|
PR VAGINAL HYSTERECTOMY 250 GM/< W/RPR ENTEROCELE
|
Professional
|
Both
|
$2,840.00
|
|
|
Service Code
|
HCPCS 58270
|
| Min. Negotiated Rate |
$506.09 |
| Max. Negotiated Rate |
$2,130.00 |
| Rate for Payer: Aetna Commercial |
$1,054.63
|
| Rate for Payer: Aetna Medicare |
$787.04
|
| Rate for Payer: BCBS Complete |
$531.39
|
| Rate for Payer: BCBS MAPPO |
$787.04
|
| Rate for Payer: BCN Commercial |
$1,340.57
|
| Rate for Payer: BCN Medicare Advantage |
$787.04
|
| Rate for Payer: Cash Price |
$2,272.00
|
| Rate for Payer: Cash Price |
$2,272.00
|
| Rate for Payer: Cofinity Commercial |
$1,133.34
|
| Rate for Payer: Cofinity Commercial |
$1,054.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.04
|
| Rate for Payer: Healthscope Commercial |
$944.45
|
| Rate for Payer: Healthscope Whirlpool |
$944.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.39
|
| Rate for Payer: Meridian Medicaid |
$531.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$865.74
|
| Rate for Payer: Nomi Health Commercial |
$944.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,130.00
|
| Rate for Payer: PACE SWMI |
$787.04
|
| Rate for Payer: PHP Medicare Advantage |
$787.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$506.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,357.71
|
| Rate for Payer: Priority Health Medicare |
$787.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,357.71
|
| Rate for Payer: Railroad Medicare Medicare |
$787.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,578.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$787.04
|
| Rate for Payer: UHC Exchange |
$1,578.48
|
| Rate for Payer: UHC Medicaid |
$506.09
|
| Rate for Payer: UHCCP DNSP |
$787.04
|
| Rate for Payer: UHCCP Medicaid |
$506.09
|
|
|
PR VAGINAL HYSTERECTOMY UTERUS > 250 GM
|
Professional
|
Both
|
$3,005.00
|
|
|
Service Code
|
HCPCS 58290
|
| Min. Negotiated Rate |
$645.18 |
| Max. Negotiated Rate |
$2,253.75 |
| Rate for Payer: Aetna Commercial |
$1,347.73
|
| Rate for Payer: Aetna Medicare |
$1,005.77
|
| Rate for Payer: BCBS Complete |
$677.44
|
| Rate for Payer: BCBS MAPPO |
$1,005.77
|
| Rate for Payer: BCN Commercial |
$1,722.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,005.77
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cofinity Commercial |
$1,448.31
|
| Rate for Payer: Cofinity Commercial |
$1,347.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,005.77
|
| Rate for Payer: Healthscope Commercial |
$1,206.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,206.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,056.06
|
| Rate for Payer: Meridian Medicaid |
$677.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,106.35
|
| Rate for Payer: Nomi Health Commercial |
$1,206.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,253.75
|
| Rate for Payer: PACE SWMI |
$1,005.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,005.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$645.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,744.03
|
| Rate for Payer: Priority Health Medicare |
$1,005.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,744.03
|
| Rate for Payer: Railroad Medicare Medicare |
$1,005.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,047.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,005.77
|
| Rate for Payer: UHC Exchange |
$2,047.53
|
| Rate for Payer: UHC Medicaid |
$645.18
|
| Rate for Payer: UHCCP DNSP |
$1,005.77
|
| Rate for Payer: UHCCP Medicaid |
$645.18
|
|
|
PR VAGINAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$2,765.00
|
|
|
Service Code
|
HCPCS 58260
|
| Min. Negotiated Rate |
$473.07 |
| Max. Negotiated Rate |
$2,073.75 |
| Rate for Payer: Aetna Commercial |
$984.51
|
| Rate for Payer: Aetna Medicare |
$734.71
|
| Rate for Payer: BCBS Complete |
$496.72
|
| Rate for Payer: BCBS MAPPO |
$734.71
|
| Rate for Payer: BCN Commercial |
$1,257.90
|
| Rate for Payer: BCN Medicare Advantage |
$734.71
|
| Rate for Payer: Cash Price |
$2,212.00
|
| Rate for Payer: Cash Price |
$2,212.00
|
| Rate for Payer: Cofinity Commercial |
$984.51
|
| Rate for Payer: Cofinity Commercial |
$1,057.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$734.71
|
| Rate for Payer: Healthscope Commercial |
$881.65
|
| Rate for Payer: Healthscope Whirlpool |
$881.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$771.45
|
| Rate for Payer: Meridian Medicaid |
$496.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$808.18
|
| Rate for Payer: Nomi Health Commercial |
$881.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,073.75
|
| Rate for Payer: PACE SWMI |
$734.71
|
| Rate for Payer: PHP Medicare Advantage |
$734.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,273.98
|
