete |
$352.00
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$572.00
|
|
|
PR LIMITED VISUAL FIELD XM UNI/BI I&R
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 92081
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$50.70 |
| Rate for Payer: Aetna Commercial |
$40.87
|
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: BCBS MAPPO |
$30.50
|
| Rate for Payer: BCN Medicare Advantage |
$30.50
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$43.92
|
| Rate for Payer: Cofinity Commercial |
$40.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.50
|
| Rate for Payer: Healthscope Commercial |
$36.60
|
| Rate for Payer: Healthscope Whirlpool |
$36.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.02
|
| Rate for Payer: Nomi Health Commercial |
$36.60
|
| Rate for Payer: PACE SWMI |
$30.50
|
| Rate for Payer: PHP Medicare Advantage |
$30.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health Medicare |
$30.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.50
|
| Rate for Payer: UHC Medicare Advantage |
$30.50
|
| Rate for Payer: UHCCP DNSP |
$30.50
|
|
|
PR LINCOMYCIN INJECTION
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J2010
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$6.03
|
| Rate for Payer: Aetna Medicare |
$4.50
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$4.50
|
| Rate for Payer: BCN Medicare Advantage |
$4.50
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$6.48
|
| Rate for Payer: Cofinity Commercial |
$6.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$5.40
|
| Rate for Payer: Healthscope Whirlpool |
$5.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.72
|
| Rate for Payer: Nomi Health Commercial |
$5.40
|
| Rate for Payer: PACE SWMI |
$4.50
|
| Rate for Payer: PHP Medicare Advantage |
$4.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$4.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.50
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
| Rate for Payer: UHCCP DNSP |
$4.50
|
|
|
PR LITHOLAPAXY COMP/LG > 2.5 CM
|
Professional
|
Both
|
$936.00
|
|
|
Service Code
|
HCPCS 52318
|
| Min. Negotiated Rate |
$374.40 |
| Max. Negotiated Rate |
$646.65 |
| Rate for Payer: Aetna Commercial |
$601.74
|
| Rate for Payer: Aetna Medicare |
$449.06
|
| Rate for Payer: BCBS Complete |
$374.40
|
| Rate for Payer: BCBS MAPPO |
$449.06
|
| Rate for Payer: BCN Medicare Advantage |
$449.06
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cofinity Commercial |
$646.65
|
| Rate for Payer: Cofinity Commercial |
$601.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.06
|
| Rate for Payer: Healthscope Commercial |
$538.87
|
| Rate for Payer: Healthscope Whirlpool |
$538.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$471.51
|
| Rate for Payer: Nomi Health Commercial |
$538.87
|
| Rate for Payer: PACE SWMI |
$449.06
|
| Rate for Payer: PHP Medicare Advantage |
$449.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.40
|
| Rate for Payer: Priority Health Medicare |
$449.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$449.06
|
| Rate for Payer: UHC Medicare Advantage |
$449.06
|
| Rate for Payer: UHCCP DNSP |
$449.06
|
|
|
PR LITHOLAPAXY SMPL/SM <2.5 CM
|
Professional
|
Both
|
$1,658.00
|
|
|
Service Code
|
HCPCS 52317
|
| Min. Negotiated Rate |
$329.19 |
| Max. Negotiated Rate |
$1,077.70 |
| Rate for Payer: Aetna Commercial |
$441.11
|
| Rate for Payer: Aetna Medicare |
$329.19
|
| Rate for Payer: BCBS Complete |
$663.20
|
| Rate for Payer: BCBS MAPPO |
$329.19
|
| Rate for Payer: BCN Medicare Advantage |
$329.19
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Cofinity Commercial |
$474.03
|
| Rate for Payer: Cofinity Commercial |
$441.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.19
|
| Rate for Payer: Healthscope Commercial |
$395.03
|
| Rate for Payer: Healthscope Whirlpool |
$395.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.65
|
| Rate for Payer: Nomi Health Commercial |
$395.03
|
| Rate for Payer: PACE SWMI |
$329.19
|
| Rate for Payer: PHP Medicare Advantage |
$329.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.70
|
| Rate for Payer: Priority Health Medicare |
$329.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$329.19
|
| Rate for Payer: UHC Medicare Advantage |
$329.19
|
| Rate for Payer: UHCCP DNSP |
$329.19
|
|
|
PR LITHOTRIPSY XTRCORP SHOCK WAVE
|
Professional
|
Both
|
$1,547.00
|
|
|
Service Code
|
HCPCS 50590
|
| Min. Negotiated Rate |
$546.36 |
| Max. Negotiated Rate |
$1,005.55 |
| Rate for Payer: Aetna Commercial |
$732.12
|
| Rate for Payer: Aetna Medicare |
$546.36
|
| Rate for Payer: BCBS Complete |
$618.80
|
| Rate for Payer: BCBS MAPPO |
$546.36
|
| Rate for Payer: BCN Medicare Advantage |
$546.36
|
| Rate for Payer: Cash Price |
$1,237.60
|
| Rate for Payer: Cash Price |
$1,237.60
|
| Rate for Payer: Cofinity Commercial |
$786.76
|
| Rate for Payer: Cofinity Commercial |
$732.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$546.36
|
| Rate for Payer: Healthscope Commercial |
$655.63
|
| Rate for Payer: Healthscope Whirlpool |
$655.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$573.68
|
| Rate for Payer: Nomi Health Commercial |
$655.63
|
| Rate for Payer: PACE SWMI |
$546.36
|
| Rate for Payer: PHP Medicare Advantage |
$546.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.55
|
| Rate for Payer: Priority Health Medicare |
$546.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$546.36
|
| Rate for Payer: UHC Medicare Advantage |
$546.36
|
| Rate for Payer: UHCCP DNSP |
$546.36
|
|
