|
PR SYNOVECTOMY CARPOMETACARPAL JOINT
|
Professional
|
Both
|
$1,182.00
|
|
|
Service Code
|
HCPCS 26130
|
| Min. Negotiated Rate |
$454.89 |
| Max. Negotiated Rate |
$768.30 |
| Rate for Payer: Aetna Commercial |
$609.55
|
| Rate for Payer: Aetna Medicare |
$454.89
|
| Rate for Payer: BCBS Complete |
$472.80
|
| Rate for Payer: BCBS MAPPO |
$454.89
|
| Rate for Payer: BCN Medicare Advantage |
$454.89
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cofinity Commercial |
$655.04
|
| Rate for Payer: Cofinity Commercial |
$609.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$454.89
|
| Rate for Payer: Healthscope Commercial |
$545.87
|
| Rate for Payer: Healthscope Whirlpool |
$545.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$477.63
|
| Rate for Payer: Nomi Health Commercial |
$545.87
|
| Rate for Payer: PACE SWMI |
$454.89
|
| Rate for Payer: PHP Medicare Advantage |
$454.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$768.30
|
| Rate for Payer: Priority Health Medicare |
$454.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$454.89
|
| Rate for Payer: UHC Medicare Advantage |
$454.89
|
| Rate for Payer: UHCCP DNSP |
$454.89
|
|
|
PR SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT
|
Professional
|
Both
|
$1,276.00
|
|
|
Service Code
|
HCPCS 25118
|
| Min. Negotiated Rate |
$371.57 |
| Max. Negotiated Rate |
$829.40 |
| Rate for Payer: Aetna Commercial |
$497.90
|
| Rate for Payer: Aetna Medicare |
$371.57
|
| Rate for Payer: BCBS Complete |
$510.40
|
| Rate for Payer: BCBS MAPPO |
$371.57
|
| Rate for Payer: BCN Medicare Advantage |
$371.57
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cofinity Commercial |
$535.06
|
| Rate for Payer: Cofinity Commercial |
$497.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.57
|
| Rate for Payer: Healthscope Commercial |
$445.88
|
| Rate for Payer: Healthscope Whirlpool |
$445.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$445.88
|
| Rate for Payer: PACE SWMI |
$371.57
|
| Rate for Payer: PHP Medicare Advantage |
$371.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$829.40
|
| Rate for Payer: Priority Health Medicare |
$371.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.57
|
| Rate for Payer: UHC Medicare Advantage |
$371.57
|
| Rate for Payer: UHCCP DNSP |
$371.57
|
|
|
PR SYNOVECTOMY METATARSOPHALANGEAL JOINT EACH
|
Professional
|
Both
|
$1,016.00
|
|
|
Service Code
|
HCPCS 28072
|
| Min. Negotiated Rate |
$311.75 |
| Max. Negotiated Rate |
$660.40 |
| Rate for Payer: Aetna Commercial |
$417.75
|
| Rate for Payer: Aetna Medicare |
$311.75
|
| Rate for Payer: BCBS Complete |
$406.40
|
| Rate for Payer: BCBS MAPPO |
$311.75
|
| Rate for Payer: BCN Medicare Advantage |
$311.75
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cofinity Commercial |
$448.92
|
| Rate for Payer: Cofinity Commercial |
$417.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.75
|
| Rate for Payer: Healthscope Commercial |
$374.10
|
| Rate for Payer: Healthscope Whirlpool |
$374.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$327.34
|
| Rate for Payer: Nomi Health Commercial |
$374.10
|
| Rate for Payer: PACE SWMI |
$311.75
|
| Rate for Payer: PHP Medicare Advantage |
$311.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$660.40
|
| Rate for Payer: Priority Health Medicare |
$311.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$311.75
|
| Rate for Payer: UHC Medicare Advantage |
$311.75
|
| Rate for Payer: UHCCP DNSP |
$311.75
|
|
|
PR SYNVCT MTCARPHLNGL JT W/INTRNSC RLS&XTNSR HOOD
|
Professional
|
Both
|
$1,726.00
|
|
|
Service Code
|
HCPCS 26135
|
| Min. Negotiated Rate |
$537.34 |
| Max. Negotiated Rate |
$1,121.90 |
| Rate for Payer: Aetna Commercial |
$720.04
|
| Rate for Payer: Aetna Medicare |
$537.34
|
| Rate for Payer: BCBS Complete |
$690.40
|
| Rate for Payer: BCBS MAPPO |
$537.34
|
| Rate for Payer: BCN Medicare Advantage |
