|
PR SIMPLE UROFLOMETRY
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 51736
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$17.07
|
| Rate for Payer: Aetna Medicare |
$12.74
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$12.74
|
| Rate for Payer: BCN Medicare Advantage |
$12.74
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$18.35
|
| Rate for Payer: Cofinity Commercial |
$17.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$15.29
|
| Rate for Payer: Healthscope Whirlpool |
$15.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.38
|
| Rate for Payer: Nomi Health Commercial |
$15.29
|
| Rate for Payer: PACE SWMI |
$12.74
|
| Rate for Payer: PHP Medicare Advantage |
$12.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.50
|
| Rate for Payer: Priority Health Medicare |
$12.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.74
|
| Rate for Payer: UHC Medicare Advantage |
$12.74
|
| Rate for Payer: UHCCP DNSP |
$12.74
|
|
|
PR SINUSOT FRNT NONOBLIT W/OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$2,143.00
|
|
|
Service Code
|
HCPCS 31087
|
| Min. Negotiated Rate |
$857.20 |
| Max. Negotiated Rate |
$1,515.43 |
| Rate for Payer: Aetna Commercial |
$1,410.19
|
| Rate for Payer: Aetna Medicare |
$1,052.38
|
| Rate for Payer: BCBS Complete |
$857.20
|
| Rate for Payer: BCBS MAPPO |
$1,052.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,052.38
|
| Rate for Payer: Cash Price |
$1,714.40
|
| Rate for Payer: Cash Price |
$1,714.40
|
| Rate for Payer: Cofinity Commercial |
$1,515.43
|
| Rate for Payer: Cofinity Commercial |
$1,410.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,052.38
|
| Rate for Payer: Healthscope Commercial |
$1,262.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,262.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,105.00
|
| Rate for Payer: Nomi Health Commercial |
$1,262.86
|
| Rate for Payer: PACE SWMI |
$1,052.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,052.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.95
|
| Rate for Payer: Priority Health Medicare |
$1,052.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,052.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,052.38
|
| Rate for Payer: UHCCP DNSP |
$1,052.38
|
|
|
PR SINUSOT FRNT OBLIT W/O OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$2,085.00
|
|
|
Service Code
|
HCPCS 31081
|
| Min. Negotiated Rate |
$834.00 |
| Max. Negotiated Rate |
$1,569.99 |
| Rate for Payer: Aetna Commercial |
$1,460.96
|
| Rate for Payer: Aetna Medicare |
$1,090.27
|
| Rate for Payer: BCBS Complete |
$834.00
|
| Rate for Payer: BCBS MAPPO |
$1,090.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,090.27
|
| Rate for Payer: Cash Price |
$1,668.00
|
| Rate for Payer: Cash Price |
$1,668.00
|
| Rate for Payer: Cofinity Commercial |
$1,569.99
|
| Rate for Payer: Cofinity Commercial |
$1,460.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,090.27
|
| Rate for Payer: Healthscope Commercial |
$1,308.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,308.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,144.78
|
| Rate for Payer: Nomi Health Commercial |
$1,308.32
|
| Rate for Payer: PACE SWMI |
$1,090.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,090.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,355.25
|
| Rate for Payer: Priority Health Medicare |
$1,090.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,090.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,090.27
|
| Rate for Payer: UHCCP DNSP |
$1,090.27
|
|
|
PR SINUSOT FRNT OBLIT W/OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$2,667.00
|
|
|
Service Code
|
HCPCS 31085
|
| Min. Negotiated Rate |
$1,066.80 |
| Max. Negotiated Rate |
$1,733.55 |
| Rate for Payer: Aetna Commercial |
$1,560.71
|
| Rate for Payer: Aetna Medicare |
$1,164.71
|
| Rate for Payer: BCBS Complete |
