|
PR PRQ SKEL FIXJ HUMRL CNDYLR FX MEDIAL/LAT W/MANJ
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 24582
|
| Min. Negotiated Rate |
$788.60 |
| Max. Negotiated Rate |
$1,543.75 |
| Rate for Payer: Aetna Commercial |
$1,056.72
|
| Rate for Payer: Aetna Medicare |
$820.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,135.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,056.72
|
| Rate for Payer: BCBS Complete |
$950.00
|
| Rate for Payer: BCBS MAPPO |
$788.60
|
| Rate for Payer: BCN Medicare Advantage |
$788.60
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cofinity Commercial |
$1,135.58
|
| Rate for Payer: Cofinity Commercial |
$1,056.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$788.60
|
| Rate for Payer: Healthscope Commercial |
$1,261.76
|
| Rate for Payer: Healthscope Commercial |
$1,458.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$828.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,543.75
|
| Rate for Payer: Nomi Health Commercial |
$946.32
|
| Rate for Payer: PACE SWMI |
$788.60
|
| Rate for Payer: PHP Medicare Advantage |
$788.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,543.75
|
| Rate for Payer: Priority Health Medicare |
$788.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$788.60
|
| Rate for Payer: UHC Medicare Advantage |
$788.60
|
|
|
PR PRQ SKEL FIXJ HUMRL EPCNDYLR FX MEDIAL/LAT MANJ
|
Professional
|
Both
|
$1,886.00
|
|
|
Service Code
|
HCPCS 24566
|
| Min. Negotiated Rate |
$697.59 |
| Max. Negotiated Rate |
$1,290.54 |
| Rate for Payer: Aetna Commercial |
$934.77
|
| Rate for Payer: Aetna Medicare |
$725.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$934.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.53
|
| Rate for Payer: BCBS Complete |
$754.40
|
| Rate for Payer: BCBS MAPPO |
$697.59
|
| Rate for Payer: BCN Medicare Advantage |
$697.59
|
| Rate for Payer: Cash Price |
$1,508.80
|
| Rate for Payer: Cash Price |
$1,508.80
|
| Rate for Payer: Cofinity Commercial |
$934.77
|
| Rate for Payer: Cofinity Commercial |
$1,004.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$697.59
|
| Rate for Payer: Healthscope Commercial |
$1,290.54
|
| Rate for Payer: Healthscope Commercial |
$1,116.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$732.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,225.90
|
| Rate for Payer: Nomi Health Commercial |
$837.11
|
| Rate for Payer: PACE SWMI |
$697.59
|
| Rate for Payer: PHP Medicare Advantage |
$697.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,225.90
|
| Rate for Payer: Priority Health Medicare |
$697.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$697.59
|
| Rate for Payer: UHC Medicare Advantage |
$697.59
|
|
|
PR PRQ SKEL FIXJ INTERPHALANGEAL JOINT DISLC W/MANJ
|
Professional
|
Both
|
$591.00
|
|
|
Service Code
|
HCPCS 28666
|
| Min. Negotiated Rate |
$165.03 |
| Max. Negotiated Rate |
$384.15 |
| Rate for Payer: Aetna Commercial |
$221.14
|
| Rate for Payer: Aetna Medicare |
$171.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.14
|
| Rate for Payer: BCBS Complete |
$236.40
|
| Rate for Payer: BCBS MAPPO |
$165.03
|
| Rate for Payer: BCN Medicare Advantage |
$165.03
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cofinity Commercial |
$237.64
|
| Rate for Payer: Cofinity Commercial |
$221.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.03
|
| Rate for Payer: Healthscope Commercial |
$264.05
|
| Rate for Payer: Healthscope Commercial |
$305.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.15
|
| Rate for Payer: Nomi Health Commercial |
$198.04
|
| Rate for Payer: PACE SWMI |
$165.03
|
| Rate for Payer: PHP Medicare Advantage |
$165.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.15
|
| Rate for Payer: Priority Health Medicare |
$165.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.03
|
| Rate for Payer: UHC Medicare Advantage |
$165.03
|
|
|
PR PRQ SKEL FIXJ IPHAL JT DISLC W/MANJ
|
Professional
|
Both
|
$1,389.00
|
|
|
Service Code
