|
PR VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX
|
Professional
|
Both
|
$1,335.00
|
|
|
Service Code
|
HCPCS 37500
|
| Min. Negotiated Rate |
$534.00 |
| Max. Negotiated Rate |
$873.94 |
| Rate for Payer: Aetna Commercial |
$813.25
|
| Rate for Payer: Aetna Medicare |
$606.90
|
| Rate for Payer: BCBS Complete |
$534.00
|
| Rate for Payer: BCBS MAPPO |
$606.90
|
| Rate for Payer: BCN Medicare Advantage |
$606.90
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cofinity Commercial |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$813.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$606.90
|
| Rate for Payer: Healthscope Commercial |
$728.28
|
| Rate for Payer: Healthscope Whirlpool |
$728.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$637.25
|
| Rate for Payer: Nomi Health Commercial |
$728.28
|
| Rate for Payer: PACE SWMI |
$606.90
|
| Rate for Payer: PHP Medicare Advantage |
$606.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$867.75
|
| Rate for Payer: Priority Health Medicare |
$606.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$606.90
|
| Rate for Payer: UHC Medicare Advantage |
$606.90
|
| Rate for Payer: UHCCP DNSP |
$606.90
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I
|
Professional
|
Both
|
$1,515.00
|
|
|
Service Code
|
HCPCS 37242
|
| Min. Negotiated Rate |
$450.23 |
| Max. Negotiated Rate |
$984.75 |
| Rate for Payer: Aetna Commercial |
$603.31
|
| Rate for Payer: Aetna Medicare |
$450.23
|
| Rate for Payer: BCBS Complete |
$606.00
|
| Rate for Payer: BCBS MAPPO |
$450.23
|
| Rate for Payer: BCN Medicare Advantage |
$450.23
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cofinity Commercial |
$648.33
|
| Rate for Payer: Cofinity Commercial |
$603.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$450.23
|
| Rate for Payer: Healthscope Commercial |
$540.28
|
| Rate for Payer: Healthscope Whirlpool |
$540.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$472.74
|
| Rate for Payer: Nomi Health Commercial |
$540.28
|
| Rate for Payer: PACE SWMI |
$450.23
|
| Rate for Payer: PHP Medicare Advantage |
$450.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.75
|
| Rate for Payer: Priority Health Medicare |
$450.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$450.23
|
| Rate for Payer: UHC Medicare Advantage |
$450.23
|
| Rate for Payer: UHCCP DNSP |
$450.23
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE
|
Professional
|
Both
|
$9,702.00
|
|
|
Service Code
|
HCPCS 37244
|
| Min. Negotiated Rate |
$620.47 |
| Max. Negotiated Rate |
$6,306.30 |
| Rate for Payer: Aetna Commercial |
$831.43
|
| Rate for Payer: Aetna Medicare |
$620.47
|
| Rate for Payer: BCBS Complete |
$3,880.80
|
| Rate for Payer: BCBS MAPPO |
$620.47
|
| Rate for Payer: BCN Medicare Advantage |
$620.47
|
| Rate for Payer: Cash Price |
$7,761.60
|
| Rate for Payer: Cash Price |
$7,761.60
|
| Rate for Payer: Cofinity Commercial |
$893.48
|
| Rate for Payer: Cofinity Commercial |
$831.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$620.47
|
| Rate for Payer: Healthscope Commercial |
$744.56
|
| Rate for Payer: Healthscope Whirlpool |
$744.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$651.49
|
| Rate for Payer: Nomi Health Commercial |
$744.56
|
| Rate for Payer: PACE SWMI |
$620.47
|
| Rate for Payer: PHP Medicare Advantage |
$620.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,306.30
|
| Rate for Payer: Priority Health Medicare |
$620.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$620.47
|
| Rate for Payer: UHC Medicare Advantage |
$620.47
|
| Rate for Payer: UHCCP DNSP |
$620.47
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 37241
|
| Min. Negotiated Rate |
$276.40 |
| Max. Negotiated Rate |
$581.21 |
| Rate for Payer: Aetna Commercial |
$540.85
|
| Rate for Payer: Aetna Medicare |
$403.62
|
| Rate for Payer: BCBS Complete |
$276.40
|
| Rate for Payer: BCBS MAPPO |
$403.62
|
| Rate for Payer: BCN Medicare Advantage |
$403.62
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cofinity Commercial |
$581.21
|
| Rate for Payer: Cofinity Commercial |