$1,066.80
|
| Rate for Payer: BCBS MAPPO |
$1,164.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,164.71
|
| Rate for Payer: Cash Price |
$2,133.60
|
| Rate for Payer: Cash Price |
$2,133.60
|
| Rate for Payer: Cofinity Commercial |
$1,677.18
|
| Rate for Payer: Cofinity Commercial |
$1,560.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,164.71
|
| Rate for Payer: Healthscope Commercial |
$1,397.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,397.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,222.95
|
| Rate for Payer: Nomi Health Commercial |
$1,397.65
|
| Rate for Payer: PACE SWMI |
$1,164.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,164.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,733.55
|
| Rate for Payer: Priority Health Medicare |
$1,164.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,164.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,164.71
|
| Rate for Payer: UHCCP DNSP |
$1,164.71
|
|
|
PR SINUSOT MAX ANTRT RAD W/RMVL ANTROCH POLYPS
|
Professional
|
Both
|
$1,124.00
|
|
|
Service Code
|
HCPCS 31032
|
| Min. Negotiated Rate |
$449.60 |
| Max. Negotiated Rate |
$800.28 |
| Rate for Payer: Aetna Commercial |
$744.71
|
| Rate for Payer: Aetna Medicare |
$555.75
|
| Rate for Payer: BCBS Complete |
$449.60
|
| Rate for Payer: BCBS MAPPO |
$555.75
|
| Rate for Payer: BCN Medicare Advantage |
$555.75
|
| Rate for Payer: Cash Price |
$899.20
|
| Rate for Payer: Cash Price |
$899.20
|
| Rate for Payer: Cofinity Commercial |
$800.28
|
| Rate for Payer: Cofinity Commercial |
$744.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$555.75
|
| Rate for Payer: Healthscope Commercial |
$666.90
|
| Rate for Payer: Healthscope Whirlpool |
$666.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$583.54
|
| Rate for Payer: Nomi Health Commercial |
$666.90
|
| Rate for Payer: PACE SWMI |
$555.75
|
| Rate for Payer: PHP Medicare Advantage |
$555.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$730.60
|
| Rate for Payer: Priority Health Medicare |
$555.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$555.75
|
| Rate for Payer: UHC Medicare Advantage |
$555.75
|
| Rate for Payer: UHCCP DNSP |
$555.75
|
|
|
PR SINUSOTOMY FRNT OBLITERATIVE W/O FLAP BROW INC
|
Professional
|
Both
|
$2,264.00
|
|
|
Service Code
|
HCPCS 31080
|
| Min. Negotiated Rate |
$905.60 |
| Max. Negotiated Rate |
$1,471.60 |
| Rate for Payer: Aetna Commercial |
$1,360.07
|
| Rate for Payer: Aetna Medicare |
$1,014.98
|
| Rate for Payer: BCBS Complete |
$905.60
|
| Rate for Payer: BCBS MAPPO |
$1,014.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,014.98
|
| Rate for Payer: Cash Price |
$1,811.20
|
| Rate for Payer: Cash Price |
$1,811.20
|
| Rate for Payer: Cofinity Commercial |
$1,461.57
|
| Rate for Payer: Cofinity Commercial |
$1,360.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,014.98
|
| Rate for Payer: Healthscope Commercial |
$1,217.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,217.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,065.73
|
| Rate for Payer: Nomi Health Commercial |
$1,217.98
|
| Rate for Payer: PACE SWMI |
$1,014.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,014.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,471.60
|
| Rate for Payer: Priority Health Medicare |
$1,014.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,014.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,014.98
|
| Rate for Payer: UHCCP DNSP |
$1,014.98
|
|
|
PR SINUSOTOMY FRONTAL EXTERNAL SIMPLE
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 31070
|
| Min. Negotiated Rate |
$354.40 |
| Max. Negotiated Rate |
$632.72 |
| Rate for Payer: Aetna Commercial |
$588.78
|
| Rate for Payer: Aetna Medicare |
$439.39
|
| Rate for Payer: BCBS Complete |
$354.40
|
| Rate for Payer: BCBS MAPPO |
$439.39
|
| Rate for Payer: BCN Medicare Advantage |
