|
PR TCAT MITRAL VALVE REPAIR INITIAL PROSTHESIS
|
Professional
|
Both
|
$3,759.00
|
|
|
Service Code
|
HCPCS 33418
|
| Min. Negotiated Rate |
$1,503.60 |
| Max. Negotiated Rate |
$2,469.02 |
| Rate for Payer: Aetna Commercial |
$2,297.56
|
| Rate for Payer: Aetna Medicare |
$1,714.60
|
| Rate for Payer: BCBS Complete |
$1,503.60
|
| Rate for Payer: BCBS MAPPO |
$1,714.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,714.60
|
| Rate for Payer: Cash Price |
$3,007.20
|
| Rate for Payer: Cash Price |
$3,007.20
|
| Rate for Payer: Cofinity Commercial |
$2,469.02
|
| Rate for Payer: Cofinity Commercial |
$2,297.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,714.60
|
| Rate for Payer: Healthscope Commercial |
$2,057.52
|
| Rate for Payer: Healthscope Whirlpool |
$2,057.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,800.33
|
| Rate for Payer: Nomi Health Commercial |
$2,057.52
|
| Rate for Payer: PACE SWMI |
$1,714.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,714.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,443.35
|
| Rate for Payer: Priority Health Medicare |
$1,714.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,714.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,714.60
|
| Rate for Payer: UHCCP DNSP |
$1,714.60
|
|
|
PR TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS
|
Professional
|
Both
|
$4,624.00
|
|
|
Service Code
|
HCPCS 61624
|
| Min. Negotiated Rate |
$1,142.22 |
| Max. Negotiated Rate |
$3,005.60 |
| Rate for Payer: Aetna Commercial |
$1,530.57
|
| Rate for Payer: Aetna Medicare |
$1,142.22
|
| Rate for Payer: BCBS Complete |
$1,849.60
|
| Rate for Payer: BCBS MAPPO |
$1,142.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.22
|
| Rate for Payer: Cash Price |
$3,699.20
|
| Rate for Payer: Cash Price |
$3,699.20
|
| Rate for Payer: Cofinity Commercial |
$1,644.80
|
| Rate for Payer: Cofinity Commercial |
$1,530.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.22
|
| Rate for Payer: Healthscope Commercial |
$1,370.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,370.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.33
|
| Rate for Payer: Nomi Health Commercial |
$1,370.66
|
| Rate for Payer: PACE SWMI |
$1,142.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,005.60
|
| Rate for Payer: Priority Health Medicare |
$1,142.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,142.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,142.22
|
| Rate for Payer: UHCCP DNSP |
$1,142.22
|
|
|
PR TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS
|
Professional
|
Both
|
$1,849.00
|
|
|
Service Code
|
HCPCS 61626
|
| Min. Negotiated Rate |
$739.60 |
| Max. Negotiated Rate |
$1,270.37 |
| Rate for Payer: Aetna Commercial |
$1,182.15
|
| Rate for Payer: Aetna Medicare |
$882.20
|
| Rate for Payer: BCBS Complete |
$739.60
|
| Rate for Payer: BCBS MAPPO |
$882.20
|
| Rate for Payer: BCN Medicare Advantage |
$882.20
|
| Rate for Payer: Cash Price |
$1,479.20
|
| Rate for Payer: Cash Price |
$1,479.20
|
| Rate for Payer: Cofinity Commercial |
$1,270.37
|
| Rate for Payer: Cofinity Commercial |
$1,182.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$882.20
|
| Rate for Payer: Healthscope Commercial |
$1,058.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,058.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$926.31
|
| Rate for Payer: Nomi Health Commercial |
$1,058.64
|
| Rate for Payer: PACE SWMI |
$882.20
|
| Rate for Payer: PHP Medicare Advantage |
$882.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,201.85
|
| Rate for Payer: Priority Health Medicare |
$882.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$882.20
|
| Rate for Payer: UHC Medicare Advantage |
