|
PR REVJ/RPLCMT HPGLSL NERVE NSTIM RA PG&RESPIR SNR
|
Professional
|
Both
|
$1,754.00
|
|
|
Service Code
|
HCPCS 64583
|
| Min. Negotiated Rate |
$701.60 |
| Max. Negotiated Rate |
$1,530.43 |
| Rate for Payer: Aetna Commercial |
$1,108.53
|
| Rate for Payer: Aetna Medicare |
$860.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,191.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,108.53
|
| Rate for Payer: BCBS Complete |
$701.60
|
| Rate for Payer: BCBS MAPPO |
$827.26
|
| Rate for Payer: BCN Medicare Advantage |
$827.26
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Cofinity Commercial |
$1,191.25
|
| Rate for Payer: Cofinity Commercial |
$1,108.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$827.26
|
| Rate for Payer: Healthscope Commercial |
$1,323.62
|
| Rate for Payer: Healthscope Commercial |
$1,530.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$868.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.10
|
| Rate for Payer: Nomi Health Commercial |
$992.71
|
| Rate for Payer: PACE SWMI |
$827.26
|
| Rate for Payer: PHP Medicare Advantage |
$827.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,140.10
|
| Rate for Payer: Priority Health Medicare |
$827.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$827.26
|
| Rate for Payer: UHC Medicare Advantage |
$827.26
|
|
|
PR REVJ/RPLMNT CH WAL RESPIR ELTRD & CONJ PULSE GEN
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 0467T
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Aetna Medicare |
$408.00
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
|
|
PR REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT
|
Professional
|
Both
|
$4,568.00
|
|
|
Service Code
|
HCPCS 27486
|
| Min. Negotiated Rate |
$1,352.57 |
| Max. Negotiated Rate |
$2,969.20 |
| Rate for Payer: Aetna Commercial |
$1,812.44
|
| Rate for Payer: Aetna Medicare |
$1,406.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,812.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,947.70
|
| Rate for Payer: BCBS Complete |
$1,827.20
|
| Rate for Payer: BCBS MAPPO |
$1,352.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,352.57
|
| Rate for Payer: Cash Price |
$3,654.40
|
| Rate for Payer: Cash Price |
$3,654.40
|
| Rate for Payer: Cofinity Commercial |
$1,947.70
|
| Rate for Payer: Cofinity Commercial |
$1,812.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,352.57
|
| Rate for Payer: Healthscope Commercial |
$2,502.25
|
| Rate for Payer: Healthscope Commercial |
$2,164.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,420.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,969.20
|
| Rate for Payer: Nomi Health Commercial |
$1,623.08
|
| Rate for Payer: PACE SWMI |
$1,352.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,352.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,969.20
|
| Rate for Payer: Priority Health Medicare |
$1,352.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,352.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,352.57
|
|
|
PR REVJ TOT HIP ARTHRP ACTBLR W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$3,038.00
|
|
|
Service Code
|
HCPCS 27137
|
| Min. Negotiated Rate |
$1,215.20 |
| Max. Negotiated Rate |
$2,610.68 |
| Rate for Payer: Aetna Commercial |
$1,890.98
|
| Rate for Payer: Aetna Medicare |
$1,467.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,890.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,032.10
|
| Rate for Payer: BCBS Complete |
$1,215.20
|
| Rate for Payer: BCBS MAPPO |
$1,411.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,411.18
|
| Rate for Payer: Cash Price |
$2,430.40
|
| Rate for Payer: Cash Price |
$2,430.40
|
| Rate for Payer: Cofinity Commercial |
$1,890.98
|
| Rate for Payer: Cofinity Commercial |
$2,032.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,411.18
|
| Rate for Payer: Healthscope Commercial |
$2,257.89
|
| Rate for Payer: Healthscope Commercial |
$2,610.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,481.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,974.70
|
| Rate for Payer: Nomi Health Commercial |
$1,693.42
|
| Rate for Payer: PACE SWMI |
$1,411.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,411.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,974.70
|
| Rate for Payer: Priority Health Medicare |
$1,411.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,411.18
|
| Rate for Payer: UHC Medicare Advantage |
$1,411.18
|
|
|
PR REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$3,958.00
|
|
|
Service Code
|
HCPCS 27134
|
| Min. Negotiated Rate |
$1,583.20 |
| Max. Negotiated Rate |
$3,390.44 |
| Rate for Payer: Aetna Commercial |
$2,455.78
|
| Rate for Payer: Aetna Medicare |
$1,905.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,639.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,455.78
|
| Rate for Payer: BCBS Complete |
$1,583.20
|
| Rate for Payer: BCBS MAPPO |
$1,832.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,832.67
|
| Rate for Payer: Cash Price |
$3,166.40
|
| Rate for Payer: Cash Price |
$3,166.40
|
| Rate for Payer: Cofinity Commercial |
$2,639.04
|
| Rate for Payer: Cofinity Commercial |
$2,455.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,832.67
|
| Rate for Payer: Healthscope Commercial |
$3,390.44
|
| Rate for Payer: Healthscope Commercial |
$2,932.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,924.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,572.70
|
| Rate for Payer: Nomi Health Commercial |
$2,199.20
|
| Rate for Payer: PACE SWMI |
$1,832.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,832.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,572.70
|
| Rate for Payer: Priority Health Medicare |
$1,832.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,832.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,832.67
|
|
|
PR REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT
|
Professional
|
Both
|
$3,157.00
|
|
|
Service Code
|
HCPCS 27138
|
| Min. Negotiated Rate |
$1,262.80 |
| Max. Negotiated Rate |
$2,712.38 |
| Rate for Payer: Aetna Commercial |
$1,964.64
|
| Rate for Payer: Aetna Medicare |
$1,524.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,111.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,964.64