$439.39
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$632.72
|
| Rate for Payer: Cofinity Commercial |
$588.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.39
|
| Rate for Payer: Healthscope Commercial |
$527.27
|
| Rate for Payer: Healthscope Whirlpool |
$527.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.36
|
| Rate for Payer: Nomi Health Commercial |
$527.27
|
| Rate for Payer: PACE SWMI |
$439.39
|
| Rate for Payer: PHP Medicare Advantage |
$439.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health Medicare |
$439.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.39
|
| Rate for Payer: UHC Medicare Advantage |
$439.39
|
| Rate for Payer: UHCCP DNSP |
$439.39
|
|
|
PR SINUSOTOMY MAXILLARY ANTROTOMY INTRANASAL
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 31020
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: Aetna Commercial |
$425.57
|
| Rate for Payer: Aetna Medicare |
$317.59
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: BCBS MAPPO |
$317.59
|
| Rate for Payer: BCN Medicare Advantage |
$317.59
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$457.33
|
| Rate for Payer: Cofinity Commercial |
$425.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$317.59
|
| Rate for Payer: Healthscope Commercial |
$381.11
|
| Rate for Payer: Healthscope Whirlpool |
$381.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$333.47
|
| Rate for Payer: Nomi Health Commercial |
$381.11
|
| Rate for Payer: PACE SWMI |
$317.59
|
| Rate for Payer: PHP Medicare Advantage |
$317.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health Medicare |
$317.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$317.59
|
| Rate for Payer: UHC Medicare Advantage |
$317.59
|
| Rate for Payer: UHCCP DNSP |
$317.59
|
|
|
PR SINUSOTOMY MAXILLARY RAD W/O RMVL ANTROCH POLYPS
|
Professional
|
Both
|
$1,156.00
|
|
|
Service Code
|
HCPCS 31030
|
| Min. Negotiated Rate |
$462.40 |
| Max. Negotiated Rate |
$751.40 |
| Rate for Payer: Aetna Commercial |
$645.67
|
| Rate for Payer: Aetna Medicare |
$481.84
|
| Rate for Payer: BCBS Complete |
$462.40
|
| Rate for Payer: BCBS MAPPO |
$481.84
|
| Rate for Payer: BCN Medicare Advantage |
$481.84
|
| Rate for Payer: Cash Price |
$924.80
|
| Rate for Payer: Cash Price |
$924.80
|
| Rate for Payer: Cofinity Commercial |
$693.85
|
| Rate for Payer: Cofinity Commercial |
$645.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$481.84
|
| Rate for Payer: Healthscope Commercial |
$578.21
|
| Rate for Payer: Healthscope Whirlpool |
$578.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$505.93
|
| Rate for Payer: Nomi Health Commercial |
$578.21
|
| Rate for Payer: PACE SWMI |
$481.84
|
| Rate for Payer: PHP Medicare Advantage |
$481.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$751.40
|
| Rate for Payer: Priority Health Medicare |
$481.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$481.84
|
| Rate for Payer: UHC Medicare Advantage |
$481.84
|
| Rate for Payer: UHCCP DNSP |
$481.84
|
|
|
PR SINUSOT SPHENOID W/MUCOSAL STRIPPING/RMVL POLYP
|
Professional
|
Both
|
$1,867.00
|
|
|
Service Code
|
HCPCS 31051
|
| Min. Negotiated Rate |
$642.02 |
| Max. Negotiated Rate |
$1,213.55 |
| Rate for Payer: Aetna Commercial |
$860.31
|
| Rate for Payer: Aetna Medicare |
$642.02
|
| Rate for Payer: BCBS Complete |
$746.80
|
| Rate for Payer: BCBS MAPPO |
$642.02
|
| Rate for Payer: BCN Medicare Advantage |
$642.02
|
| Rate for Payer: Cash Price |
$1,493.60
|
| Rate for Payer: Cash Price |
$1,493.60
|
| Rate for Payer: Cofinity Commercial |
$924.51
|
| Rate for Payer: Cofinity Commercial |
$860.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$642.02
|
| Rate for Payer: Healthscope Commercial |
$770.42
|
| Rate for Payer: Healthscope Whirlpool |
$770.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$674.12
|