|
HCPCS 26776
|
| Min. Negotiated Rate |
$434.96 |
| Max. Negotiated Rate |
$902.85 |
| Rate for Payer: Aetna Commercial |
$582.85
|
| Rate for Payer: Aetna Medicare |
$452.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$626.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$582.85
|
| Rate for Payer: BCBS Complete |
$555.60
|
| Rate for Payer: BCBS MAPPO |
$434.96
|
| Rate for Payer: BCN Medicare Advantage |
$434.96
|
| Rate for Payer: Cash Price |
$1,111.20
|
| Rate for Payer: Cash Price |
$1,111.20
|
| Rate for Payer: Cofinity Commercial |
$626.34
|
| Rate for Payer: Cofinity Commercial |
$582.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$434.96
|
| Rate for Payer: Healthscope Commercial |
$804.68
|
| Rate for Payer: Healthscope Commercial |
$695.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$456.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$902.85
|
| Rate for Payer: Nomi Health Commercial |
$521.95
|
| Rate for Payer: PACE SWMI |
$434.96
|
| Rate for Payer: PHP Medicare Advantage |
$434.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.85
|
| Rate for Payer: Priority Health Medicare |
$434.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$434.96
|
| Rate for Payer: UHC Medicare Advantage |
$434.96
|
|
|
PR PRQ SKEL FIXJ METACARPOPHALANGEAL DISLC W/MANJ
|
Professional
|
Both
|
$1,375.00
|
|
|
Service Code
|
HCPCS 26706
|
| Min. Negotiated Rate |
$433.61 |
| Max. Negotiated Rate |
$893.75 |
| Rate for Payer: Aetna Commercial |
$581.04
|
| Rate for Payer: Aetna Medicare |
$450.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.04
|
| Rate for Payer: BCBS Complete |
$550.00
|
| Rate for Payer: BCBS MAPPO |
$433.61
|
| Rate for Payer: BCN Medicare Advantage |
$433.61
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cofinity Commercial |
$624.40
|
| Rate for Payer: Cofinity Commercial |
$581.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.61
|
| Rate for Payer: Healthscope Commercial |
$693.78
|
| Rate for Payer: Healthscope Commercial |
$802.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$455.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$893.75
|
| Rate for Payer: Nomi Health Commercial |
$520.33
|
| Rate for Payer: PACE SWMI |
$433.61
|
| Rate for Payer: PHP Medicare Advantage |
$433.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$893.75
|
| Rate for Payer: Priority Health Medicare |
$433.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.61
|
| Rate for Payer: UHC Medicare Advantage |
$433.61
|
|
|
PR PRQ SKEL FIXJ METAR FX W/MANJ
|
Professional
|
Both
|
$1,077.00
|
|
|
Service Code
|
HCPCS 28476
|
| Min. Negotiated Rate |
$370.07 |
| Max. Negotiated Rate |
$700.05 |
| Rate for Payer: Aetna Commercial |
$495.89
|
| Rate for Payer: Aetna Medicare |
$384.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.89
|
| Rate for Payer: BCBS Complete |
$430.80
|
| Rate for Payer: BCBS MAPPO |
$370.07
|
| Rate for Payer: BCN Medicare Advantage |
$370.07
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cofinity Commercial |
$532.90
|
| Rate for Payer: Cofinity Commercial |
$495.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$370.07
|
| Rate for Payer: Healthscope Commercial |
$684.63
|
| Rate for Payer: Healthscope Commercial |
$592.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$388.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$700.05
|
| Rate for Payer: Nomi Health Commercial |
$444.08
|
| Rate for Payer: PACE SWMI |
$370.07
|
| Rate for Payer: PHP Medicare Advantage |
$370.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.05
|
| Rate for Payer: Priority Health Medicare |
$370.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$370.07
|
| Rate for Payer: UHC Medicare Advantage |
$370.07
|
|
|
PR PRQ SKEL FIXJ METATARSOPHLNGL JT DISLC W/MANJ
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
HCPCS 28636
|
| Min. Negotiated Rate |
$215.92 |
| Max. Negotiated Rate |
$427.05 |
| Rate for Payer: Aetna Commercial |