$882.20
|
| Rate for Payer: UHCCP DNSP |
$882.20
|
|
|
PR TCAT PLMT IV STENT ICRA W/BALO ANGIOP IF PFRMD
|
Professional
|
Both
|
$6,793.00
|
|
|
Service Code
|
HCPCS 61635
|
| Min. Negotiated Rate |
$1,458.27 |
| Max. Negotiated Rate |
$4,415.45 |
| Rate for Payer: Aetna Commercial |
$1,954.08
|
| Rate for Payer: Aetna Medicare |
$1,458.27
|
| Rate for Payer: BCBS Complete |
$2,717.20
|
| Rate for Payer: BCBS MAPPO |
$1,458.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,458.27
|
| Rate for Payer: Cash Price |
$5,434.40
|
| Rate for Payer: Cash Price |
$5,434.40
|
| Rate for Payer: Cofinity Commercial |
$2,099.91
|
| Rate for Payer: Cofinity Commercial |
$1,954.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,458.27
|
| Rate for Payer: Healthscope Commercial |
$1,749.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,749.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,531.18
|
| Rate for Payer: Nomi Health Commercial |
$1,749.92
|
| Rate for Payer: PACE SWMI |
$1,458.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,458.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,415.45
|
| Rate for Payer: Priority Health Medicare |
$1,458.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,458.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,458.27
|
| Rate for Payer: UHCCP DNSP |
$1,458.27
|
|
|
PR TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL
|
Professional
|
Both
|
$9,873.00
|
|
|
Service Code
|
HCPCS 0075T
|
| Min. Negotiated Rate |
$3,949.20 |
| Max. Negotiated Rate |
$6,417.45 |
| Rate for Payer: Aetna Medicare |
$4,936.50
|
| Rate for Payer: BCBS Complete |
$3,949.20
|
| Rate for Payer: Cash Price |
$7,898.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,417.45
|
|
|
PR TCAT REMOVAL PERM LEADLESS PM RIGHT VENTR W/IMG
|
Professional
|
Both
|
$1,729.00
|
|
|
Service Code
|
HCPCS 33275
|
| Min. Negotiated Rate |
$481.08 |
| Max. Negotiated Rate |
$1,123.85 |
| Rate for Payer: Aetna Commercial |
$644.65
|
| Rate for Payer: Aetna Medicare |
$481.08
|
| Rate for Payer: BCBS Complete |
$691.60
|
| Rate for Payer: BCBS MAPPO |
$481.08
|
| Rate for Payer: BCN Medicare Advantage |
$481.08
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cofinity Commercial |
$692.76
|
| Rate for Payer: Cofinity Commercial |
$644.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$481.08
|
| Rate for Payer: Healthscope Commercial |
$577.30
|
| Rate for Payer: Healthscope Whirlpool |
$577.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$505.13
|
| Rate for Payer: Nomi Health Commercial |
$577.30
|
| Rate for Payer: PACE SWMI |
$481.08
|
| Rate for Payer: PHP Medicare Advantage |
$481.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,123.85
|
| Rate for Payer: Priority Health Medicare |
$481.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$481.08
|
| Rate for Payer: UHC Medicare Advantage |
$481.08
|
| Rate for Payer: UHCCP DNSP |
$481.08
|
|
|
PR TCD STD ICR ART VEN-ARTL SHNT DETCJ IV MBUBB NJX
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 93893
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$438.75 |
| Rate for Payer: Aetna Commercial |
$400.83
|
| Rate for Payer: Aetna Medicare |
$299.13
|
| Rate for Payer: BCBS Complete |
$270.00
|
| Rate for Payer: BCBS MAPPO |
$299.13
|
| Rate for Payer: BCN Medicare Advantage |
$299.13
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$430.75
|
| Rate for Payer: Cofinity Commercial |
$400.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.13
|
| Rate for Payer: Healthscope Commercial |
$358.96
|
| Rate for Payer: Healthscope Whirlpool |
$358.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.09
|
| Rate for Payer: Nomi Health Commercial |
$358.96
|