| Rate for Payer: Nomi Health Commercial |
$770.42
|
| Rate for Payer: PACE SWMI |
$642.02
|
| Rate for Payer: PHP Medicare Advantage |
$642.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,213.55
|
| Rate for Payer: Priority Health Medicare |
$642.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$642.02
|
| Rate for Payer: UHC Medicare Advantage |
$642.02
|
| Rate for Payer: UHCCP DNSP |
$642.02
|
|
|
PR SKIN LESION SHAVE/EXCISION (15 MIN)
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00367
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
PR SKIN LESION SHAVE/EXCISION (30 MIN)
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 00368
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Aetna Medicare |
$255.00
|
| Rate for Payer: BCBS Complete |
$204.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
|
|
PR SKYLA, 13.5 MG
|
Professional
|
Both
|
$1,462.00
|
|
|
Service Code
|
HCPCS J7301
|
| Min. Negotiated Rate |
$584.80 |
| Max. Negotiated Rate |
$950.30 |
| Rate for Payer: Aetna Medicare |
$731.00
|
| Rate for Payer: BCBS Complete |
$584.80
|
| Rate for Payer: Cash Price |
$1,169.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$950.30
|
|
|
PR SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 36251
|
| Min. Negotiated Rate |
$205.60 |
| Max. Negotiated Rate |
$348.68 |
| Rate for Payer: Aetna Commercial |
$324.47
|
| Rate for Payer: Aetna Medicare |
$242.14
|
| Rate for Payer: BCBS Complete |
$205.60
|
| Rate for Payer: BCBS MAPPO |
$242.14
|
| Rate for Payer: BCN Medicare Advantage |
$242.14
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Cofinity Commercial |
$348.68
|
| Rate for Payer: Cofinity Commercial |
$324.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.14
|
| Rate for Payer: Healthscope Commercial |
$290.57
|
| Rate for Payer: Healthscope Whirlpool |
$290.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$254.25
|
| Rate for Payer: Nomi Health Commercial |
$290.57
|
| Rate for Payer: PACE SWMI |
$242.14
|
| Rate for Payer: PHP Medicare Advantage |
$242.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.10
|
| Rate for Payer: Priority Health Medicare |
$242.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$242.14
|
| Rate for Payer: UHC Medicare Advantage |
$242.14
|
| Rate for Payer: UHCCP DNSP |
$242.14
|
|
|
PR SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 36252
|
| Min. Negotiated Rate |
$267.60 |
| Max. Negotiated Rate |
$489.31 |
| Rate for Payer: Aetna Commercial |
$455.33
|
| Rate for Payer: Aetna Medicare |
$339.80
|
| Rate for Payer: BCBS Complete |
$267.60
|
| Rate for Payer: BCBS MAPPO |
$339.80
|
| Rate for Payer: BCN Medicare Advantage |
$339.80
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$489.31
|
| Rate for Payer: Cofinity Commercial |
$455.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.80
|
| Rate for Payer: Healthscope Commercial |
$407.76
|
| Rate for Payer: Healthscope Whirlpool |
$407.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.79
|
| Rate for Payer: Nomi Health Commercial |
$407.76
|
| Rate for Payer: PACE SWMI |
$339.80
|
| Rate for Payer: PHP Medicare Advantage |
$339.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health Medicare |
$339.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.80
|
| Rate for Payer: UHC Medicare Advantage |
$339.80
|
| Rate for Payer: UHCCP DNSP |
$339.80
|
|
|
PR SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART
|
Professional
|
Both
|
$1,801.00
|
|
|
Service Code
|
HCPCS 36223
|
| Min. Negotiated Rate |
$320.20 |
| Max. Negotiated Rate |
$1,170.65 |
| Rate for Payer: Aetna Commercial |
$429.07
|
| Rate for Payer: Aetna Medicare |
$320.20
|
| Rate for Payer: BCBS Complete |
$720.40
|
| Rate for Payer: BCBS MAPPO |
$320.20
|
| Rate for Payer: BCN Medicare Advantage |
$320.20
|
| Rate for Payer: Cash Price |
$1,440.80
|
| Rate for Payer: Cash Price |