$537.34
|
| Rate for Payer: Cash Price |
$1,380.80
|
| Rate for Payer: Cash Price |
$1,380.80
|
| Rate for Payer: Cofinity Commercial |
$773.77
|
| Rate for Payer: Cofinity Commercial |
$720.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.34
|
| Rate for Payer: Healthscope Commercial |
$644.81
|
| Rate for Payer: Healthscope Whirlpool |
$644.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.21
|
| Rate for Payer: Nomi Health Commercial |
$644.81
|
| Rate for Payer: PACE SWMI |
$537.34
|
| Rate for Payer: PHP Medicare Advantage |
$537.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,121.90
|
| Rate for Payer: Priority Health Medicare |
$537.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.34
|
| Rate for Payer: UHC Medicare Advantage |
$537.34
|
| Rate for Payer: UHCCP DNSP |
$537.34
|
|
|
PR SYNVCT PROX IPHAL JT W/XTNSR RCNSTJ EA IPHAL JT
|
Professional
|
Both
|
$1,476.00
|
|
|
Service Code
|
HCPCS 26140
|
| Min. Negotiated Rate |
$491.61 |
| Max. Negotiated Rate |
$959.40 |
| Rate for Payer: Aetna Commercial |
$658.76
|
| Rate for Payer: Aetna Medicare |
$491.61
|
| Rate for Payer: BCBS Complete |
$590.40
|
| Rate for Payer: BCBS MAPPO |
$491.61
|
| Rate for Payer: BCN Medicare Advantage |
$491.61
|
| Rate for Payer: Cash Price |
$1,180.80
|
| Rate for Payer: Cash Price |
$1,180.80
|
| Rate for Payer: Cofinity Commercial |
$707.92
|
| Rate for Payer: Cofinity Commercial |
$658.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$491.61
|
| Rate for Payer: Healthscope Commercial |
$589.93
|
| Rate for Payer: Healthscope Whirlpool |
$589.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$516.19
|
| Rate for Payer: Nomi Health Commercial |
$589.93
|
| Rate for Payer: PACE SWMI |
$491.61
|
| Rate for Payer: PHP Medicare Advantage |
$491.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.40
|
| Rate for Payer: Priority Health Medicare |
$491.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$491.61
|
| Rate for Payer: UHC Medicare Advantage |
$491.61
|
| Rate for Payer: UHCCP DNSP |
$491.61
|
|
|
PR SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN
|
Professional
|
Both
|
$1,680.00
|
|
|
Service Code
|
HCPCS 26145
|
| Min. Negotiated Rate |
$500.59 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Aetna Commercial |
$670.79
|
| Rate for Payer: Aetna Medicare |
$500.59
|
| Rate for Payer: BCBS Complete |
$672.00
|
| Rate for Payer: BCBS MAPPO |
$500.59
|
| Rate for Payer: BCN Medicare Advantage |
$500.59
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cofinity Commercial |
$720.85
|
| Rate for Payer: Cofinity Commercial |
$670.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$500.59
|
| Rate for Payer: Healthscope Commercial |
$600.71
|
| Rate for Payer: Healthscope Whirlpool |
$600.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$525.62
|
| Rate for Payer: Nomi Health Commercial |
$600.71
|
| Rate for Payer: PACE SWMI |
$500.59
|
| Rate for Payer: PHP Medicare Advantage |
$500.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,092.00
|
| Rate for Payer: Priority Health Medicare |
$500.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$500.59
|
| Rate for Payer: UHC Medicare Advantage |
$500.59
|
| Rate for Payer: UHCCP DNSP |
$500.59
|
|
|
PR SYNVCT XTNSR TDN SHTH WRST 1 RESCJ DSTL ULNA
|
Professional
|
Both
|
$1,796.00
|
|
|
Service Code
|
HCPCS 25119
|
| Min. Negotiated Rate |
$487.16 |
| Max. Negotiated Rate |
$1,167.40 |
| Rate for Payer: Aetna Commercial |
$652.79
|
| Rate for Payer: Aetna Medicare |
$487.16
|
| Rate for Payer: BCBS Complete |
$718.40
|
| Rate for Payer: BCBS MAPPO |
$487.16
|
| Rate for Payer: BCN Medicare Advantage |
$487.16
|
| Rate for Payer: Cash Price |
$1,436.80
|
| Rate for Payer: Cash Price |
$1,436.80
|
| Rate for Payer: Cofinity Commercial |
$701.51
|
| Rate for Payer: Cofinity Commercial |