| Rate for Payer: Priority Health Medicare |
$734.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,273.98
|
| Rate for Payer: Railroad Medicare Medicare |
$734.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,477.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$734.71
|
| Rate for Payer: UHC Exchange |
$1,477.63
|
| Rate for Payer: UHC Medicaid |
$473.07
|
| Rate for Payer: UHCCP DNSP |
$734.71
|
| Rate for Payer: UHCCP Medicaid |
$473.07
|
|
|
PR VAGINAL HYSTERECTOMY W/TOT/PRTL VAGINECTOMY
|
Professional
|
Both
|
$2,488.00
|
|
|
Service Code
|
HCPCS 58275
|
| Min. Negotiated Rate |
$558.49 |
| Max. Negotiated Rate |
$1,866.00 |
| Rate for Payer: Aetna Commercial |
$1,164.30
|
| Rate for Payer: Aetna Medicare |
$868.88
|
| Rate for Payer: BCBS Complete |
$586.41
|
| Rate for Payer: BCBS MAPPO |
$868.88
|
| Rate for Payer: BCN Commercial |
$1,486.97
|
| Rate for Payer: BCN Medicare Advantage |
$868.88
|
| Rate for Payer: Cash Price |
$1,990.40
|
| Rate for Payer: Cash Price |
$1,990.40
|
| Rate for Payer: Cofinity Commercial |
$1,251.19
|
| Rate for Payer: Cofinity Commercial |
$1,164.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.88
|
| Rate for Payer: Healthscope Commercial |
$1,042.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,042.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$912.32
|
| Rate for Payer: Meridian Medicaid |
$586.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$955.77
|
| Rate for Payer: Nomi Health Commercial |
$1,042.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,866.00
|
| Rate for Payer: PACE SWMI |
$868.88
|
| Rate for Payer: PHP Medicare Advantage |
$868.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$558.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,505.99
|
| Rate for Payer: Priority Health Medicare |
$868.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,505.99
|
| Rate for Payer: Railroad Medicare Medicare |
$868.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,751.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$868.88
|
| Rate for Payer: UHC Exchange |
$1,751.47
|
| Rate for Payer: UHC Medicaid |
$558.49
|
| Rate for Payer: UHCCP DNSP |
$868.88
|
| Rate for Payer: UHCCP Medicaid |
$558.49
|
|
|
PR VAGINECTOMY COMPLETE REMOVAL VAGINAL WALL
|
Professional
|
Both
|
$2,086.00
|
|
|
Service Code
|
HCPCS 57110
|
| Min. Negotiated Rate |
$508.86 |
| Max. Negotiated Rate |
$1,597.09 |
| Rate for Payer: Aetna Commercial |
$1,059.63
|
| Rate for Payer: Aetna Medicare |
$790.77
|
| Rate for Payer: BCBS Complete |
$534.30
|
| Rate for Payer: BCBS MAPPO |
$790.77
|
| Rate for Payer: BCN Commercial |
$1,352.51
|
| Rate for Payer: BCN Medicare Advantage |
$790.77
|
| Rate for Payer: Cash Price |
$1,668.80
|
| Rate for Payer: Cash Price |
$1,668.80
|
| Rate for Payer: Cofinity Commercial |
$1,138.71
|
| Rate for Payer: Cofinity Commercial |
$1,059.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$790.77
|
| Rate for Payer: Healthscope Commercial |
$948.92
|
| Rate for Payer: Healthscope Whirlpool |
$948.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$830.31
|
| Rate for Payer: Meridian Medicaid |
$534.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$869.85
|
| Rate for Payer: Nomi Health Commercial |
$948.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,564.50
|
| Rate for Payer: PACE SWMI |
$790.77
|
| Rate for Payer: PHP Medicare Advantage |
$790.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,369.80
|
| Rate for Payer: Priority Health Medicare |
$790.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,369.80
|
| Rate for Payer: Railroad Medicare Medicare |
$790.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,597.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$790.77
|
| Rate for Payer: UHC Exchange |
$1,597.09
|
| Rate for Payer: UHC Medicaid |
$508.86
|
| Rate for Payer: UHCCP DNSP |
$790.77
|
| Rate for Payer: UHCCP Medicaid |
$508.86
|
|
|
PR VAGINECTOMY PARTIAL REMOVAL VAGINAL WALL
|
Professional
|
Both
|
$2,053.00
|
|
|
Service Code
|
HCPCS 57106
|
| Min. Negotiated Rate |
$313.96 |
| Max. Negotiated Rate |
$1,539.75 |
| Rate for Payer: Aetna Commercial |
$643.84
|
| Rate for Payer: Aetna Medicare |
$480.48
|
| Rate for Payer: BCBS Complete |
$329.66
|
| Rate for Payer: BCBS MAPPO |
$480.48
|
| Rate for Payer: BCN Commercial |
$808.22
|
| Rate for Payer: BCN Medicare Advantage |
$480.48
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cofinity Commercial |
$691.89
|
| Rate for Payer: Cofinity Commercial |
$643.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.48
|
| Rate for Payer: Healthscope Commercial |
$576.58
|
| Rate for Payer: Healthscope Whirlpool |
$576.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$504.50
|