$1,440.80
|
| Rate for Payer: Cofinity Commercial |
$461.09
|
| Rate for Payer: Cofinity Commercial |
$429.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.20
|
| Rate for Payer: Healthscope Commercial |
$384.24
|
| Rate for Payer: Healthscope Whirlpool |
$384.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$336.21
|
| Rate for Payer: Nomi Health Commercial |
$384.24
|
| Rate for Payer: PACE SWMI |
$320.20
|
| Rate for Payer: PHP Medicare Advantage |
$320.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,170.65
|
| Rate for Payer: Priority Health Medicare |
$320.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.20
|
| Rate for Payer: UHC Medicare Advantage |
$320.20
|
| Rate for Payer: UHCCP DNSP |
$320.20
|
|
|
PR SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 36222
|
| Min. Negotiated Rate |
$275.22 |
| Max. Negotiated Rate |
$1,075.75 |
| Rate for Payer: Aetna Commercial |
$368.79
|
| Rate for Payer: Aetna Medicare |
$275.22
|
| Rate for Payer: BCBS Complete |
$662.00
|
| Rate for Payer: BCBS MAPPO |
$275.22
|
| Rate for Payer: BCN Medicare Advantage |
$275.22
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cofinity Commercial |
$396.32
|
| Rate for Payer: Cofinity Commercial |
$368.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.22
|
| Rate for Payer: Healthscope Commercial |
$330.26
|
| Rate for Payer: Healthscope Whirlpool |
$330.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.98
|
| Rate for Payer: Nomi Health Commercial |
$330.26
|
| Rate for Payer: PACE SWMI |
$275.22
|
| Rate for Payer: PHP Medicare Advantage |
$275.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.75
|
| Rate for Payer: Priority Health Medicare |
$275.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.22
|
| Rate for Payer: UHC Medicare Advantage |
$275.22
|
| Rate for Payer: UHCCP DNSP |
$275.22
|
|
|
PR SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY
|
Professional
|
Both
|
$1,009.00
|
|
|
Service Code
|
HCPCS 36014
|
| Min. Negotiated Rate |
$144.36 |
| Max. Negotiated Rate |
$655.85 |
| Rate for Payer: Aetna Commercial |
$193.44
|
| Rate for Payer: Aetna Medicare |
$144.36
|
| Rate for Payer: BCBS Complete |
$403.60
|
| Rate for Payer: BCBS MAPPO |
$144.36
|
| Rate for Payer: BCN Medicare Advantage |
$144.36
|
| Rate for Payer: Cash Price |
$807.20
|
| Rate for Payer: Cash Price |
$807.20
|
| Rate for Payer: Cofinity Commercial |
$207.88
|
| Rate for Payer: Cofinity Commercial |
$193.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.36
|
| Rate for Payer: Healthscope Commercial |
$173.23
|
| Rate for Payer: Healthscope Whirlpool |
$173.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.58
|
| Rate for Payer: Nomi Health Commercial |
$173.23
|
| Rate for Payer: PACE SWMI |
$144.36
|
| Rate for Payer: PHP Medicare Advantage |
$144.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$655.85
|
| Rate for Payer: Priority Health Medicare |
$144.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.36
|
| Rate for Payer: UHC Medicare Advantage |
$144.36
|
| Rate for Payer: UHCCP DNSP |
$144.36
|
|
|
PR SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT
|
Professional
|
Both
|
$1,360.00
|
|
|
Service Code
|
HCPCS 36228
|
| Min. Negotiated Rate |
$244.43 |
| Max. Negotiated Rate |
$884.00 |
| Rate for Payer: Aetna Commercial |
$327.54
|
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: BCBS Complete |
$544.00
|
| Rate for Payer: BCBS MAPPO |
$244.43
|
| Rate for Payer: BCN Medicare Advantage |
$244.43
|
| Rate for Payer: Cash Price |
$1,088.00
|
| Rate for Payer: Cash Price |
$1,088.00
|
| Rate for Payer: Cofinity Commercial |
$351.98
|
| Rate for Payer: Cofinity Commercial |
$327.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.43
|
| Rate for Payer: Healthscope Commercial |
$293.32
|
| Rate for Payer: Healthscope Whirlpool |