$652.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$487.16
|
| Rate for Payer: Healthscope Commercial |
$584.59
|
| Rate for Payer: Healthscope Whirlpool |
$584.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$511.52
|
| Rate for Payer: Nomi Health Commercial |
$584.59
|
| Rate for Payer: PACE SWMI |
$487.16
|
| Rate for Payer: PHP Medicare Advantage |
$487.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.40
|
| Rate for Payer: Priority Health Medicare |
$487.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$487.16
|
| Rate for Payer: UHC Medicare Advantage |
$487.16
|
| Rate for Payer: UHCCP DNSP |
$487.16
|
|
|
PR SYNVISC OR SYNVISC-ONE
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS J7325
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Commercial |
$10.65
|
| Rate for Payer: Aetna Medicare |
$7.95
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS MAPPO |
$7.95
|
| Rate for Payer: BCN Medicare Advantage |
$7.95
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$11.45
|
| Rate for Payer: Cofinity Commercial |
$10.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.95
|
| Rate for Payer: Healthscope Commercial |
$9.54
|
| Rate for Payer: Healthscope Whirlpool |
$9.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.35
|
| Rate for Payer: Nomi Health Commercial |
$9.54
|
| Rate for Payer: PACE SWMI |
$7.95
|
| Rate for Payer: PHP Medicare Advantage |
$7.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health Medicare |
$7.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.95
|
| Rate for Payer: UHC Medicare Advantage |
$7.95
|
| Rate for Payer: UHCCP DNSP |
$7.95
|
|
|
PR TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 11103
|
| Min. Negotiated Rate |
$20.59 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Aetna Commercial |
$27.59
|
| Rate for Payer: Aetna Medicare |
$20.59
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: BCBS MAPPO |
$20.59
|
| Rate for Payer: BCN Medicare Advantage |
$20.59
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Cofinity Commercial |
$27.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.59
|
| Rate for Payer: Healthscope Commercial |
$24.71
|
| Rate for Payer: Healthscope Whirlpool |
$24.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.62
|
| Rate for Payer: Nomi Health Commercial |
$24.71
|
| Rate for Payer: PACE SWMI |
$20.59
|
| Rate for Payer: PHP Medicare Advantage |
$20.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health Medicare |
$20.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.59
|
| Rate for Payer: UHC Medicare Advantage |
$20.59
|
| Rate for Payer: UHCCP DNSP |
$20.59
|
|
|
PR TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 11102
|
| Min. Negotiated Rate |
$35.41 |
| Max. Negotiated Rate |
$126.10 |
| Rate for Payer: Aetna Commercial |
$47.45
|
| Rate for Payer: Aetna Medicare |
$35.41
|
| Rate for Payer: BCBS Complete |
$77.60
|
| Rate for Payer: BCBS MAPPO |
$35.41
|
| Rate for Payer: BCN Medicare Advantage |
$35.41
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$50.99
|
| Rate for Payer: Cofinity Commercial |
$47.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.41
|
| Rate for Payer: Healthscope Commercial |
$42.49
|
| Rate for Payer: Healthscope Whirlpool |
$42.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.18
|
| Rate for Payer: Nomi Health Commercial |
$42.49
|
| Rate for Payer: PACE SWMI |
$35.41
|
| Rate for Payer: PHP Medicare Advantage |
$35.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.10
|
| Rate for Payer: Priority Health Medicare |
$35.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.41
|
| Rate for Payer: UHC Medicare Advantage |
$35.41
|
| Rate for Payer: UHCCP DNSP |
$35.41
|
|
|
PR TAP BLOCK UNILATERAL BY INJECTION(S)
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 64486
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna Commercial |
$66.97
|