| Rate for Payer: PACE SWMI |
$299.13
|
| Rate for Payer: PHP Medicare Advantage |
$299.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.75
|
| Rate for Payer: Priority Health Medicare |
$299.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$299.13
|
| Rate for Payer: UHC Medicare Advantage |
$299.13
|
| Rate for Payer: UHCCP DNSP |
$299.13
|
|
|
PR TDAP VACCINE 7 YRS/> IM
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 90715
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$57.33 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Medicare |
$39.81
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS MAPPO |
$39.81
|
| Rate for Payer: BCN Medicare Advantage |
$39.81
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$57.33
|
| Rate for Payer: Cofinity Commercial |
$53.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.81
|
| Rate for Payer: Healthscope Commercial |
$47.77
|
| Rate for Payer: Healthscope Whirlpool |
$47.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.80
|
| Rate for Payer: Nomi Health Commercial |
$47.77
|
| Rate for Payer: PACE SWMI |
$39.81
|
| Rate for Payer: PHP Medicare Advantage |
$39.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health Medicare |
$39.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.81
|
| Rate for Payer: UHC Medicare Advantage |
$39.81
|
| Rate for Payer: UHCCP DNSP |
$39.81
|
|
|
PR TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN
|
Professional
|
Both
|
$2,633.00
|
|
|
Service Code
|
HCPCS 25310
|
| Min. Negotiated Rate |
$687.05 |
| Max. Negotiated Rate |
$1,711.45 |
| Rate for Payer: Aetna Commercial |
$920.65
|
| Rate for Payer: Aetna Medicare |
$687.05
|
| Rate for Payer: BCBS Complete |
$1,053.20
|
| Rate for Payer: BCBS MAPPO |
$687.05
|
| Rate for Payer: BCN Medicare Advantage |
$687.05
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cofinity Commercial |
$989.35
|
| Rate for Payer: Cofinity Commercial |
$920.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$687.05
|
| Rate for Payer: Healthscope Commercial |
$824.46
|
| Rate for Payer: Healthscope Whirlpool |
$824.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$721.40
|
| Rate for Payer: Nomi Health Commercial |
$824.46
|
| Rate for Payer: PACE SWMI |
$687.05
|
| Rate for Payer: PHP Medicare Advantage |
$687.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,711.45
|
| Rate for Payer: Priority Health Medicare |
$687.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$687.05
|
| Rate for Payer: UHC Medicare Advantage |
$687.05
|
| Rate for Payer: UHCCP DNSP |
$687.05
|
|
|
PR TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1/TDN GR
|
Professional
|
Both
|
$1,583.00
|
|
|
Service Code
|
HCPCS 25312
|
| Min. Negotiated Rate |
$633.20 |
| Max. Negotiated Rate |
$1,028.95 |
| Rate for Payer: Aetna Commercial |
$931.21
|
| Rate for Payer: Aetna Medicare |
$694.93
|
| Rate for Payer: BCBS Complete |
$633.20
|
| Rate for Payer: BCBS MAPPO |
$694.93
|
| Rate for Payer: BCN Medicare Advantage |
$694.93
|
| Rate for Payer: Cash Price |
$1,266.40
|
| Rate for Payer: Cash Price |
$1,266.40
|
| Rate for Payer: Cofinity Commercial |
$931.21
|
| Rate for Payer: Cofinity Commercial |
$1,000.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.93
|
| Rate for Payer: Healthscope Commercial |
$833.92
|
| Rate for Payer: Healthscope Whirlpool |
$833.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.68
|
| Rate for Payer: Nomi Health Commercial |
$833.92
|
| Rate for Payer: PACE SWMI |
$694.93
|
| Rate for Payer: PHP Medicare Advantage |
$694.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,028.95
|
| Rate for Payer: Priority Health Medicare |
$694.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$694.93