| Rate for Payer: Meridian Medicaid |
$329.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$528.53
|
| Rate for Payer: Nomi Health Commercial |
$576.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,539.75
|
| Rate for Payer: PACE SWMI |
$480.48
|
| Rate for Payer: PHP Medicare Advantage |
$480.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$818.55
|
| Rate for Payer: Priority Health Medicare |
$480.48
|
| Rate for Payer: Priority Health Narrow Network |
$818.55
|
| Rate for Payer: Railroad Medicare Medicare |
$480.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$901.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$480.48
|
| Rate for Payer: UHC Exchange |
$901.65
|
| Rate for Payer: UHC Medicaid |
$313.96
|
| Rate for Payer: UHCCP DNSP |
$480.48
|
| Rate for Payer: UHCCP Medicaid |
$313.96
|
|
|
PR VAGINOPLASTY INTERSEX STATE
|
Professional
|
Both
|
$2,609.00
|
|
|
Service Code
|
HCPCS 57335
|
| Min. Negotiated Rate |
$660.73 |
| Max. Negotiated Rate |
$2,074.65 |
| Rate for Payer: Aetna Commercial |
$1,376.74
|
| Rate for Payer: Aetna Medicare |
$1,027.42
|
| Rate for Payer: BCBS Complete |
$693.77
|
| Rate for Payer: BCBS MAPPO |
$1,027.42
|
| Rate for Payer: BCN Commercial |
$1,760.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,027.42
|
| Rate for Payer: Cash Price |
$2,087.20
|
| Rate for Payer: Cash Price |
$2,087.20
|
| Rate for Payer: Cofinity Commercial |
$1,479.48
|
| Rate for Payer: Cofinity Commercial |
$1,376.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,027.42
|
| Rate for Payer: Healthscope Commercial |
$1,232.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,232.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,078.79
|
| Rate for Payer: Meridian Medicaid |
$693.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,130.16
|
| Rate for Payer: Nomi Health Commercial |
$1,232.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,956.75
|
| Rate for Payer: PACE SWMI |
$1,027.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,027.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$660.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,783.37
|
| Rate for Payer: Priority Health Medicare |
$1,027.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,783.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,027.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,074.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,027.42
|
| Rate for Payer: UHC Exchange |
$2,074.65
|
| Rate for Payer: UHC Medicaid |
$660.73
|
| Rate for Payer: UHCCP DNSP |
$1,027.42
|
| Rate for Payer: UHCCP Medicaid |
$660.73
|
|
|
PR VAGNC PRTL RMVL VAG WALL W/RMVL PARAVAGINAL TISS
|
Professional
|
Both
|
$2,648.00
|
|
|
Service Code
|
HCPCS 57107
|
| Min. Negotiated Rate |
$842.42 |
| Max. Negotiated Rate |
$2,536.54 |
| Rate for Payer: Aetna Commercial |
$1,754.74
|
| Rate for Payer: Aetna Medicare |
$1,309.51
|
| Rate for Payer: BCBS Complete |
$884.54
|
| Rate for Payer: BCBS MAPPO |
$1,309.51
|
| Rate for Payer: BCN Commercial |
$2,186.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,309.51
|
| Rate for Payer: Cash Price |
$2,118.40
|
| Rate for Payer: Cash Price |
$2,118.40
|
| Rate for Payer: Cofinity Commercial |
$1,885.69
|
| Rate for Payer: Cofinity Commercial |
$1,754.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,309.51
|
| Rate for Payer: Healthscope Commercial |
$1,571.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,571.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,374.99
|
| Rate for Payer: Meridian Medicaid |
$884.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,440.46
|
| Rate for Payer: Nomi Health Commercial |
$1,571.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,986.00
|
| Rate for Payer: PACE SWMI |
$1,309.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,309.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$842.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,214.58
|
| Rate for Payer: Priority Health Medicare |
$1,309.51
|
| Rate for Payer: Priority Health Narrow Network |
$2,214.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,309.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,536.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,309.51
|
| Rate for Payer: UHC Exchange |
$2,536.54
|
| Rate for Payer: UHC Medicaid |
$842.42
|
| Rate for Payer: UHCCP DNSP |
$1,309.51
|
| Rate for Payer: UHCCP Medicaid |
$842.42
|
|
|
PR VAGOTOMY PFRMD W/PRTL DSTL GSTRCT
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 43635
|
| Min. Negotiated Rate |
$64.33 |
| Max. Negotiated Rate |
$203.86 |
| Rate for Payer: Aetna Commercial |
$136.36
|
| Rate for Payer: Aetna Medicare |
$101.76
|
| Rate for Payer: BCBS Complete |
$67.55
|
| Rate for Payer: BCBS MAPPO |