$293.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.65
|
| Rate for Payer: Nomi Health Commercial |
$293.32
|
| Rate for Payer: PACE SWMI |
$244.43
|
| Rate for Payer: PHP Medicare Advantage |
$244.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.00
|
| Rate for Payer: Priority Health Medicare |
$244.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.43
|
| Rate for Payer: UHC Medicare Advantage |
$244.43
|
| Rate for Payer: UHCCP DNSP |
$244.43
|
|
|
PR SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART
|
Professional
|
Both
|
$1,258.00
|
|
|
Service Code
|
HCPCS 36224
|
| Min. Negotiated Rate |
$359.67 |
| Max. Negotiated Rate |
$817.70 |
| Rate for Payer: Aetna Commercial |
$481.96
|
| Rate for Payer: Aetna Medicare |
$359.67
|
| Rate for Payer: BCBS Complete |
$503.20
|
| Rate for Payer: BCBS MAPPO |
$359.67
|
| Rate for Payer: BCN Medicare Advantage |
$359.67
|
| Rate for Payer: Cash Price |
$1,006.40
|
| Rate for Payer: Cash Price |
$1,006.40
|
| Rate for Payer: Cofinity Commercial |
$517.92
|
| Rate for Payer: Cofinity Commercial |
$481.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$359.67
|
| Rate for Payer: Healthscope Commercial |
$431.60
|
| Rate for Payer: Healthscope Whirlpool |
$431.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$377.65
|
| Rate for Payer: Nomi Health Commercial |
$431.60
|
| Rate for Payer: PACE SWMI |
$359.67
|
| Rate for Payer: PHP Medicare Advantage |
$359.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.70
|
| Rate for Payer: Priority Health Medicare |
$359.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$359.67
|
| Rate for Payer: UHC Medicare Advantage |
$359.67
|
| Rate for Payer: UHCCP DNSP |
$359.67
|
|
|
PR SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$2,344.00
|
|
|
Service Code
|
HCPCS 36216
|
| Min. Negotiated Rate |
$260.65 |
| Max. Negotiated Rate |
$1,523.60 |
| Rate for Payer: Aetna Commercial |
$349.27
|
| Rate for Payer: Aetna Medicare |
$260.65
|
| Rate for Payer: BCBS Complete |
$937.60
|
| Rate for Payer: BCBS MAPPO |
$260.65
|
| Rate for Payer: BCN Medicare Advantage |
$260.65
|
| Rate for Payer: Cash Price |
$1,875.20
|
| Rate for Payer: Cash Price |
$1,875.20
|
| Rate for Payer: Cofinity Commercial |
$375.34
|
| Rate for Payer: Cofinity Commercial |
$349.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.65
|
| Rate for Payer: Healthscope Commercial |
$312.78
|
| Rate for Payer: Healthscope Whirlpool |
$312.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.68
|
| Rate for Payer: Nomi Health Commercial |
$312.78
|
| Rate for Payer: PACE SWMI |
$260.65
|
| Rate for Payer: PHP Medicare Advantage |
$260.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,523.60
|
| Rate for Payer: Priority Health Medicare |
$260.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.65
|
| Rate for Payer: UHC Medicare Advantage |
$260.65
|
| Rate for Payer: UHCCP DNSP |
$260.65
|
|
|
PR SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH
|
Professional
|
Both
|
$1,042.00
|
|
|
Service Code
|
HCPCS 36246
|
| Min. Negotiated Rate |
$240.57 |
| Max. Negotiated Rate |
$677.30 |
| Rate for Payer: Aetna Commercial |
$322.36
|
| Rate for Payer: Aetna Medicare |
$240.57
|
| Rate for Payer: BCBS Complete |
$416.80
|
| Rate for Payer: BCBS MAPPO |
$240.57
|
| Rate for Payer: BCN Medicare Advantage |
$240.57
|
| Rate for Payer: Cash Price |
$833.60
|
| Rate for Payer: Cash Price |
$833.60
|
| Rate for Payer: Cofinity Commercial |
$346.42
|
| Rate for Payer: Cofinity Commercial |
$322.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.57
|
| Rate for Payer: Healthscope Commercial |
$288.68
|
| Rate for Payer: Healthscope Whirlpool |
$288.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$252.60
|
| Rate for Payer: Nomi Health Commercial |
$288.68
|
| Rate for Payer: PACE SWMI |
$240.57
|
| Rate for Payer: PHP Medicare Advantage |