|
| Rate for Payer: UHC Medicare Advantage |
$694.93
|
| Rate for Payer: UHCCP DNSP |
$694.93
|
|
|
PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 90714
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$53.81 |
| Rate for Payer: Aetna Commercial |
$50.08
|
| Rate for Payer: Aetna Medicare |
$37.37
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$37.37
|
| Rate for Payer: BCN Medicare Advantage |
$37.37
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$53.81
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.37
|
| Rate for Payer: Healthscope Commercial |
$44.84
|
| Rate for Payer: Healthscope Whirlpool |
$44.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.24
|
| Rate for Payer: Nomi Health Commercial |
$44.84
|
| Rate for Payer: PACE SWMI |
$37.37
|
| Rate for Payer: PHP Medicare Advantage |
$37.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health Medicare |
$37.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.37
|
| Rate for Payer: UHC Medicare Advantage |
$37.37
|
| Rate for Payer: UHCCP DNSP |
$37.37
|
|
|
PR TEAEC W/GRAFT EA ADDL TIBIAL/PERONEAL ART
|
Professional
|
Both
|
$942.00
|
|
|
Service Code
|
HCPCS 35306
|
| Min. Negotiated Rate |
$376.80 |
| Max. Negotiated Rate |
$618.24 |
| Rate for Payer: Aetna Commercial |
$575.30
|
| Rate for Payer: Aetna Medicare |
$429.33
|
| Rate for Payer: BCBS Complete |
$376.80
|
| Rate for Payer: BCBS MAPPO |
$429.33
|
| Rate for Payer: BCN Medicare Advantage |
$429.33
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cofinity Commercial |
$618.24
|
| Rate for Payer: Cofinity Commercial |
$575.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$429.33
|
| Rate for Payer: Healthscope Commercial |
$515.20
|
| Rate for Payer: Healthscope Whirlpool |
$515.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$450.80
|
| Rate for Payer: Nomi Health Commercial |
$515.20
|
| Rate for Payer: PACE SWMI |
$429.33
|
| Rate for Payer: PHP Medicare Advantage |
$429.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.30
|
| Rate for Payer: Priority Health Medicare |
$429.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$429.33
|
| Rate for Payer: UHC Medicare Advantage |
$429.33
|
| Rate for Payer: UHCCP DNSP |
$429.33
|
|
|
PR TEAEC W/GRAFT POPLITEAL ARTERY
|
Professional
|
Both
|
$2,387.00
|
|
|
Service Code
|
HCPCS 35303
|
| Min. Negotiated Rate |
$954.80 |
| Max. Negotiated Rate |
$1,693.43 |
| Rate for Payer: Aetna Commercial |
$1,575.83
|
| Rate for Payer: Aetna Medicare |
$1,175.99
|
| Rate for Payer: BCBS Complete |
$954.80
|
| Rate for Payer: BCBS MAPPO |
$1,175.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,175.99
|
| Rate for Payer: Cash Price |
$1,909.60
|
| Rate for Payer: Cash Price |
$1,909.60
|
| Rate for Payer: Cofinity Commercial |
$1,693.43
|
| Rate for Payer: Cofinity Commercial |
$1,575.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,175.99
|
| Rate for Payer: Healthscope Commercial |
$1,411.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,411.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,234.79
|
| Rate for Payer: Nomi Health Commercial |
$1,411.19
|
| Rate for Payer: PACE SWMI |
$1,175.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,175.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,551.55
|
| Rate for Payer: Priority Health Medicare |
$1,175.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,175.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,175.99
|
| Rate for Payer: UHCCP DNSP |
$1,175.99
|
|
|
PR TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY
|
Professional
|
Both
|
$2,192.00
|
|
|
Service Code
|
HCPCS 35302
|
| Min. Negotiated Rate |
$876.80 |
| Max. Negotiated Rate |
$1,540.32 |