$101.76
|
| Rate for Payer: BCN Commercial |
$167.32
|
| Rate for Payer: BCN Medicare Advantage |
$101.76
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$146.53
|
| Rate for Payer: Cofinity Commercial |
$136.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.76
|
| Rate for Payer: Healthscope Commercial |
$122.11
|
| Rate for Payer: Healthscope Whirlpool |
$122.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.85
|
| Rate for Payer: Meridian Medicaid |
$67.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.94
|
| Rate for Payer: Nomi Health Commercial |
$122.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: PACE SWMI |
$101.76
|
| Rate for Payer: PHP Medicare Advantage |
$101.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$203.86
|
| Rate for Payer: Priority Health Medicare |
$101.76
|
| Rate for Payer: Priority Health Narrow Network |
$203.86
|
| Rate for Payer: Railroad Medicare Medicare |
$101.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$202.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.76
|
| Rate for Payer: UHC Exchange |
$202.62
|
| Rate for Payer: UHC Medicaid |
$64.33
|
| Rate for Payer: UHCCP DNSP |
$101.76
|
| Rate for Payer: UHCCP Medicaid |
$64.33
|
|
|
PR VALVECTOMY TRICUSPID VALVE W/CARDIOPULMONARY BYP
|
Professional
|
Both
|
$5,005.00
|
|
|
Service Code
|
HCPCS 33460
|
| Min. Negotiated Rate |
$1,431.15 |
| Max. Negotiated Rate |
$4,296.08 |
| Rate for Payer: Aetna Commercial |
$3,016.42
|
| Rate for Payer: Aetna Medicare |
$2,251.06
|
| Rate for Payer: BCBS Complete |
$1,502.71
|
| Rate for Payer: BCBS MAPPO |
$2,251.06
|
| Rate for Payer: BCN Commercial |
$3,507.77
|
| Rate for Payer: BCN Medicare Advantage |
$2,251.06
|
| Rate for Payer: Cash Price |
$4,004.00
|
| Rate for Payer: Cash Price |
$4,004.00
|
| Rate for Payer: Cofinity Commercial |
$3,241.53
|
| Rate for Payer: Cofinity Commercial |
$3,016.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,251.06
|
| Rate for Payer: Healthscope Commercial |
$2,701.27
|
| Rate for Payer: Healthscope Whirlpool |
$2,701.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,363.61
|
| Rate for Payer: Meridian Medicaid |
$1,502.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,476.17
|
| Rate for Payer: Nomi Health Commercial |
$2,701.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,753.75
|
| Rate for Payer: PACE SWMI |
$2,251.06
|
| Rate for Payer: PHP Medicare Advantage |
$2,251.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,431.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,772.18
|
| Rate for Payer: Priority Health Medicare |
$2,251.06
|
| Rate for Payer: Priority Health Narrow Network |
$3,772.18
|
| Rate for Payer: Railroad Medicare Medicare |
$2,251.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,296.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,251.06
|
| Rate for Payer: UHC Exchange |
$4,296.08
|
| Rate for Payer: UHC Medicaid |
$1,431.15
|
| Rate for Payer: UHCCP DNSP |
$2,251.06
|
| Rate for Payer: UHCCP Medicaid |
$1,431.15
|
|
|
PR VALVOTOMY MITRAL VALVE OPEN HEART W/BYPASS
|
Professional
|
Both
|
$9,191.00
|
|
|
Service Code
|
HCPCS 33422
|
| Min. Negotiated Rate |
$1,012.82 |
| Max. Negotiated Rate |
$6,893.25 |
| Rate for Payer: Aetna Commercial |
$2,123.22
|
| Rate for Payer: Aetna Medicare |
$1,584.49
|
| Rate for Payer: BCBS Complete |
$1,063.46
|
| Rate for Payer: BCBS MAPPO |
$1,584.49
|
| Rate for Payer: BCN Commercial |
$2,446.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,584.49
|
| Rate for Payer: Cash Price |
$7,352.80
|
| Rate for Payer: Cash Price |
$7,352.80
|
| Rate for Payer: Cofinity Commercial |
$2,281.67
|
| Rate for Payer: Cofinity Commercial |
$2,123.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,584.49
|
| Rate for Payer: Healthscope Commercial |
$1,901.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,901.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,663.71
|
| Rate for Payer: Meridian Medicaid |
$1,063.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,742.94
|
| Rate for Payer: Nomi Health Commercial |
$1,901.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,893.25
|
| Rate for Payer: PACE SWMI |
$1,584.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,584.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,012.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,630.98
|
| Rate for Payer: Priority Health Medicare |
$1,584.49
|
| Rate for Payer: Priority Health Narrow Network |
$2,630.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1,584.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,961.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,584.49
|
| Rate for Payer: UHC Exchange |
$2,961.74
|
| Rate for Payer: UHC Medicaid |