$540.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.62
|
| Rate for Payer: Healthscope Commercial |
$484.34
|
| Rate for Payer: Healthscope Whirlpool |
$484.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$423.80
|
| Rate for Payer: Nomi Health Commercial |
$484.34
|
| Rate for Payer: PACE SWMI |
$403.62
|
| Rate for Payer: PHP Medicare Advantage |
$403.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.15
|
| Rate for Payer: Priority Health Medicare |
$403.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.62
|
| Rate for Payer: UHC Medicare Advantage |
$403.62
|
| Rate for Payer: UHCCP DNSP |
$403.62
|
|
|
PR VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT
|
Professional
|
Both
|
$1,217.00
|
|
|
Service Code
|
HCPCS 37243
|
| Min. Negotiated Rate |
$486.80 |
| Max. Negotiated Rate |
$791.05 |
| Rate for Payer: Aetna Commercial |
$706.96
|
| Rate for Payer: Aetna Medicare |
$527.58
|
| Rate for Payer: BCBS Complete |
$486.80
|
| Rate for Payer: BCBS MAPPO |
$527.58
|
| Rate for Payer: BCN Medicare Advantage |
$527.58
|
| Rate for Payer: Cash Price |
$973.60
|
| Rate for Payer: Cash Price |
$973.60
|
| Rate for Payer: Cofinity Commercial |
$759.72
|
| Rate for Payer: Cofinity Commercial |
$706.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$527.58
|
| Rate for Payer: Healthscope Commercial |
$633.10
|
| Rate for Payer: Healthscope Whirlpool |
$633.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.96
|
| Rate for Payer: Nomi Health Commercial |
$633.10
|
| Rate for Payer: PACE SWMI |
$527.58
|
| Rate for Payer: PHP Medicare Advantage |
$527.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.05
|
| Rate for Payer: Priority Health Medicare |
$527.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$527.58
|
| Rate for Payer: UHC Medicare Advantage |
$527.58
|
| Rate for Payer: UHCCP DNSP |
$527.58
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
IP
|
$893.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
55250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$580.45 |
| Max. Negotiated Rate |
$893.00 |
| Rate for Payer: Aetna Commercial |
$803.70
|
| Rate for Payer: ASR ASR |
$866.21
|
| Rate for Payer: ASR Commercial |
$866.21
|
| Rate for Payer: BCBS Trust/PPO |
$727.71
|
| Rate for Payer: BCN Commercial |
$692.34
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Commercial |
$839.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$714.40
|
| Rate for Payer: Healthscope Commercial |
$893.00
|
| Rate for Payer: Healthscope Whirlpool |
$866.21
|
| Rate for Payer: Mclaren Commercial |
$803.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.05
|
| Rate for Payer: Nomi Health Commercial |
$732.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$785.84
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
HCPCS 55250
|
| Min. Negotiated Rate |
$219.07 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna Commercial |
$293.55
|
| Rate for Payer: Aetna Medicare |
$219.07
|
| Rate for Payer: BCBS Complete |
$357.20
|
| Rate for Payer: BCBS MAPPO |
$219.07
|
| Rate for Payer: BCN Medicare Advantage |
$219.07
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Commercial |
$315.46
|
| Rate for Payer: Cofinity Commercial |
$293.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.07
|
| Rate for Payer: Healthscope Commercial |
$262.88
|
| Rate for Payer: Healthscope Whirlpool |
$262.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.02
|
| Rate for Payer: Nomi Health Commercial |
$262.88
|
| Rate for Payer: PACE SWMI |
$219.07
|
| Rate for Payer: PHP Medicare Advantage |
$219.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.45
|
| Rate for Payer: Priority Health Medicare |
$219.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.07
|
| Rate for Payer: UHC Medicare Advantage |
$219.07
|
| Rate for Payer: UHCCP DNSP |
$219.07
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
OP
|
$893.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
55250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$580.45 |
| Max. Negotiated Rate |
$3,096.70 |
| Rate for Payer: Aetna Commercial |