| Rate for Payer: Aetna Commercial |
$1,433.36
|
| Rate for Payer: Aetna Medicare |
$1,069.67
|
| Rate for Payer: BCBS Complete |
$876.80
|
| Rate for Payer: BCBS MAPPO |
$1,069.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,069.67
|
| Rate for Payer: Cash Price |
$1,753.60
|
| Rate for Payer: Cash Price |
$1,753.60
|
| Rate for Payer: Cofinity Commercial |
$1,540.32
|
| Rate for Payer: Cofinity Commercial |
$1,433.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,069.67
|
| Rate for Payer: Healthscope Commercial |
$1,283.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,283.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,123.15
|
| Rate for Payer: Nomi Health Commercial |
$1,283.60
|
| Rate for Payer: PACE SWMI |
$1,069.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,069.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,424.80
|
| Rate for Payer: Priority Health Medicare |
$1,069.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,069.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,069.67
|
| Rate for Payer: UHCCP DNSP |
$1,069.67
|
|
|
PR TEAEC W/GRAFT TIBIAL/PERONEAL ART 1ST VESSEL
|
Professional
|
Both
|
$2,411.00
|
|
|
Service Code
|
HCPCS 35305
|
| Min. Negotiated Rate |
$964.40 |
| Max. Negotiated Rate |
$1,689.55 |
| Rate for Payer: Aetna Commercial |
$1,572.22
|
| Rate for Payer: Aetna Medicare |
$1,173.30
|
| Rate for Payer: BCBS Complete |
$964.40
|
| Rate for Payer: BCBS MAPPO |
$1,173.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,173.30
|
| Rate for Payer: Cash Price |
$1,928.80
|
| Rate for Payer: Cash Price |
$1,928.80
|
| Rate for Payer: Cofinity Commercial |
$1,689.55
|
| Rate for Payer: Cofinity Commercial |
$1,572.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,173.30
|
| Rate for Payer: Healthscope Commercial |
$1,407.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,407.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,231.96
|
| Rate for Payer: Nomi Health Commercial |
$1,407.96
|
| Rate for Payer: PACE SWMI |
$1,173.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,173.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,567.15
|
| Rate for Payer: Priority Health Medicare |
$1,173.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,173.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,173.30
|
| Rate for Payer: UHCCP DNSP |
$1,173.30
|
|
|
PR TEAEC W/GRAFT TIBIOPERONEAL TRUNK ARTERY
|
Professional
|
Both
|
$2,509.00
|
|
|
Service Code
|
HCPCS 35304
|
| Min. Negotiated Rate |
$1,003.60 |
| Max. Negotiated Rate |
$1,760.82 |
| Rate for Payer: Aetna Commercial |
$1,638.54
|
| Rate for Payer: Aetna Medicare |
$1,222.79
|
| Rate for Payer: BCBS Complete |
$1,003.60
|
| Rate for Payer: BCBS MAPPO |
$1,222.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,222.79
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cofinity Commercial |
$1,760.82
|
| Rate for Payer: Cofinity Commercial |
$1,638.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,222.79
|
| Rate for Payer: Healthscope Commercial |
$1,467.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,467.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,283.93
|
| Rate for Payer: Nomi Health Commercial |
$1,467.35
|
| Rate for Payer: PACE SWMI |
$1,222.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,222.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.85
|
| Rate for Payer: Priority Health Medicare |
$1,222.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,222.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,222.79
|
| Rate for Payer: UHCCP DNSP |
$1,222.79
|
|
|
PR TEAEC W/PATCH GRF CAROTID VERTB SUBCLAV NECK INC
|
Professional
|
Both
|
$3,698.00
|
|
|
Service Code
|
HCPCS 35301
|