$1,012.82
|
| Rate for Payer: UHCCP DNSP |
$1,584.49
|
| Rate for Payer: UHCCP Medicaid |
$1,012.82
|
|
|
PR VALVULOPLASTY MITRAL VALVE W/CARDIAC BYPASS
|
Professional
|
Both
|
$8,768.00
|
|
|
Service Code
|
HCPCS 33425
|
| Min. Negotiated Rate |
$1,626.04 |
| Max. Negotiated Rate |
$6,576.00 |
| Rate for Payer: Aetna Commercial |
$3,425.09
|
| Rate for Payer: Aetna Medicare |
$2,556.04
|
| Rate for Payer: BCBS Complete |
$1,707.34
|
| Rate for Payer: BCBS MAPPO |
$2,556.04
|
| Rate for Payer: BCN Commercial |
$4,002.28
|
| Rate for Payer: BCN Medicare Advantage |
$2,556.04
|
| Rate for Payer: Cash Price |
$7,014.40
|
| Rate for Payer: Cash Price |
$7,014.40
|
| Rate for Payer: Cofinity Commercial |
$3,680.70
|
| Rate for Payer: Cofinity Commercial |
$3,425.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,556.04
|
| Rate for Payer: Healthscope Commercial |
$3,067.25
|
| Rate for Payer: Healthscope Whirlpool |
$3,067.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,683.84
|
| Rate for Payer: Meridian Medicaid |
$1,707.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,811.64
|
| Rate for Payer: Nomi Health Commercial |
$3,067.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,576.00
|
| Rate for Payer: PACE SWMI |
$2,556.04
|
| Rate for Payer: PHP Medicare Advantage |
$2,556.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,626.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,303.94
|
| Rate for Payer: Priority Health Medicare |
$2,556.04
|
| Rate for Payer: Priority Health Narrow Network |
$4,303.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,556.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,875.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,556.04
|
| Rate for Payer: UHC Exchange |
$4,875.10
|
| Rate for Payer: UHC Medicaid |
$1,626.04
|
| Rate for Payer: UHCCP DNSP |
$2,556.04
|
| Rate for Payer: UHCCP Medicaid |
$1,626.04
|
|
|
PR VALVULOPLASTY TRICUSPID VALVE W/O RING INSERTION
|
Professional
|
Both
|
$7,770.00
|
|
|
Service Code
|
HCPCS 33463
|
| Min. Negotiated Rate |
$1,827.33 |
| Max. Negotiated Rate |
$5,827.50 |
| Rate for Payer: Aetna Commercial |
$3,853.45
|
| Rate for Payer: Aetna Medicare |
$2,875.71
|
| Rate for Payer: BCBS Complete |
$1,918.70
|
| Rate for Payer: BCBS MAPPO |
$2,875.71
|
| Rate for Payer: BCN Commercial |
$4,508.72
|
| Rate for Payer: BCN Medicare Advantage |
$2,875.71
|
| Rate for Payer: Cash Price |
$6,216.00
|
| Rate for Payer: Cash Price |
$6,216.00
|
| Rate for Payer: Cofinity Commercial |
$4,141.02
|
| Rate for Payer: Cofinity Commercial |
$3,853.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,875.71
|
| Rate for Payer: Healthscope Commercial |
$3,450.85
|
| Rate for Payer: Healthscope Whirlpool |
$3,450.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,019.50
|
| Rate for Payer: Meridian Medicaid |
$1,918.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,163.28
|
| Rate for Payer: Nomi Health Commercial |
$3,450.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,827.50
|
| Rate for Payer: PACE SWMI |
$2,875.71
|
| Rate for Payer: PHP Medicare Advantage |
$2,875.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,827.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,848.55
|
| Rate for Payer: Priority Health Medicare |
$2,875.71
|
| Rate for Payer: Priority Health Narrow Network |
$4,848.55
|
| Rate for Payer: Railroad Medicare Medicare |
$2,875.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,511.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,875.71
|
| Rate for Payer: UHC Exchange |
$5,511.61
|
| Rate for Payer: UHC Medicaid |
$1,827.33
|
| Rate for Payer: UHCCP DNSP |
$2,875.71
|
| Rate for Payer: UHCCP Medicaid |
$1,827.33
|
|
|
PR VALVULOPLASTY TRICUSPID VALVE W/RING INSERTION
|
Professional
|
Both
|
$5,269.00
|
|
|
Service Code
|
HCPCS 33464
|
| Min. Negotiated Rate |
$1,449.25 |
| Max. Negotiated Rate |
$4,354.26 |
| Rate for Payer: Aetna Commercial |
$3,050.56
|
| Rate for Payer: Aetna Medicare |
$2,276.54
|
| Rate for Payer: BCBS Complete |
$1,521.71
|
| Rate for Payer: BCBS MAPPO |
$2,276.54
|
| Rate for Payer: BCN Commercial |
$3,578.49
|
| Rate for Payer: BCN Medicare Advantage |
$2,276.54
|
| Rate for Payer: Cash Price |
$4,215.20
|
| Rate for Payer: Cash Price |
$4,215.20
|
| Rate for Payer: Cofinity Commercial |
$3,050.56
|
| Rate for Payer: Cofinity Commercial |
$3,278.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,276.54
|
| Rate for Payer: Healthscope Commercial |
$2,731.85
|
| Rate for Payer: Healthscope Whirlpool |
$2,731.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,390.37
|
| Rate for Payer: Meridian Medicaid |
$1,521.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,504.19
|
| Rate for Payer: Nomi Health Commercial |