$240.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$677.30
|
| Rate for Payer: Priority Health Medicare |
$240.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$240.57
|
| Rate for Payer: UHC Medicare Advantage |
$240.57
|
| Rate for Payer: UHCCP DNSP |
$240.57
|
|
|
PR SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH
|
Professional
|
Both
|
$1,304.00
|
|
|
Service Code
|
HCPCS 36247
|
| Min. Negotiated Rate |
$282.44 |
| Max. Negotiated Rate |
$847.60 |
| Rate for Payer: Aetna Commercial |
$378.47
|
| Rate for Payer: Aetna Medicare |
$282.44
|
| Rate for Payer: BCBS Complete |
$521.60
|
| Rate for Payer: BCBS MAPPO |
$282.44
|
| Rate for Payer: BCN Medicare Advantage |
$282.44
|
| Rate for Payer: Cash Price |
$1,043.20
|
| Rate for Payer: Cash Price |
$1,043.20
|
| Rate for Payer: Cofinity Commercial |
$406.71
|
| Rate for Payer: Cofinity Commercial |
$378.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$282.44
|
| Rate for Payer: Healthscope Commercial |
$338.93
|
| Rate for Payer: Healthscope Whirlpool |
$338.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$296.56
|
| Rate for Payer: Nomi Health Commercial |
$338.93
|
| Rate for Payer: PACE SWMI |
$282.44
|
| Rate for Payer: PHP Medicare Advantage |
$282.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$847.60
|
| Rate for Payer: Priority Health Medicare |
$282.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$282.44
|
| Rate for Payer: UHC Medicare Advantage |
$282.44
|
| Rate for Payer: UHCCP DNSP |
$282.44
|
|
|
PR SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$1,377.00
|
|
|
Service Code
|
HCPCS 36217
|
| Min. Negotiated Rate |
$324.61 |
| Max. Negotiated Rate |
$895.05 |
| Rate for Payer: Aetna Commercial |
$434.98
|
| Rate for Payer: Aetna Medicare |
$324.61
|
| Rate for Payer: BCBS Complete |
$550.80
|
| Rate for Payer: BCBS MAPPO |
$324.61
|
| Rate for Payer: BCN Medicare Advantage |
$324.61
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cofinity Commercial |
$467.44
|
| Rate for Payer: Cofinity Commercial |
$434.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.61
|
| Rate for Payer: Healthscope Commercial |
$389.53
|
| Rate for Payer: Healthscope Whirlpool |
$389.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$340.84
|
| Rate for Payer: Nomi Health Commercial |
$389.53
|
| Rate for Payer: PACE SWMI |
$324.61
|
| Rate for Payer: PHP Medicare Advantage |
$324.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.05
|
| Rate for Payer: Priority Health Medicare |
$324.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.61
|
| Rate for Payer: UHC Medicare Advantage |
$324.61
|
| Rate for Payer: UHCCP DNSP |
$324.61
|
|
|
PR SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH
|
Professional
|
Both
|
$835.00
|
|
|
Service Code
|
HCPCS 36245
|
| Min. Negotiated Rate |
$224.63 |
| Max. Negotiated Rate |
$542.75 |
| Rate for Payer: Aetna Commercial |
$301.00
|
| Rate for Payer: Aetna Medicare |
$224.63
|
| Rate for Payer: BCBS Complete |
$334.00
|
| Rate for Payer: BCBS MAPPO |
$224.63
|
| Rate for Payer: BCN Medicare Advantage |
$224.63
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Cofinity Commercial |
$323.47
|
| Rate for Payer: Cofinity Commercial |
$301.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$224.63
|
| Rate for Payer: Healthscope Commercial |
$269.56
|
| Rate for Payer: Healthscope Whirlpool |
$269.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$235.86
|
| Rate for Payer: Nomi Health Commercial |
$269.56
|
| Rate for Payer: PACE SWMI |
$224.63
|
| Rate for Payer: PHP Medicare Advantage |
$224.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.75
|
| Rate for Payer: Priority Health Medicare |
$224.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$224.63
|
| Rate for Payer: UHC Medicare Advantage |
$224.63
|
| Rate for Payer: UHCCP DNSP |
$224.63
|
|