| Rate for Payer: Aetna Medicare |
$49.98
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS MAPPO |
$49.98
|
| Rate for Payer: BCN Medicare Advantage |
$49.98
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$71.97
|
| Rate for Payer: Cofinity Commercial |
$66.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.98
|
| Rate for Payer: Healthscope Commercial |
$59.98
|
| Rate for Payer: Healthscope Whirlpool |
$59.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.48
|
| Rate for Payer: Nomi Health Commercial |
$59.98
|
| Rate for Payer: PACE SWMI |
$49.98
|
| Rate for Payer: PHP Medicare Advantage |
$49.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$49.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.98
|
| Rate for Payer: UHC Medicare Advantage |
$49.98
|
| Rate for Payer: UHCCP DNSP |
$49.98
|
|
|
PR TATTOOING INCL MICROPIGMENTATION 6.0 CM/<
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
HCPCS 11920
|
| Min. Negotiated Rate |
$108.46 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Aetna Commercial |
$145.34
|
| Rate for Payer: Aetna Medicare |
$108.46
|
| Rate for Payer: BCBS Complete |
$129.20
|
| Rate for Payer: BCBS MAPPO |
$108.46
|
| Rate for Payer: BCN Medicare Advantage |
$108.46
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$156.18
|
| Rate for Payer: Cofinity Commercial |
$145.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.46
|
| Rate for Payer: Healthscope Commercial |
$130.15
|
| Rate for Payer: Healthscope Whirlpool |
$130.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.88
|
| Rate for Payer: Nomi Health Commercial |
$130.15
|
| Rate for Payer: PACE SWMI |
$108.46
|
| Rate for Payer: PHP Medicare Advantage |
$108.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health Medicare |
$108.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.46
|
| Rate for Payer: UHC Medicare Advantage |
$108.46
|
| Rate for Payer: UHCCP DNSP |
$108.46
|
|
|
PR TATTOOING INCL MICROPIGMENTATION 6.1-20.0 CM
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 11921
|
| Min. Negotiated Rate |
$124.62 |
| Max. Negotiated Rate |
$241.80 |
| Rate for Payer: Aetna Commercial |
$166.99
|
| Rate for Payer: Aetna Medicare |
$124.62
|
| Rate for Payer: BCBS Complete |
$148.80
|
| Rate for Payer: BCBS MAPPO |
$124.62
|
| Rate for Payer: BCN Medicare Advantage |
$124.62
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cofinity Commercial |
$179.45
|
| Rate for Payer: Cofinity Commercial |
$166.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.62
|
| Rate for Payer: Healthscope Commercial |
$149.54
|
| Rate for Payer: Healthscope Whirlpool |
$149.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.85
|
| Rate for Payer: Nomi Health Commercial |
$149.54
|
| Rate for Payer: PACE SWMI |
$124.62
|
| Rate for Payer: PHP Medicare Advantage |
$124.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.80
|
| Rate for Payer: Priority Health Medicare |
$124.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.62
|
| Rate for Payer: UHC Medicare Advantage |
$124.62
|
| Rate for Payer: UHCCP DNSP |
$124.62
|
|
|
PR TATTOOING INCL MICROPIGMENTATION EA 20.0 CM
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 11922
|
| Min. Negotiated Rate |
$27.14 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Commercial |
$36.37
|
| Rate for Payer: Aetna Medicare |
$27.14
|
| Rate for Payer: BCBS Complete |
$48.40
|
| Rate for Payer: BCBS MAPPO |
$27.14
|
| Rate for Payer: BCN Medicare Advantage |
$27.14
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cofinity Commercial |
$39.08
|
| Rate for Payer: Cofinity Commercial |
$36.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.14
|
| Rate for Payer: Healthscope Commercial |
$32.57
|
| Rate for Payer: Healthscope Whirlpool |
$32.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.50
|
| Rate for Payer: Nomi Health Commercial |
$32.57