$2,731.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,951.75
|
| Rate for Payer: PACE SWMI |
$2,276.54
|
| Rate for Payer: PHP Medicare Advantage |
$2,276.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,449.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,848.22
|
| Rate for Payer: Priority Health Medicare |
$2,276.54
|
| Rate for Payer: Priority Health Narrow Network |
$3,848.22
|
| Rate for Payer: Railroad Medicare Medicare |
$2,276.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,354.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,276.54
|
| Rate for Payer: UHC Exchange |
$4,354.26
|
| Rate for Payer: UHC Medicaid |
$1,449.25
|
| Rate for Payer: UHCCP DNSP |
$2,276.54
|
| Rate for Payer: UHCCP Medicaid |
$1,449.25
|
|
|
PR VANTAS IMPLANT
|
Professional
|
Both
|
$3,503.00
|
|
|
Service Code
|
HCPCS J9225
|
| Min. Negotiated Rate |
$2,627.25 |
| Max. Negotiated Rate |
$5,264.35 |
| Rate for Payer: Aetna Commercial |
$4,678.90
|
| Rate for Payer: BCBS Trust/PPO |
$5,264.35
|
| Rate for Payer: BCN Commercial |
$5,264.35
|
| Rate for Payer: Cash Price |
$2,802.40
|
| Rate for Payer: Cash Price |
$2,802.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,627.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,873.86
|
| Rate for Payer: UHC Exchange |
$4,873.86
|
|
|
PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
HCPCS 90716
|
| Min. Negotiated Rate |
$166.50 |
| Max. Negotiated Rate |
$192.12 |
| Rate for Payer: Aetna Commercial |
$177.68
|
| Rate for Payer: BCBS Trust/PPO |
$192.12
|
| Rate for Payer: BCN Commercial |
$179.94
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$192.12
|
| Rate for Payer: UHC Exchange |
$192.12
|
|
|
PR VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX
|
Professional
|
Both
|
$1,375.00
|
|
|
Service Code
|
HCPCS 37500
|
| Min. Negotiated Rate |
$550.00 |
| Max. Negotiated Rate |
$1,031.25 |
| Rate for Payer: Aetna Commercial |
$846.67
|
| Rate for Payer: BCBS Complete |
$550.00
|
| Rate for Payer: BCN Commercial |
$927.74
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,031.25
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I
|
Professional
|
Both
|
$1,560.00
|
|
|
Service Code
|
HCPCS 37242
|
| Min. Negotiated Rate |
$263.69 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Aetna Commercial |
$557.43
|
| Rate for Payer: Aetna Medicare |
$415.99
|
| Rate for Payer: BCBS Complete |
$276.87
|
| Rate for Payer: BCBS MAPPO |
$415.99
|
| Rate for Payer: BCN Commercial |
$691.69
|
| Rate for Payer: BCN Medicare Advantage |
$415.99
|
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: Cofinity Commercial |
$599.03
|
| Rate for Payer: Cofinity Commercial |
$557.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.99
|
| Rate for Payer: Healthscope Commercial |
$499.19
|
| Rate for Payer: Healthscope Whirlpool |
$499.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.79
|
| Rate for Payer: Meridian Medicaid |
$276.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$457.59
|
| Rate for Payer: Nomi Health Commercial |
$499.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,170.00
|
| Rate for Payer: PACE SWMI |
$415.99
|
| Rate for Payer: PHP Medicare Advantage |
$415.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$263.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$743.83
|
| Rate for Payer: Priority Health Medicare |
$415.99
|
| Rate for Payer: Priority Health Narrow Network |
$743.83
|
| Rate for Payer: Railroad Medicare Medicare |
$415.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$855.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$415.99
|
| Rate for Payer: UHC Exchange |
$855.28
|
| Rate for Payer: UHC Medicaid |
$263.69
|
| Rate for Payer: UHCCP DNSP |
$415.99
|
| Rate for Payer: UHCCP Medicaid |
$263.69
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE
|
Professional
|
Both
|
$9,993.00
|
|
|
Service Code
|
HCPCS 37244
|
| Min. Negotiated Rate |
$361.04 |
| Max. Negotiated Rate |
$7,494.75 |
| Rate for Payer: Aetna Commercial |
$759.65
|
| Rate for Payer: Aetna Medicare |
$566.90
|
| Rate for Payer: BCBS Complete |
$379.09
|
| Rate for Payer: BCBS MAPPO |
$566.90
|
| Rate for Payer: BCN Commercial |
$960.61
|
| Rate for Payer: BCN Medicare Advantage |
$566.90
|
| Rate for Payer: Cash Price |
$7,994.40
|
| Rate for Payer: Cash Price |
$7,994.40
|
| Rate for Payer: Cofinity Commercial |
$816.34
|
| Rate for Payer: Cofinity Commercial |
$759.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$566.90
|
| Rate for Payer: Healthscope Commercial |
$680.28
|
| Rate for Payer: Healthscope Whirlpool |
$680.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$595.25
|
| Rate for Payer: Meridian Medicaid |