| Min. Negotiated Rate |
$1,081.80 |
| Max. Negotiated Rate |
$2,403.70 |
| Rate for Payer: Aetna Commercial |
$1,449.61
|
| Rate for Payer: Aetna Medicare |
$1,081.80
|
| Rate for Payer: BCBS Complete |
$1,479.20
|
| Rate for Payer: BCBS MAPPO |
$1,081.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,081.80
|
| Rate for Payer: Cash Price |
$2,958.40
|
| Rate for Payer: Cash Price |
$2,958.40
|
| Rate for Payer: Cofinity Commercial |
$1,557.79
|
| Rate for Payer: Cofinity Commercial |
$1,449.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,081.80
|
| Rate for Payer: Healthscope Commercial |
$1,298.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,298.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,135.89
|
| Rate for Payer: Nomi Health Commercial |
$1,298.16
|
| Rate for Payer: PACE SWMI |
$1,081.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,081.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,403.70
|
| Rate for Payer: Priority Health Medicare |
$1,081.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,081.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.80
|
| Rate for Payer: UHCCP DNSP |
$1,081.80
|
|
|
PR TEAEC W/WO PATCH GRAFT ABDOMINAL AORTA
|
Professional
|
Both
|
$4,734.00
|
|
|
Service Code
|
HCPCS 35331
|
| Min. Negotiated Rate |
$1,387.99 |
| Max. Negotiated Rate |
$3,077.10 |
| Rate for Payer: Aetna Commercial |
$1,859.91
|
| Rate for Payer: Aetna Medicare |
$1,387.99
|
| Rate for Payer: BCBS Complete |
$1,893.60
|
| Rate for Payer: BCBS MAPPO |
$1,387.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,387.99
|
| Rate for Payer: Cash Price |
$3,787.20
|
| Rate for Payer: Cash Price |
$3,787.20
|
| Rate for Payer: Cofinity Commercial |
$1,998.71
|
| Rate for Payer: Cofinity Commercial |
$1,859.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,387.99
|
| Rate for Payer: Healthscope Commercial |
$1,665.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,665.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,457.39
|
| Rate for Payer: Nomi Health Commercial |
$1,665.59
|
| Rate for Payer: PACE SWMI |
$1,387.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,387.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,077.10
|
| Rate for Payer: Priority Health Medicare |
$1,387.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,387.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,387.99
|
| Rate for Payer: UHCCP DNSP |
$1,387.99
|
|
|
PR TEAEC W/WO PATCH GRAFT COMBINED AORTOILIOFEMORAL
|
Professional
|
Both
|
$3,341.00
|
|
|
Service Code
|
HCPCS 35363
|
| Min. Negotiated Rate |
$1,336.40 |
| Max. Negotiated Rate |
$2,254.42 |
| Rate for Payer: Aetna Commercial |
$2,097.86
|
| Rate for Payer: Aetna Medicare |
$1,565.57
|
| Rate for Payer: BCBS Complete |
$1,336.40
|
| Rate for Payer: BCBS MAPPO |
$1,565.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,565.57
|
| Rate for Payer: Cash Price |
$2,672.80
|
| Rate for Payer: Cash Price |
$2,672.80
|
| Rate for Payer: Cofinity Commercial |
$2,254.42
|
| Rate for Payer: Cofinity Commercial |
$2,097.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,565.57
|
| Rate for Payer: Healthscope Commercial |
$1,878.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,878.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,643.85
|
| Rate for Payer: Nomi Health Commercial |
$1,878.68
|
| Rate for Payer: PACE SWMI |
$1,565.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,565.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,171.65
|
| Rate for Payer: Priority Health Medicare |
$1,565.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,565.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,565.57
|
| Rate for Payer: UHCCP DNSP |
$1,565.57