$803.70
|
| Rate for Payer: Aetna Medicare |
$1,997.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: ASR ASR |
$866.21
|
| Rate for Payer: ASR Commercial |
$866.21
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCBS Trust/PPO |
$731.28
|
| Rate for Payer: BCN Commercial |
$692.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Commercial |
$839.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$714.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$893.00
|
| Rate for Payer: Healthscope Whirlpool |
$866.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,997.87
|
| Rate for Payer: Mclaren Commercial |
$803.70
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.05
|
| Rate for Payer: Nomi Health Commercial |
$732.26
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$2,197.66
|
| Rate for Payer: PHP Medicaid |
$1,070.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$782.45
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health Narrow Network |
$625.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$785.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,096.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP DNSP |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
55250
|
| Min. Negotiated Rate |
$219.07 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna Commercial |
$293.55
|
| Rate for Payer: Aetna Medicare |
$219.07
|
| Rate for Payer: BCBS Complete |
$357.20
|
| Rate for Payer: BCBS MAPPO |
$219.07
|
| Rate for Payer: BCN Medicare Advantage |
$219.07
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Commercial |
$315.46
|
| Rate for Payer: Cofinity Commercial |
$293.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.07
|
| Rate for Payer: Healthscope Commercial |
$262.88
|
| Rate for Payer: Healthscope Whirlpool |
$262.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.02
|
| Rate for Payer: Nomi Health Commercial |
$262.88
|
| Rate for Payer: PACE SWMI |
$219.07
|
| Rate for Payer: PHP Medicare Advantage |
$219.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.45
|
| Rate for Payer: Priority Health Medicare |
$219.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.07
|
| Rate for Payer: UHC Medicare Advantage |
$219.07
|
| Rate for Payer: UHCCP DNSP |
$219.07
|
|
|
PR VASOVASOSTOMY VASOVASORRHAPHY
|
Professional
|
Both
|
$952.00
|
|
|
Service Code
|
HCPCS 55400
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$688.71 |
| Rate for Payer: Aetna Commercial |
$640.88
|
| Rate for Payer: Aetna Medicare |
$478.27
|
| Rate for Payer: BCBS Complete |
$380.80
|
| Rate for Payer: BCBS MAPPO |
$478.27
|
| Rate for Payer: BCN Medicare Advantage |
$478.27
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cofinity Commercial |
$688.71
|
| Rate for Payer: Cofinity Commercial |
$640.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$478.27
|
| Rate for Payer: Healthscope Commercial |
$573.92
|
| Rate for Payer: Healthscope Whirlpool |
$573.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$502.18
|
| Rate for Payer: Nomi Health Commercial |
$573.92
|
| Rate for Payer: PACE SWMI |
$478.27
|
| Rate for Payer: PHP Medicare Advantage |
$478.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.80
|
| Rate for Payer: Priority Health Medicare |
$478.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$478.27
|
| Rate for Payer: UHC Medicare Advantage |
$478.27
|
| Rate for Payer: UHCCP DNSP |
$478.27
|
|
|
PR VCRPEC LAT XTRCAVITARY DCMPRN THRC/LMBR EA SEG
|
Professional
|
Both
|
$2,770.00
|
|
|
Service Code
|
HCPCS 63103
|
| Min. Negotiated Rate |
$286.24 |
| Max. Negotiated Rate |
$1,800.50 |
| Rate for Payer: Aetna Commercial |
$383.56
|
| Rate for Payer: Aetna Medicare |
$286.24
|
| Rate for Payer: BCBS Complete |
$1,108.00
|
| Rate for Payer: BCBS MAPPO |
$286.24
|
| Rate for Payer: BCN Medicare Advantage |
$286.24
|
| Rate for Payer: Cash Price |
$2,216.00
|
| Rate for Payer: Cash Price |
$2,216.00
|
| Rate for Payer: Cofinity Commercial |
$412.19
|
| Rate for Payer: Cofinity Commercial |
$383.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$286.24
|