$289.33
|
| Rate for Payer: Aetna Medicare |
$224.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.33
|
| Rate for Payer: BCBS Complete |
$262.80
|
| Rate for Payer: BCBS MAPPO |
$215.92
|
| Rate for Payer: BCN Medicare Advantage |
$215.92
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$310.92
|
| Rate for Payer: Cofinity Commercial |
$289.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.92
|
| Rate for Payer: Healthscope Commercial |
$345.47
|
| Rate for Payer: Healthscope Commercial |
$399.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.05
|
| Rate for Payer: Nomi Health Commercial |
$259.10
|
| Rate for Payer: PACE SWMI |
$215.92
|
| Rate for Payer: PHP Medicare Advantage |
$215.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health Medicare |
$215.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.92
|
| Rate for Payer: UHC Medicare Advantage |
$215.92
|
|
|
PR PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T
|
Professional
|
Both
|
$1,540.00
|
|
|
Service Code
|
HCPCS 26727
|
| Min. Negotiated Rate |
$458.98 |
| Max. Negotiated Rate |
$1,001.00 |
| Rate for Payer: Aetna Commercial |
$615.03
|
| Rate for Payer: Aetna Medicare |
$477.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.03
|
| Rate for Payer: BCBS Complete |
$616.00
|
| Rate for Payer: BCBS MAPPO |
$458.98
|
| Rate for Payer: BCN Medicare Advantage |
$458.98
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cofinity Commercial |
$660.93
|
| Rate for Payer: Cofinity Commercial |
$615.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$458.98
|
| Rate for Payer: Healthscope Commercial |
$849.11
|
| Rate for Payer: Healthscope Commercial |
$734.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$481.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,001.00
|
| Rate for Payer: Nomi Health Commercial |
$550.78
|
| Rate for Payer: PACE SWMI |
$458.98
|
| Rate for Payer: PHP Medicare Advantage |
$458.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.00
|
| Rate for Payer: Priority Health Medicare |
$458.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$458.98
|
| Rate for Payer: UHC Medicare Advantage |
$458.98
|
|
|
PR PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX
|
Professional
|
Both
|
$2,577.00
|
|
|
Service Code
|
HCPCS 24538
|
| Min. Negotiated Rate |
$756.93 |
| Max. Negotiated Rate |
$1,675.05 |
| Rate for Payer: Aetna Commercial |
$1,014.29
|
| Rate for Payer: Aetna Medicare |
$787.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,089.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,014.29
|
| Rate for Payer: BCBS Complete |
$1,030.80
|
| Rate for Payer: BCBS MAPPO |
$756.93
|
| Rate for Payer: BCN Medicare Advantage |
$756.93
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cofinity Commercial |
$1,089.98
|
| Rate for Payer: Cofinity Commercial |
$1,014.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$756.93
|
| Rate for Payer: Healthscope Commercial |
$1,211.09
|
| Rate for Payer: Healthscope Commercial |
$1,400.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$794.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,675.05
|
| Rate for Payer: Nomi Health Commercial |
$908.32
|
| Rate for Payer: PACE SWMI |
$756.93
|
| Rate for Payer: PHP Medicare Advantage |
$756.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,675.05
|
| Rate for Payer: Priority Health Medicare |
$756.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$756.93
|
| Rate for Payer: UHC Medicare Advantage |
$756.93
|
|
|
PR PRQ SKEL FIXJ TALOTARSAL JT DISLC W/MANJ
|
Professional
|
Both
|
$978.00
|
|
|
Service Code
|
HCPCS 28576
|
| Min. Negotiated Rate |
$379.24 |
| Max. Negotiated Rate |
$701.59 |
| Rate for Payer: Aetna Commercial |
$508.18
|
| Rate for Payer: Aetna Medicare |
$394.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.18
|
| Rate for Payer: BCBS Complete |
$391.20
|
| Rate for Payer: BCBS MAPPO |
$379.24
|
| Rate for Payer: BCN Medicare Advantage |
$379.24