|
| Rate for Payer: PACE SWMI |
$27.14
|
| Rate for Payer: PHP Medicare Advantage |
$27.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.65
|
| Rate for Payer: Priority Health Medicare |
$27.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.14
|
| Rate for Payer: UHC Medicare Advantage |
$27.14
|
| Rate for Payer: UHCCP DNSP |
$27.14
|
|
|
PR TC99M DISOFENIN
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS A9510
|
| 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 TC99M MEBROFENIN
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS A9537
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$157.95 |
| Rate for Payer: Aetna Medicare |
$121.50
|
| Rate for Payer: BCBS Complete |
$97.20
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
|
|
PR TC99M MEDRONATE
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS A9503
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: Aetna Medicare |
$46.00
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
|
|
PR TC99M PERTECHNETATE
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS A9512
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
|
|
PR TC99M SESTAMIBI
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS A9500
|
| Min. Negotiated Rate |
$128.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Medicare |
$160.00
|
| Rate for Payer: BCBS Complete |
$128.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
|
|
PR TCATH STENT PLACEMT ANTEGRADE CAROTID/INNOMINATE
|
Professional
|
Both
|
$1,814.00
|
|
|
Service Code
|
HCPCS 37218
|
| Min. Negotiated Rate |
$725.60 |
| Max. Negotiated Rate |
$1,179.10 |
| Rate for Payer: Aetna Commercial |
$1,061.76
|
| Rate for Payer: Aetna Medicare |
$792.36
|
| Rate for Payer: BCBS Complete |
$725.60
|
| Rate for Payer: BCBS MAPPO |
$792.36
|
| Rate for Payer: BCN Medicare Advantage |
$792.36
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Cofinity Commercial |
$1,141.00
|
| Rate for Payer: Cofinity Commercial |
$1,061.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$792.36
|
| Rate for Payer: Healthscope Commercial |
$950.83
|
| Rate for Payer: Healthscope Whirlpool |
$950.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$831.98
|
| Rate for Payer: Nomi Health Commercial |
$950.83
|
| Rate for Payer: PACE SWMI |
$792.36
|
| Rate for Payer: PHP Medicare Advantage |
$792.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,179.10
|
| Rate for Payer: Priority Health Medicare |
$792.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$792.36
|
| Rate for Payer: UHC Medicare Advantage |
$792.36
|
| Rate for Payer: UHCCP DNSP |
$792.36
|
|
|
PR TCATH STENT PLACEMT RETROGRAD CAROTID/INNOMINATE
|
Professional
|
Both
|
$1,755.00
|
|
|
Service Code
|
HCPCS 37217
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$1,494.16 |
| Rate for Payer: Aetna Commercial |
$1,390.40
|
| Rate for Payer: Aetna Medicare |
$1,037.61
|
| Rate for Payer: BCBS Complete |
$702.00
|
| Rate for Payer: BCBS MAPPO |
$1,037.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,037.61
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cofinity Commercial |
$1,494.16
|
| Rate for Payer: Cofinity Commercial |
$1,390.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,037.61
|
| Rate for Payer: Healthscope Commercial |
$1,245.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,245.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,089.49
|
| Rate for Payer: Nomi Health Commercial |
$1,245.13
|
| Rate for Payer: PACE SWMI |
$1,037.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,037.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,140.75
|
| Rate for Payer: Priority Health Medicare |
$1,037.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,037.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,037.61
|
| Rate for Payer: UHCCP DNSP |
$1,037.61
|
|
|
PR TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR
|
Professional
|
Both
|
$687.00
|
|
|
Service Code
|
HCPCS 33289
|
| Min. Negotiated Rate |
$274.80 |
| Max. Negotiated Rate |
$458.60 |
| Rate for Payer: Aetna Commercial |
$426.75
|
| Rate for Payer: Aetna Medicare |
$318.47
|
| Rate for Payer: BCBS Complete |
$274.80
|
| Rate for Payer: BCBS MAPPO |
$318.47
|
| Rate for Payer: BCN Medicare Advantage |
$318.47
|
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Cofinity Commercial |
$458.60
|
| Rate for Payer: Cofinity Commercial |
$426.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.47
|
| Rate for Payer: Healthscope Commercial |
$382.16
|
| Rate for Payer: Healthscope Whirlpool |
$382.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$334.39
|
| Rate for Payer: Nomi Health Commercial |
$382.16
|
| Rate for Payer: PACE SWMI |
$318.47
|
| Rate for Payer: PHP Medicare Advantage |
$318.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.55
|
| Rate for Payer: Priority Health Medicare |
$318.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$318.47
|
| Rate for Payer: UHC Medicare Advantage |
$318.47
|
| Rate for Payer: UHCCP DNSP |
$318.47
|
|
|
PR TCAT INSJ/RPL PERM LEADLESS PACEMAKER RV W/IMG
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
HCPCS 33274
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna Commercial |
$607.11
|
| Rate for Payer: Aetna Medicare |
$453.07
|
| Rate for Payer: BCBS Complete |
$408.00
|
| Rate for Payer: BCBS MAPPO |
$453.07
|
| Rate for Payer: BCN Medicare Advantage |
$453.07
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cofinity Commercial |
$652.42
|
| Rate for Payer: Cofinity Commercial |
$607.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$453.07
|
| Rate for Payer: Healthscope Commercial |
$543.68
|
| Rate for Payer: Healthscope Whirlpool |
$543.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$475.72
|
| Rate for Payer: Nomi Health Commercial |
$543.68
|
| Rate for Payer: PACE SWMI |
$453.07
|
| Rate for Payer: PHP Medicare Advantage |
$453.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.00
|
| Rate for Payer: Priority Health Medicare |
$453.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$453.07
|
| Rate for Payer: UHC Medicare Advantage |
$453.07
|
| Rate for Payer: UHCCP DNSP |
$453.07
|
|
|
PR TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ
|
Professional
|
Both
|
$2,110.00
|
|
|
Service Code
|
HCPCS 37215
|
| Min. Negotiated Rate |
$844.00 |
| Max. Negotiated Rate |
$1,371.50 |
| Rate for Payer: Aetna Commercial |
$1,265.54
|
| Rate for Payer: Aetna Medicare |
$944.43
|
| Rate for Payer: BCBS Complete |
$844.00
|
| Rate for Payer: BCBS MAPPO |
$944.43
|
| Rate for Payer: BCN Medicare Advantage |
$944.43
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cofinity Commercial |
$1,359.98
|
| Rate for Payer: Cofinity Commercial |
$1,265.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$944.43
|
| Rate for Payer: Healthscope Commercial |
$1,133.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,133.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$991.65
|
| Rate for Payer: Nomi Health Commercial |
$1,133.32
|
| Rate for Payer: PACE SWMI |
$944.43
|
| Rate for Payer: PHP Medicare Advantage |
$944.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.50
|
| Rate for Payer: Priority Health Medicare |
$944.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$944.43
|
| Rate for Payer: UHC Medicare Advantage |
$944.43
|
| Rate for Payer: UHCCP DNSP |
$944.43
|
|
|
PR TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ
|
Professional
|
Both
|
$4,184.00
|
|
|
Service Code
|
HCPCS 37216
|
| Min. Negotiated Rate |
$1,673.60 |
| Max. Negotiated Rate |
$2,719.60 |
| Rate for Payer: Aetna Medicare |
$2,092.00
|
| Rate for Payer: BCBS Complete |
$1,673.60
|
| Rate for Payer: Cash Price |
$3,347.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,719.60
|
|