| Rate for Payer: Healthscope Commercial |
$343.49
|
| Rate for Payer: Healthscope Whirlpool |
$343.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$300.55
|
| Rate for Payer: Nomi Health Commercial |
$343.49
|
| Rate for Payer: PACE SWMI |
$286.24
|
| Rate for Payer: PHP Medicare Advantage |
$286.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,800.50
|
| Rate for Payer: Priority Health Medicare |
$286.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$286.24
|
| Rate for Payer: UHC Medicare Advantage |
$286.24
|
| Rate for Payer: UHCCP DNSP |
$286.24
|
|
|
PR VCRPEC LES 1 SGM XDRL CERVICAL
|
Professional
|
Both
|
$4,705.00
|
|
|
Service Code
|
HCPCS 63300
|
| Min. Negotiated Rate |
$1,791.63 |
| Max. Negotiated Rate |
$3,058.25 |
| Rate for Payer: Aetna Commercial |
$2,400.78
|
| Rate for Payer: Aetna Medicare |
$1,791.63
|
| Rate for Payer: BCBS Complete |
$1,882.00
|
| Rate for Payer: BCBS MAPPO |
$1,791.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,791.63
|
| Rate for Payer: Cash Price |
$3,764.00
|
| Rate for Payer: Cash Price |
$3,764.00
|
| Rate for Payer: Cofinity Commercial |
$2,579.95
|
| Rate for Payer: Cofinity Commercial |
$2,400.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,791.63
|
| Rate for Payer: Healthscope Commercial |
$2,149.96
|
| Rate for Payer: Healthscope Whirlpool |
$2,149.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.21
|
| Rate for Payer: Nomi Health Commercial |
$2,149.96
|
| Rate for Payer: PACE SWMI |
$1,791.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,791.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,058.25
|
| Rate for Payer: Priority Health Medicare |
$1,791.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,791.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,791.63
|
| Rate for Payer: UHCCP DNSP |
$1,791.63
|
|
|
PR VCRPEC LES 1 SGM XDRL THORACIC TTHRC
|
Professional
|
Both
|
$4,655.00
|
|
|
Service Code
|
HCPCS 63301
|
| Min. Negotiated Rate |
$1,862.00 |
| Max. Negotiated Rate |
$3,025.75 |
| Rate for Payer: Aetna Commercial |
$2,807.22
|
| Rate for Payer: Aetna Medicare |
$2,094.94
|
| Rate for Payer: BCBS Complete |
$1,862.00
|
| Rate for Payer: BCBS MAPPO |
$2,094.94
|
| Rate for Payer: BCN Medicare Advantage |
$2,094.94
|
| Rate for Payer: Cash Price |
$3,724.00
|
| Rate for Payer: Cash Price |
$3,724.00
|
| Rate for Payer: Cofinity Commercial |
$3,016.71
|
| Rate for Payer: Cofinity Commercial |
$2,807.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,094.94
|
| Rate for Payer: Healthscope Commercial |
$2,513.93
|
| Rate for Payer: Healthscope Whirlpool |
$2,513.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,199.69
|
| Rate for Payer: Nomi Health Commercial |
$2,513.93
|
| Rate for Payer: PACE SWMI |
$2,094.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,094.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,025.75
|
| Rate for Payer: Priority Health Medicare |
$2,094.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,094.94
|
| Rate for Payer: UHC Medicare Advantage |
$2,094.94
|
| Rate for Payer: UHCCP DNSP |
$2,094.94
|
|
|
PR VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR 1 SEG
|
Professional
|
Both
|
$9,223.00
|
|
|
Service Code
|
HCPCS 63087
|
| Min. Negotiated Rate |
$2,378.90 |
| Max. Negotiated Rate |
$5,994.95 |
| Rate for Payer: Aetna Commercial |
$3,187.73
|
| Rate for Payer: Aetna Medicare |
$2,378.90
|
| Rate for Payer: BCBS Complete |
$3,689.20
|
| Rate for Payer: BCBS MAPPO |
$2,378.90
|
| Rate for Payer: BCN Medicare Advantage |
$2,378.90
|
| Rate for Payer: Cash Price |
$7,378.40
|
| Rate for Payer: Cash Price |
$7,378.40
|
| Rate for Payer: Cofinity Commercial |
$3,425.62
|
| Rate for Payer: Cofinity Commercial |
$3,187.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,378.90
|
| Rate for Payer: Healthscope Commercial |
$2,854.68
|
| Rate for Payer: Healthscope Whirlpool |
$2,854.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,497.84
|
| Rate for Payer: Nomi Health Commercial |
$2,854.68
|
| Rate for Payer: PACE SWMI |
$2,378.90
|
| Rate for Payer: PHP Medicare Advantage |