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cofinity Commercial |
$546.11
|
| Rate for Payer: Cofinity Commercial |
$508.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.24
|
| Rate for Payer: Healthscope Commercial |
$701.59
|
| Rate for Payer: Healthscope Commercial |
$606.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$398.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$635.70
|
| Rate for Payer: Nomi Health Commercial |
$455.09
|
| Rate for Payer: PACE SWMI |
$379.24
|
| Rate for Payer: PHP Medicare Advantage |
$379.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.70
|
| Rate for Payer: Priority Health Medicare |
$379.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$379.24
|
| Rate for Payer: UHC Medicare Advantage |
$379.24
|
|
|
PR PRQ SKEL FIXJ TARS JT DISLC W/MANJ
|
Professional
|
Both
|
$1,346.00
|
|
|
Service Code
|
HCPCS 28606
|
| Min. Negotiated Rate |
$384.56 |
| Max. Negotiated Rate |
$874.90 |
| Rate for Payer: Aetna Commercial |
$515.31
|
| Rate for Payer: Aetna Medicare |
$399.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.31
|
| Rate for Payer: BCBS Complete |
$538.40
|
| Rate for Payer: BCBS MAPPO |
$384.56
|
| Rate for Payer: BCN Medicare Advantage |
$384.56
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cofinity Commercial |
$553.77
|
| Rate for Payer: Cofinity Commercial |
$515.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.56
|
| Rate for Payer: Healthscope Commercial |
$615.30
|
| Rate for Payer: Healthscope Commercial |
$711.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$874.90
|
| Rate for Payer: Nomi Health Commercial |
$461.47
|
| Rate for Payer: PACE SWMI |
$384.56
|
| Rate for Payer: PHP Medicare Advantage |
$384.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.90
|
| Rate for Payer: Priority Health Medicare |
$384.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$384.56
|
| Rate for Payer: UHC Medicare Advantage |
$384.56
|
|
|
PR PRQ SKEL FIXJ TARSL DISLC XCP TALOTARSAL W/MANJ
|
Professional
|
Both
|
$798.00
|
|
|
Service Code
|
HCPCS 28546
|
| Min. Negotiated Rate |
$319.20 |
| Max. Negotiated Rate |
$628.91 |
| Rate for Payer: Aetna Commercial |
$455.53
|
| Rate for Payer: Aetna Medicare |
$353.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$489.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.53
|
| Rate for Payer: BCBS Complete |
$319.20
|
| Rate for Payer: BCBS MAPPO |
$339.95
|
| Rate for Payer: BCN Medicare Advantage |
$339.95
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cofinity Commercial |
$489.53
|
| Rate for Payer: Cofinity Commercial |
$455.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.95
|
| Rate for Payer: Healthscope Commercial |
$628.91
|
| Rate for Payer: Healthscope Commercial |
$543.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$518.70
|
| Rate for Payer: Nomi Health Commercial |
$407.94
|
| Rate for Payer: PACE SWMI |
$339.95
|
| Rate for Payer: PHP Medicare Advantage |
$339.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.70
|
| Rate for Payer: Priority Health Medicare |
$339.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.95
|
| Rate for Payer: UHC Medicare Advantage |
$339.95
|
|
|
PR PRQ SKEL FIXJ TARSL FX XCP TALUS&CALCNS W/MANJ
|
Professional
|
Both
|
$464.00
|
|
|
Service Code
|
HCPCS 28456
|
| Min. Negotiated Rate |
$185.60 |
| Max. Negotiated Rate |
$648.68 |
| Rate for Payer: Aetna Commercial |
$469.86
|
| Rate for Payer: Aetna Medicare |
$364.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.86
|
| Rate for Payer: BCBS Complete |
$185.60
|
| Rate for Payer: BCBS MAPPO |
$350.64
|
| Rate for Payer: BCN Medicare Advantage |
$350.64
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Cofinity Commercial |
$504.92
|
| Rate for Payer: Cofinity Commercial |
$469.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.64
|
| Rate for Payer: Healthscope Commercial |
$561.02
|
| Rate for Payer: Healthscope Commercial |