|
|
|
PR TEAEC W/WO PATCH GRAFT COMMON FEMORAL
|
Professional
|
Both
|
$1,751.00
|
|
|
Service Code
|
HCPCS 35371
|
| Min. Negotiated Rate |
$700.40 |
| Max. Negotiated Rate |
$1,138.15 |
| Rate for Payer: Aetna Commercial |
$1,045.09
|
| Rate for Payer: Aetna Medicare |
$779.92
|
| Rate for Payer: BCBS Complete |
$700.40
|
| Rate for Payer: BCBS MAPPO |
$779.92
|
| Rate for Payer: BCN Medicare Advantage |
$779.92
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cofinity Commercial |
$1,123.08
|
| Rate for Payer: Cofinity Commercial |
$1,045.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$779.92
|
| Rate for Payer: Healthscope Commercial |
$935.90
|
| Rate for Payer: Healthscope Whirlpool |
$935.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$818.92
|
| Rate for Payer: Nomi Health Commercial |
$935.90
|
| Rate for Payer: PACE SWMI |
$779.92
|
| Rate for Payer: PHP Medicare Advantage |
$779.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,138.15
|
| Rate for Payer: Priority Health Medicare |
$779.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$779.92
|
| Rate for Payer: UHC Medicare Advantage |
$779.92
|
| Rate for Payer: UHCCP DNSP |
$779.92
|
|
|
PR TEAEC W/WO PATCH GRAFT DEEP PROFUNDA FEMORAL
|
Professional
|
Both
|
$3,773.00
|
|
|
Service Code
|
HCPCS 35372
|
| Min. Negotiated Rate |
$934.36 |
| Max. Negotiated Rate |
$2,452.45 |
| Rate for Payer: Aetna Commercial |
$1,252.04
|
| Rate for Payer: Aetna Medicare |
$934.36
|
| Rate for Payer: BCBS Complete |
$1,509.20
|
| Rate for Payer: BCBS MAPPO |
$934.36
|
| Rate for Payer: BCN Medicare Advantage |
$934.36
|
| Rate for Payer: Cash Price |
$3,018.40
|
| Rate for Payer: Cash Price |
$3,018.40
|
| Rate for Payer: Cofinity Commercial |
$1,345.48
|
| Rate for Payer: Cofinity Commercial |
$1,252.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$934.36
|
| Rate for Payer: Healthscope Commercial |
$1,121.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,121.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$981.08
|
| Rate for Payer: Nomi Health Commercial |
$1,121.23
|
| Rate for Payer: PACE SWMI |
$934.36
|
| Rate for Payer: PHP Medicare Advantage |
$934.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,452.45
|
| Rate for Payer: Priority Health Medicare |
$934.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$934.36
|
| Rate for Payer: UHC Medicare Advantage |
$934.36
|
| Rate for Payer: UHCCP DNSP |
$934.36
|
|
|
PR TEAEC W/WO PATCH GRAFT ILIAC
|
Professional
|
Both
|
$2,528.00
|
|
|
Service Code
|
HCPCS 35351
|
| Min. Negotiated Rate |
$1,011.20 |
| Max. Negotiated Rate |
$1,777.84 |
| Rate for Payer: Aetna Commercial |
$1,654.38
|
| Rate for Payer: Aetna Medicare |
$1,234.61
|
| Rate for Payer: BCBS Complete |
$1,011.20
|
| Rate for Payer: BCBS MAPPO |
$1,234.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,234.61
|
| Rate for Payer: Cash Price |
$2,022.40
|
| Rate for Payer: Cash Price |
$2,022.40
|
| Rate for Payer: Cofinity Commercial |
$1,777.84
|
| Rate for Payer: Cofinity Commercial |
$1,654.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,234.61
|
| Rate for Payer: Healthscope Commercial |
$1,481.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,481.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,296.34
|
| Rate for Payer: Nomi Health Commercial |
$1,481.53
|
| Rate for Payer: PACE SWMI |
$1,234.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,234.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,643.20
|
| Rate for Payer: Priority Health Medicare |
$1,234.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,234.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,234.61
|
| Rate for Payer: UHCCP DNSP |
$1,234.61
|
|