$2,378.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,994.95
|
| Rate for Payer: Priority Health Medicare |
$2,378.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,378.90
|
| Rate for Payer: UHC Medicare Advantage |
$2,378.90
|
| Rate for Payer: UHCCP DNSP |
$2,378.90
|
|
|
PR VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR EA SEG
|
Professional
|
Both
|
$3,162.00
|
|
|
Service Code
|
HCPCS 63088
|
| Min. Negotiated Rate |
$252.89 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Commercial |
$338.87
|
| Rate for Payer: Aetna Medicare |
$252.89
|
| Rate for Payer: BCBS Complete |
$1,264.80
|
| Rate for Payer: BCBS MAPPO |
$252.89
|
| Rate for Payer: BCN Medicare Advantage |
$252.89
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Cofinity Commercial |
$364.16
|
| Rate for Payer: Cofinity Commercial |
$338.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$252.89
|
| Rate for Payer: Healthscope Commercial |
$303.47
|
| Rate for Payer: Healthscope Whirlpool |
$303.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$265.53
|
| Rate for Payer: Nomi Health Commercial |
$303.47
|
| Rate for Payer: PACE SWMI |
$252.89
|
| Rate for Payer: PHP Medicare Advantage |
$252.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,055.30
|
| Rate for Payer: Priority Health Medicare |
$252.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$252.89
|
| Rate for Payer: UHC Medicare Advantage |
$252.89
|
| Rate for Payer: UHCCP DNSP |
$252.89
|
|
|
PR VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC 1 SEG
|
Professional
|
Both
|
$7,274.00
|
|
|
Service Code
|
HCPCS 63090
|
| Min. Negotiated Rate |
$1,891.99 |
| Max. Negotiated Rate |
$4,728.10 |
| Rate for Payer: Aetna Commercial |
$2,535.27
|
| Rate for Payer: Aetna Medicare |
$1,891.99
|
| Rate for Payer: BCBS Complete |
$2,909.60
|
| Rate for Payer: BCBS MAPPO |
$1,891.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,891.99
|
| Rate for Payer: Cash Price |
$5,819.20
|
| Rate for Payer: Cash Price |
$5,819.20
|
| Rate for Payer: Cofinity Commercial |
$2,724.47
|
| Rate for Payer: Cofinity Commercial |
$2,535.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,891.99
|
| Rate for Payer: Healthscope Commercial |
$2,270.39
|
| Rate for Payer: Healthscope Whirlpool |
$2,270.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,986.59
|
| Rate for Payer: Nomi Health Commercial |
$2,270.39
|
| Rate for Payer: PACE SWMI |
$1,891.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,891.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,728.10
|
| Rate for Payer: Priority Health Medicare |
$1,891.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,891.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,891.99
|
| Rate for Payer: UHCCP DNSP |
$1,891.99
|
|
|
PR VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC EA SEG
|
Professional
|
Both
|
$2,478.00
|
|
|
Service Code
|
HCPCS 63091
|
| Min. Negotiated Rate |
$169.83 |
| Max. Negotiated Rate |
$1,610.70 |
| Rate for Payer: Aetna Commercial |
$227.57
|
| Rate for Payer: Aetna Medicare |
$169.83
|
| Rate for Payer: BCBS Complete |
$991.20
|
| Rate for Payer: BCBS MAPPO |
$169.83
|
| Rate for Payer: BCN Medicare Advantage |
$169.83
|
| Rate for Payer: Cash Price |
$1,982.40
|
| Rate for Payer: Cash Price |
$1,982.40
|
| Rate for Payer: Cofinity Commercial |
$244.56
|
| Rate for Payer: Cofinity Commercial |
$227.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.83
|
| Rate for Payer: Healthscope Commercial |
$203.80
|
| Rate for Payer: Healthscope Whirlpool |
$203.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.32
|
| Rate for Payer: Nomi Health Commercial |
$203.80
|
| Rate for Payer: PACE SWMI |
$169.83
|
| Rate for Payer: PHP Medicare Advantage |
$169.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,610.70
|
| Rate for Payer: Priority Health Medicare |
$169.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.83
|
| Rate for Payer: UHC Medicare Advantage |
$169.83
|
| Rate for Payer: UHCCP DNSP |
$169.83
|
|
|
PR VEIN SCREEN
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 00515
|
|