$648.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$368.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.60
|
| Rate for Payer: Nomi Health Commercial |
$420.77
|
| Rate for Payer: PACE SWMI |
$350.64
|
| Rate for Payer: PHP Medicare Advantage |
$350.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.60
|
| Rate for Payer: Priority Health Medicare |
$350.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$350.64
|
| Rate for Payer: UHC Medicare Advantage |
$350.64
|
|
|
PR PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT
|
Professional
|
Both
|
$2,053.00
|
|
|
Service Code
|
HCPCS 93580
|
| Min. Negotiated Rate |
$821.20 |
| Max. Negotiated Rate |
$1,714.67 |
| Rate for Payer: Aetna Commercial |
$1,241.98
|
| Rate for Payer: Aetna Medicare |
$963.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,334.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,241.98
|
| Rate for Payer: BCBS Complete |
$821.20
|
| Rate for Payer: BCBS MAPPO |
$926.85
|
| Rate for Payer: BCN Medicare Advantage |
$926.85
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cofinity Commercial |
$1,334.66
|
| Rate for Payer: Cofinity Commercial |
$1,241.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.85
|
| Rate for Payer: Healthscope Commercial |
$1,714.67
|
| Rate for Payer: Healthscope Commercial |
$1,482.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$973.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,334.45
|
| Rate for Payer: Nomi Health Commercial |
$1,112.22
|
| Rate for Payer: PACE SWMI |
$926.85
|
| Rate for Payer: PHP Medicare Advantage |
$926.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.45
|
| Rate for Payer: Priority Health Medicare |
$926.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$926.85
|
| Rate for Payer: UHC Medicare Advantage |
$926.85
|
|
|
PR PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
HCPCS 37197
|
| Min. Negotiated Rate |
$205.20 |
| Max. Negotiated Rate |
$527.42 |
| Rate for Payer: Aetna Commercial |
$382.02
|
| Rate for Payer: Aetna Medicare |
$296.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.02
|
| Rate for Payer: BCBS Complete |
$205.20
|
| Rate for Payer: BCBS MAPPO |
$285.09
|
| Rate for Payer: BCN Medicare Advantage |
$285.09
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cofinity Commercial |
$410.53
|
| Rate for Payer: Cofinity Commercial |
$382.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.09
|
| Rate for Payer: Healthscope Commercial |
$456.14
|
| Rate for Payer: Healthscope Commercial |
$527.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$299.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.45
|
| Rate for Payer: Nomi Health Commercial |
$342.11
|
| Rate for Payer: PACE SWMI |
$285.09
|
| Rate for Payer: PHP Medicare Advantage |
$285.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.45
|
| Rate for Payer: Priority Health Medicare |
$285.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.09
|
| Rate for Payer: UHC Medicare Advantage |
$285.09
|
|
|
PR PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY
|
Professional
|
Both
|
$1,046.00
|
|
|
Service Code
|
HCPCS 92973
|
| Min. Negotiated Rate |
$167.39 |
| Max. Negotiated Rate |
$679.90 |
| Rate for Payer: Aetna Commercial |
$224.30
|
| Rate for Payer: Aetna Medicare |
$174.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.30
|
| Rate for Payer: BCBS Complete |
$418.40
|
| Rate for Payer: BCBS MAPPO |
$167.39
|
| Rate for Payer: BCN Medicare Advantage |
$167.39
|
| Rate for Payer: Cash Price |
$836.80
|
| Rate for Payer: Cash Price |
$836.80
|
| Rate for Payer: Cofinity Commercial |
$241.04
|
| Rate for Payer: Cofinity Commercial |
$224.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.39
|
| Rate for Payer: Healthscope Commercial |
$309.67
|
| Rate for Payer: Healthscope Commercial |
$267.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$679.90
|
| Rate for Payer: Nomi Health Commercial |
$200.87
|
| Rate for Payer: PACE SWMI |
$167.39
|