|
PR TEAEC W/WO PATCH GRAFT ILIOFEMORAL
|
Professional
|
Both
|
$2,053.00
|
|
|
Service Code
|
HCPCS 35355
|
| Min. Negotiated Rate |
$821.20 |
| Max. Negotiated Rate |
$1,421.38 |
| Rate for Payer: Aetna Commercial |
$1,322.67
|
| Rate for Payer: Aetna Medicare |
$987.07
|
| Rate for Payer: BCBS Complete |
$821.20
|
| Rate for Payer: BCBS MAPPO |
$987.07
|
| Rate for Payer: BCN Medicare Advantage |
$987.07
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cofinity Commercial |
$1,421.38
|
| Rate for Payer: Cofinity Commercial |
$1,322.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$987.07
|
| Rate for Payer: Healthscope Commercial |
$1,184.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,184.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,036.42
|
| Rate for Payer: Nomi Health Commercial |
$1,184.48
|
| Rate for Payer: PACE SWMI |
$987.07
|
| Rate for Payer: PHP Medicare Advantage |
$987.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.45
|
| Rate for Payer: Priority Health Medicare |
$987.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$987.07
|
| Rate for Payer: UHC Medicare Advantage |
$987.07
|
| Rate for Payer: UHCCP DNSP |
$987.07
|
|
|
PR TEAEC W/WO PATCH GRAFT MESENTERIC CELIAC/RENAL
|
Professional
|
Both
|
$4,508.00
|
|
|
Service Code
|
HCPCS 35341
|
| Min. Negotiated Rate |
$1,319.77 |
| Max. Negotiated Rate |
$2,930.20 |
| Rate for Payer: Aetna Commercial |
$1,768.49
|
| Rate for Payer: Aetna Medicare |
$1,319.77
|
| Rate for Payer: BCBS Complete |
$1,803.20
|
| Rate for Payer: BCBS MAPPO |
$1,319.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,319.77
|
| Rate for Payer: Cash Price |
$3,606.40
|
| Rate for Payer: Cash Price |
$3,606.40
|
| Rate for Payer: Cofinity Commercial |
$1,900.47
|
| Rate for Payer: Cofinity Commercial |
$1,768.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,319.77
|
| Rate for Payer: Healthscope Commercial |
$1,583.72
|
| Rate for Payer: Healthscope Whirlpool |
$1,583.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,385.76
|
| Rate for Payer: Nomi Health Commercial |
$1,583.72
|
| Rate for Payer: PACE SWMI |
$1,319.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,319.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,930.20
|
| Rate for Payer: Priority Health Medicare |
$1,319.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,319.77
|
| Rate for Payer: UHC Medicare Advantage |
$1,319.77
|
| Rate for Payer: UHCCP DNSP |
$1,319.77
|
|
|
PR TEAEC W/WO PATCH GRF AXILLARY-BRACHIAL
|
Professional
|
Both
|
$3,855.00
|
|
|
Service Code
|
HCPCS 35321
|
| Min. Negotiated Rate |
$869.25 |
| Max. Negotiated Rate |
$2,505.75 |
| Rate for Payer: Aetna Commercial |
$1,164.80
|
| Rate for Payer: Aetna Medicare |
$869.25
|
| Rate for Payer: BCBS Complete |
$1,542.00
|
| Rate for Payer: BCBS MAPPO |
$869.25
|
| Rate for Payer: BCN Medicare Advantage |
$869.25
|
| Rate for Payer: Cash Price |
$3,084.00
|
| Rate for Payer: Cash Price |
$3,084.00
|
| Rate for Payer: Cofinity Commercial |
$1,251.72
|
| Rate for Payer: Cofinity Commercial |
$1,164.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$869.25
|
| Rate for Payer: Healthscope Commercial |
$1,043.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,043.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$912.71
|
| Rate for Payer: Nomi Health Commercial |
$1,043.10
|
| Rate for Payer: PACE SWMI |
$869.25
|
| Rate for Payer: PHP Medicare Advantage |
$869.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,505.75
|
| Rate for Payer: Priority Health Medicare |
$869.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$869.25
|
| Rate for Payer: UHC Medicare Advantage |
$869.25
|
| Rate for Payer: UHCCP DNSP |
$869.25
|
|