Hospital Revenue Code
|
990
|
| 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 VEN CATHJ SLCTV ORGAN BLD SAMPLING
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 36500
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$250.89 |
| Rate for Payer: Aetna Commercial |
$233.47
|
| Rate for Payer: Aetna Medicare |
$174.23
|
| Rate for Payer: BCBS Complete |
$139.60
|
| Rate for Payer: BCBS MAPPO |
$174.23
|
| Rate for Payer: BCN Medicare Advantage |
$174.23
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cofinity Commercial |
$250.89
|
| Rate for Payer: Cofinity Commercial |
$233.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.23
|
| Rate for Payer: Healthscope Commercial |
$209.08
|
| Rate for Payer: Healthscope Whirlpool |
$209.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.94
|
| Rate for Payer: Nomi Health Commercial |
$209.08
|
| Rate for Payer: PACE SWMI |
$174.23
|
| Rate for Payer: PHP Medicare Advantage |
$174.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.85
|
| Rate for Payer: Priority Health Medicare |
$174.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.23
|
| Rate for Payer: UHC Medicare Advantage |
$174.23
|
| Rate for Payer: UHCCP DNSP |
$174.23
|
|
|
PR VENOUS ANASTOMOSIS OPEN SPLENORENAL PROXIMAL
|
Professional
|
Both
|
$4,367.00
|
|
|
Service Code
|
HCPCS 37180
|
| Min. Negotiated Rate |
$1,746.80 |
| Max. Negotiated Rate |
$2,971.21 |
| Rate for Payer: Aetna Commercial |
$2,764.88
|
| Rate for Payer: Aetna Medicare |
$2,063.34
|
| Rate for Payer: BCBS Complete |
$1,746.80
|
| Rate for Payer: BCBS MAPPO |
$2,063.34
|
| Rate for Payer: BCN Medicare Advantage |
$2,063.34
|
| Rate for Payer: Cash Price |
$3,493.60
|
| Rate for Payer: Cash Price |
$3,493.60
|
| Rate for Payer: Cofinity Commercial |
$2,971.21
|
| Rate for Payer: Cofinity Commercial |
$2,764.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,063.34
|
| Rate for Payer: Healthscope Commercial |
$2,476.01
|
| Rate for Payer: Healthscope Whirlpool |
$2,476.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,166.51
|
| Rate for Payer: Nomi Health Commercial |
$2,476.01
|
| Rate for Payer: PACE SWMI |
$2,063.34
|
| Rate for Payer: PHP Medicare Advantage |
$2,063.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,838.55
|
| Rate for Payer: Priority Health Medicare |
$2,063.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,063.34
|
| Rate for Payer: UHC Medicare Advantage |
$2,063.34
|
| Rate for Payer: UHCCP DNSP |
$2,063.34
|
|
|
PR VENTILATING TUBE RMVL REQUIRING GENERAL ANES
|
Professional
|
Both
|
$613.00
|
|
|
Service Code
|
HCPCS 69424
|
| Min. Negotiated Rate |
$57.81 |
| Max. Negotiated Rate |
$398.45 |
| Rate for Payer: Aetna Commercial |
$77.47
|
| Rate for Payer: Aetna Medicare |
$57.81
|
| Rate for Payer: BCBS Complete |
$245.20
|
| Rate for Payer: BCBS MAPPO |
$57.81
|
| Rate for Payer: BCN Medicare Advantage |
$57.81
|
| Rate for Payer: Cash Price |
$490.40
|
| Rate for Payer: Cash Price |
$490.40
|
| Rate for Payer: Cofinity Commercial |
$83.25
|
| Rate for Payer: Cofinity Commercial |
$77.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.81
|
| Rate for Payer: Healthscope Commercial |
$69.37
|
| Rate for Payer: Healthscope Whirlpool |
$69.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.70
|
| Rate for Payer: Nomi Health Commercial |
$69.37
|
| Rate for Payer: PACE SWMI |
$57.81
|
| Rate for Payer: PHP Medicare Advantage |
$57.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.45
|
| Rate for Payer: Priority Health Medicare |
$57.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.81
|
| Rate for Payer: UHC Medicare Advantage |
$57.81
|
| Rate for Payer: UHCCP DNSP |
$57.81
|
|
|
PR VENTILATION ASSIST & MGMT INPATIENT 1ST DAY
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 94002
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$125.63 |
| Rate for Payer: Aetna Commercial |
$116.90
|
| Rate for Payer: Aetna Medicare |
$87.24
|
| Rate for Payer: BCBS Complete |
$68.80
|
| Rate for Payer: BCBS MAPPO |
$87.24
|
| Rate for Payer: BCN Medicare Advantage |
$87.24