| Rate for Payer: PHP Medicare Advantage |
$167.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$679.90
|
| Rate for Payer: Priority Health Medicare |
$167.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.39
|
| Rate for Payer: UHC Medicare Advantage |
$167.39
|
|
|
PR PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN
|
Professional
|
Both
|
$1,841.00
|
|
|
Service Code
|
HCPCS 37187
|
| Min. Negotiated Rate |
$372.92 |
| Max. Negotiated Rate |
$1,196.65 |
| Rate for Payer: Aetna Commercial |
$499.71
|
| Rate for Payer: Aetna Medicare |
$387.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.71
|
| Rate for Payer: BCBS Complete |
$736.40
|
| Rate for Payer: BCBS MAPPO |
$372.92
|
| Rate for Payer: BCN Medicare Advantage |
$372.92
|
| Rate for Payer: Cash Price |
$1,472.80
|
| Rate for Payer: Cash Price |
$1,472.80
|
| Rate for Payer: Cofinity Commercial |
$537.00
|
| Rate for Payer: Cofinity Commercial |
$499.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$372.92
|
| Rate for Payer: Healthscope Commercial |
$596.67
|
| Rate for Payer: Healthscope Commercial |
$689.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,196.65
|
| Rate for Payer: Nomi Health Commercial |
$447.50
|
| Rate for Payer: PACE SWMI |
$372.92
|
| Rate for Payer: PHP Medicare Advantage |
$372.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,196.65
|
| Rate for Payer: Priority Health Medicare |
$372.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$372.92
|
| Rate for Payer: UHC Medicare Advantage |
$372.92
|
|
|
PR PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH
|
Professional
|
Both
|
$2,550.00
|
|
|
Service Code
|
HCPCS 92924
|
| Min. Negotiated Rate |
$599.85 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: Aetna Commercial |
$803.80
|
| Rate for Payer: Aetna Medicare |
$623.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$863.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.80
|
| Rate for Payer: BCBS Complete |
$1,020.00
|
| Rate for Payer: BCBS MAPPO |
$599.85
|
| Rate for Payer: BCN Medicare Advantage |
$599.85
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cofinity Commercial |
$863.78
|
| Rate for Payer: Cofinity Commercial |
$803.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.85
|
| Rate for Payer: Healthscope Commercial |
$1,109.72
|
| Rate for Payer: Healthscope Commercial |
$959.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,657.50
|
| Rate for Payer: Nomi Health Commercial |
$719.82
|
| Rate for Payer: PACE SWMI |
$599.85
|
| Rate for Payer: PHP Medicare Advantage |
$599.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.50
|
| Rate for Payer: Priority Health Medicare |
$599.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.85
|
| Rate for Payer: UHC Medicare Advantage |
$599.85
|
|
|
PR PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH
|
Professional
|
Both
|
$1,078.00
|
|
|
Service Code
|
HCPCS 92921
|
| Min. Negotiated Rate |
$431.20 |
| Max. Negotiated Rate |
$700.70 |
| Rate for Payer: Aetna Medicare |
$539.00
|
| Rate for Payer: BCBS Complete |
$431.20
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$700.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.70
|
|
|
PR PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH
|
Professional
|
Both
|
$1,119.00
|
|
|
Service Code
|
HCPCS 92920
|
| Min. Negotiated Rate |
$447.60 |
| Max. Negotiated Rate |
$931.70 |
| Rate for Payer: Aetna Commercial |
$674.85
|
| Rate for Payer: Aetna Medicare |
$523.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$725.21
|
| Rate for Payer: BCBS Complete |
$447.60
|
| Rate for Payer: BCBS MAPPO |
$503.62
|
| Rate for Payer: BCN Medicare Advantage |
$503.62
|
| Rate for Payer: Cash Price |
$895.20
|
| Rate for Payer: Cash Price |
$895.20
|
| Rate for Payer: Cofinity Commercial |
$674.85
|
| Rate for Payer: Cofinity Commercial |
$725.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$503.62
|
| Rate for Payer: Healthscope Commercial |
$805.79