$379.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$623.59
|
| Rate for Payer: Nomi Health Commercial |
$680.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,494.75
|
| Rate for Payer: PACE SWMI |
$566.90
|
| Rate for Payer: PHP Medicare Advantage |
$566.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$361.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,033.00
|
| Rate for Payer: Priority Health Medicare |
$566.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,033.00
|
| Rate for Payer: Railroad Medicare Medicare |
$566.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,188.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$566.90
|
| Rate for Payer: UHC Exchange |
$1,188.92
|
| Rate for Payer: UHC Medicaid |
$361.04
|
| Rate for Payer: UHCCP DNSP |
$566.90
|
| Rate for Payer: UHCCP Medicaid |
$361.04
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I
|
Professional
|
Both
|
$712.00
|
|
|
Service Code
|
HCPCS 37241
|
| Min. Negotiated Rate |
$236.64 |
| Max. Negotiated Rate |
$783.49 |
| Rate for Payer: Aetna Commercial |
$499.49
|
| Rate for Payer: Aetna Medicare |
$372.75
|
| Rate for Payer: BCBS Complete |
$248.47
|
| Rate for Payer: BCBS MAPPO |
$372.75
|
| Rate for Payer: BCN Commercial |
$621.48
|
| Rate for Payer: BCN Medicare Advantage |
$372.75
|
| Rate for Payer: Cash Price |
$569.60
|
| Rate for Payer: Cash Price |
$569.60
|
| Rate for Payer: Cofinity Commercial |
$536.76
|
| Rate for Payer: Cofinity Commercial |
$499.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$372.75
|
| Rate for Payer: Healthscope Commercial |
$447.30
|
| Rate for Payer: Healthscope Whirlpool |
$447.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.39
|
| Rate for Payer: Meridian Medicaid |
$248.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.02
|
| Rate for Payer: Nomi Health Commercial |
$447.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$534.00
|
| Rate for Payer: PACE SWMI |
$372.75
|
| Rate for Payer: PHP Medicare Advantage |
$372.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$236.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$668.32
|
| Rate for Payer: Priority Health Medicare |
$372.75
|
| Rate for Payer: Priority Health Narrow Network |
$668.32
|
| Rate for Payer: Railroad Medicare Medicare |
$372.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$783.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$372.75
|
| Rate for Payer: UHC Exchange |
$783.49
|
| Rate for Payer: UHC Medicaid |
$236.64
|
| Rate for Payer: UHCCP DNSP |
$372.75
|
| Rate for Payer: UHCCP Medicaid |
$236.64
|
|
|
PR VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT
|
Professional
|
Both
|
$1,254.00
|
|
|
Service Code
|
HCPCS 37243
|
| Min. Negotiated Rate |
$307.57 |
| Max. Negotiated Rate |
$1,004.71 |
| Rate for Payer: Aetna Commercial |
$647.22
|
| Rate for Payer: Aetna Medicare |
$483.00
|
| Rate for Payer: BCBS Complete |
$322.95
|
| Rate for Payer: BCBS MAPPO |
$483.00
|
| Rate for Payer: BCN Commercial |
$816.69
|
| Rate for Payer: BCN Medicare Advantage |
$483.00
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cofinity Commercial |
$695.52
|
| Rate for Payer: Cofinity Commercial |
$647.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$483.00
|
| Rate for Payer: Healthscope Commercial |
$579.60
|
| Rate for Payer: Healthscope Whirlpool |
$579.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$507.15
|
| Rate for Payer: Meridian Medicaid |
$322.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$531.30
|
| Rate for Payer: Nomi Health Commercial |
$579.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$940.50
|
| Rate for Payer: PACE SWMI |
$483.00
|
| Rate for Payer: PHP Medicare Advantage |
$483.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$307.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$878.24
|
| Rate for Payer: Priority Health Medicare |
$483.00
|
| Rate for Payer: Priority Health Narrow Network |
$878.24
|
| Rate for Payer: Railroad Medicare Medicare |
$483.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,004.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$483.00
|
| Rate for Payer: UHC Exchange |
$1,004.71
|
| Rate for Payer: UHC Medicaid |
$307.57
|
| Rate for Payer: UHCCP DNSP |
$483.00
|
| Rate for Payer: UHCCP Medicaid |
$307.57
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 55250
|
| Min. Negotiated Rate |
$139.09 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna Commercial |
$283.70
|
| Rate for Payer: Aetna Medicare |
$211.72
|
| Rate for Payer: BCBS Complete |
$146.04
|
| Rate for Payer: BCBS MAPPO |
$211.72
|
| Rate for Payer: BCN Commercial |
$274.50
|
| Rate for Payer: BCN Medicare Advantage |
$211.72
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cofinity Commercial |