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$125.63
|
| Rate for Payer: Cofinity Commercial |
$116.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.24
|
| Rate for Payer: Healthscope Commercial |
$104.69
|
| Rate for Payer: Healthscope Whirlpool |
$104.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.60
|
| Rate for Payer: Nomi Health Commercial |
$104.69
|
| Rate for Payer: PACE SWMI |
$87.24
|
| Rate for Payer: PHP Medicare Advantage |
$87.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.80
|
| Rate for Payer: Priority Health Medicare |
$87.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.24
|
| Rate for Payer: UHC Medicare Advantage |
$87.24
|
| Rate for Payer: UHCCP DNSP |
$87.24
|
|
|
PR VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 94003
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$88.19 |
| Rate for Payer: Aetna Commercial |
$82.06
|
| Rate for Payer: Aetna Medicare |
$61.24
|
| Rate for Payer: BCBS Complete |
$50.40
|
| Rate for Payer: BCBS MAPPO |
$61.24
|
| Rate for Payer: BCN Medicare Advantage |
$61.24
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$88.19
|
| Rate for Payer: Cofinity Commercial |
$82.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.24
|
| Rate for Payer: Healthscope Commercial |
$73.49
|
| Rate for Payer: Healthscope Whirlpool |
$73.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.30
|
| Rate for Payer: Nomi Health Commercial |
$73.49
|
| Rate for Payer: PACE SWMI |
$61.24
|
| Rate for Payer: PHP Medicare Advantage |
$61.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health Medicare |
$61.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.24
|
| Rate for Payer: UHC Medicare Advantage |
$61.24
|
| Rate for Payer: UHCCP DNSP |
$61.24
|
|
|
PR VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/INJ
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 61026
|
| Min. Negotiated Rate |
$109.88 |
| Max. Negotiated Rate |
$365.95 |
| Rate for Payer: Aetna Commercial |
$147.24
|
| Rate for Payer: Aetna Medicare |
$109.88
|
| Rate for Payer: BCBS Complete |
$225.20
|
| Rate for Payer: BCBS MAPPO |
$109.88
|
| Rate for Payer: BCN Medicare Advantage |
$109.88
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cofinity Commercial |
$158.23
|
| Rate for Payer: Cofinity Commercial |
$147.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.88
|
| Rate for Payer: Healthscope Commercial |
$131.86
|
| Rate for Payer: Healthscope Whirlpool |
$131.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.37
|
| Rate for Payer: Nomi Health Commercial |
$131.86
|
| Rate for Payer: PACE SWMI |
$109.88
|
| Rate for Payer: PHP Medicare Advantage |
$109.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.95
|
| Rate for Payer: Priority Health Medicare |
$109.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.88
|
| Rate for Payer: UHC Medicare Advantage |
$109.88
|
| Rate for Payer: UHCCP DNSP |
$109.88
|
|
|
PR VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX
|
Professional
|
Both
|
$458.00
|
|
|
Service Code
|
HCPCS 61020
|
| Min. Negotiated Rate |
$103.89 |
| Max. Negotiated Rate |
$297.70 |
| Rate for Payer: Aetna Commercial |
$139.21
|
| Rate for Payer: Aetna Medicare |
$103.89
|
| Rate for Payer: BCBS Complete |
$183.20
|
| Rate for Payer: BCBS MAPPO |
$103.89
|
| Rate for Payer: BCN Medicare Advantage |
$103.89
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cofinity Commercial |
$149.60
|
| Rate for Payer: Cofinity Commercial |
$139.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.89
|
| Rate for Payer: Healthscope Commercial |
$124.67
|
| Rate for Payer: Healthscope Whirlpool |
$124.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.08
|
| Rate for Payer: Nomi Health Commercial |
$124.67
|
| Rate for Payer: PACE SWMI |
$103.89
|
| Rate for Payer: PHP Medicare Advantage |
$103.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.70
|
| Rate for Payer: Priority Health Medicare |
$103.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.89
|
| Rate for Payer: UHC Medicare Advantage |
$103.89
|
| Rate for Payer: UHCCP DNSP |
$103.89
|
|