|
| Rate for Payer: Healthscope Commercial |
$931.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$528.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$727.35
|
| Rate for Payer: Nomi Health Commercial |
$604.34
|
| Rate for Payer: PACE SWMI |
$503.62
|
| Rate for Payer: PHP Medicare Advantage |
$503.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$727.35
|
| Rate for Payer: Priority Health Medicare |
$503.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$503.62
|
| Rate for Payer: UHC Medicare Advantage |
$503.62
|
|
|
PR PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 92938
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
|
|
PR PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL
|
Professional
|
Both
|
$1,243.00
|
|
|
Service Code
|
HCPCS 92937
|
| Min. Negotiated Rate |
$497.20 |
| Max. Negotiated Rate |
$1,034.39 |
| Rate for Payer: Aetna Commercial |
$749.23
|
| Rate for Payer: Aetna Medicare |
$581.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$749.23
|
| Rate for Payer: BCBS Complete |
$497.20
|
| Rate for Payer: BCBS MAPPO |
$559.13
|
| Rate for Payer: BCN Medicare Advantage |
$559.13
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cofinity Commercial |
$749.23
|
| Rate for Payer: Cofinity Commercial |
$805.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$559.13
|
| Rate for Payer: Healthscope Commercial |
$894.61
|
| Rate for Payer: Healthscope Commercial |
$1,034.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$587.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$807.95
|
| Rate for Payer: Nomi Health Commercial |
$670.96
|
| Rate for Payer: PACE SWMI |
$559.13
|
| Rate for Payer: PHP Medicare Advantage |
$559.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.95
|
| Rate for Payer: Priority Health Medicare |
$559.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$559.13
|
| Rate for Payer: UHC Medicare Advantage |
$559.13
|
|
|
PR PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 92934
|
| Min. Negotiated Rate |
$498.00 |
| Max. Negotiated Rate |
$809.25 |
| Rate for Payer: Aetna Medicare |
$622.50
|
| Rate for Payer: BCBS Complete |
$498.00
|
| Rate for Payer: Cash Price |
$996.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$809.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$809.25
|
|
|
PR PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH
|
Professional
|
Both
|
$1,213.00
|
|
|
Service Code
|
HCPCS 92929
|
| Min. Negotiated Rate |
$485.20 |
| Max. Negotiated Rate |
$788.45 |
| Rate for Payer: Aetna Medicare |
$606.50
|
| Rate for Payer: BCBS Complete |
$485.20
|
| Rate for Payer: Cash Price |
$970.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.45
|
|
|
PR PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
HCPCS 92928
|
| Min. Negotiated Rate |
$497.60 |
| Max. Negotiated Rate |
$1,034.98 |
| Rate for Payer: Aetna Commercial |
$749.66
|
| Rate for Payer: Aetna Medicare |
$581.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$749.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.61
|
| Rate for Payer: BCBS Complete |
$497.60
|
| Rate for Payer: BCBS MAPPO |
$559.45
|
| Rate for Payer: BCN Medicare Advantage |
$559.45
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cofinity Commercial |
$805.61
|
| Rate for Payer: Cofinity Commercial |
$749.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$559.45
|
| Rate for Payer: Healthscope Commercial |
$895.12
|
| Rate for Payer: Healthscope Commercial |
$1,034.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$587.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$808.60
|
| Rate for Payer: Nomi Health Commercial |
$671.34
|
| Rate for Payer: PACE SWMI |
$559.45
|
| Rate for Payer: PHP Medicare Advantage |
$559.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$808.60
|
| Rate for Payer: Priority Health Medicare |
$559.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$559.45
|
| Rate for Payer: UHC Medicare Advantage |
$559.45
|
|