$304.88
|
| Rate for Payer: Cofinity Commercial |
$283.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.72
|
| Rate for Payer: Healthscope Commercial |
$254.06
|
| Rate for Payer: Healthscope Whirlpool |
$254.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.31
|
| Rate for Payer: Meridian Medicaid |
$146.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$232.89
|
| Rate for Payer: Nomi Health Commercial |
$254.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$690.00
|
| Rate for Payer: PACE SWMI |
$211.72
|
| Rate for Payer: PHP Medicare Advantage |
$211.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$379.18
|
| Rate for Payer: Priority Health Medicare |
$211.72
|
| Rate for Payer: Priority Health Narrow Network |
$379.18
|
| Rate for Payer: Railroad Medicare Medicare |
$211.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.72
|
| Rate for Payer: UHC Exchange |
$396.39
|
| Rate for Payer: UHC Medicaid |
$139.09
|
| Rate for Payer: UHCCP DNSP |
$211.72
|
| Rate for Payer: UHCCP Medicaid |
$139.09
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
55250
|
| Min. Negotiated Rate |
$139.09 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna Commercial |
$283.70
|
| Rate for Payer: Aetna Medicare |
$211.72
|
| Rate for Payer: BCBS Complete |
$146.04
|
| Rate for Payer: BCBS MAPPO |
$211.72
|
| Rate for Payer: BCN Commercial |
$274.50
|
| Rate for Payer: BCN Medicare Advantage |
$211.72
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cofinity Commercial |
$304.88
|
| Rate for Payer: Cofinity Commercial |
$283.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.72
|
| Rate for Payer: Healthscope Commercial |
$254.06
|
| Rate for Payer: Healthscope Whirlpool |
$254.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.31
|
| Rate for Payer: Meridian Medicaid |
$146.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$232.89
|
| Rate for Payer: Nomi Health Commercial |
$254.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$690.00
|
| Rate for Payer: PACE SWMI |
$211.72
|
| Rate for Payer: PHP Medicare Advantage |
$211.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$379.18
|
| Rate for Payer: Priority Health Medicare |
$211.72
|
| Rate for Payer: Priority Health Narrow Network |
$379.18
|
| Rate for Payer: Railroad Medicare Medicare |
$211.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.72
|
| Rate for Payer: UHC Exchange |
$396.39
|
| Rate for Payer: UHC Medicaid |
$139.09
|
| Rate for Payer: UHCCP DNSP |
$211.72
|
| Rate for Payer: UHCCP Medicaid |
$139.09
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
IP
|
$920.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
55250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: Aetna Commercial |
$828.00
|
| Rate for Payer: ASR ASR |
$892.40
|
| Rate for Payer: BCBS Trust/PPO |
$755.50
|
| Rate for Payer: BCN Commercial |
$755.50
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cofinity Commercial |
$864.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.00
|
| Rate for Payer: Healthscope Commercial |
$892.40
|
| Rate for Payer: Healthscope Whirlpool |
$920.00
|
| Rate for Payer: Mclaren Commercial |
$828.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.00
|
| Rate for Payer: Nomi Health Commercial |
$754.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$690.00
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
OP
|
$920.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
55250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$644.92 |
| Max. Negotiated Rate |
$2,603.59 |
| Rate for Payer: Aetna Commercial |
$828.00
|
| Rate for Payer: Aetna Medicare |
$2,082.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: ASR ASR |
$892.40
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$758.54
|
| Rate for Payer: BCN Commercial |
$758.54
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cofinity Commercial |
$864.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$892.40
|
| Rate for Payer: Healthscope Whirlpool |
$920.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,082.87
|
| Rate for Payer: Mclaren Commercial |
$828.00
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$1,143.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.00
|
| Rate for Payer: Nomi Health Commercial |
$754.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$690.00
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$2,291.16
|
| Rate for Payer: PHP Medicaid |
$1,116.42
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$806.10
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Narrow Network |
$644.92
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP DNSP |
$2,082.87
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