|
| Rate for Payer: BCBS Complete |
$1,262.80
|
| Rate for Payer: BCBS MAPPO |
$1,466.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,466.15
|
| Rate for Payer: Cash Price |
$2,525.60
|
| Rate for Payer: Cash Price |
$2,525.60
|
| Rate for Payer: Cofinity Commercial |
$2,111.26
|
| Rate for Payer: Cofinity Commercial |
$1,964.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,466.15
|
| Rate for Payer: Healthscope Commercial |
$2,345.84
|
| Rate for Payer: Healthscope Commercial |
$2,712.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,539.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,052.05
|
| Rate for Payer: Nomi Health Commercial |
$1,759.38
|
| Rate for Payer: PACE SWMI |
$1,466.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,466.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,052.05
|
| Rate for Payer: Priority Health Medicare |
$1,466.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,466.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,466.15
|
|
|
PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Facility
|
IP
|
$6,003.00
|
|
|
Service Code
|
CPT 27487
|
| Hospital Charge Code |
27487
|
| Min. Negotiated Rate |
$3,781.89 |
| Max. Negotiated Rate |
$5,402.70 |
| Rate for Payer: Aetna Commercial |
$5,102.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,901.95
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cofinity Commercial |
$4,202.10
|
| Rate for Payer: Cofinity Commercial |
$5,162.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,202.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,802.40
|
| Rate for Payer: Healthscope Commercial |
$5,402.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,102.55
|
| Rate for Payer: PHP Commercial |
$5,102.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,901.95
|
| Rate for Payer: Priority Health SBD |
$3,781.89
|
|
|
PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Professional
|
Both
|
$6,003.00
|
|
|
Service Code
|
HCPCS 27487
|
| Hospital Charge Code |
27487
|
| Min. Negotiated Rate |
$1,686.61 |
| Max. Negotiated Rate |
$3,901.95 |
| Rate for Payer: Aetna Commercial |
$2,260.06
|
| Rate for Payer: Aetna Medicare |
$1,754.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,260.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,428.72
|
| Rate for Payer: BCBS Complete |
$2,401.20
|
| Rate for Payer: BCBS MAPPO |
$1,686.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,686.61
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cofinity Commercial |
$2,260.06
|
| Rate for Payer: Cofinity Commercial |
$2,428.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,686.61
|
| Rate for Payer: Healthscope Commercial |
$3,120.23
|
| Rate for Payer: Healthscope Commercial |
$2,698.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,770.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,901.95
|
| Rate for Payer: Nomi Health Commercial |
$2,023.93
|
| Rate for Payer: PACE SWMI |
$1,686.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,686.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,901.95
|
| Rate for Payer: Priority Health Medicare |
$1,686.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,686.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,686.61
|
|
|
PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Facility
|
OP
|
$6,003.00
|
|
|
Service Code
|
CPT 27487
|
| Hospital Charge Code |
27487
|
| Min. Negotiated Rate |
$2,401.20 |
| Max. Negotiated Rate |
$5,402.70 |
| Rate for Payer: Aetna Commercial |
$5,102.55
|
| Rate for Payer: Aetna Medicare |
$3,001.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,901.95
|
| Rate for Payer: BCBS Complete |
$2,401.20
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cofinity Commercial |
$4,202.10
|
| Rate for Payer: Cofinity Commercial |
$5,162.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,202.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,802.40
|
| Rate for Payer: Healthscope Commercial |
$5,402.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,102.55
|
| Rate for Payer: PHP Commercial |
$5,102.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,901.95
|
| Rate for Payer: Priority Health SBD |
$3,781.89
|
|
|
PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Professional
|
Both
|
$6,003.00
|
|
|
Service Code
|
HCPCS 27487
|
| Min. Negotiated Rate |
$1,686.61 |
| Max. Negotiated Rate |
$3,901.95 |
| Rate for Payer: Aetna Commercial |
$2,260.06
|
| Rate for Payer: Aetna Medicare |
$1,754.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,428.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,260.06
|
| Rate for Payer: BCBS Complete |
$2,401.20
|
| Rate for Payer: BCBS MAPPO |
$1,686.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,686.61
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cofinity Commercial |
$2,428.72
|
| Rate for Payer: Cofinity Commercial |
$2,260.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,686.61
|
| Rate for Payer: Healthscope Commercial |
$3,120.23
|
| Rate for Payer: Healthscope Commercial |
$2,698.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,770.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,901.95
|
| Rate for Payer: Nomi Health Commercial |
$2,023.93
|
| Rate for Payer: PACE SWMI |
$1,686.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,686.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,901.95
|
| Rate for Payer: Priority Health Medicare |
$1,686.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,686.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,686.61
|
|
|
PR REVJ UR-CUTAN ANAST RPR FSCAL DFCT & HERNIA
|
Professional
|
Both
|
$1,435.00
|
|
|
Service Code
|
HCPCS 50728
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$1,238.19 |
| Rate for Payer: Aetna Commercial |
$896.85
|
| Rate for Payer: Aetna Medicare |
$696.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$963.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$896.85
|
| Rate for Payer: BCBS Complete |
$574.00
|
| Rate for Payer: BCBS MAPPO |
$669.29
|
| Rate for Payer: BCN Medicare Advantage |
$669.29
|
| Rate for Payer: Cash Price |
$1,148.00
|
| Rate for Payer: Cash Price |
$1,148.00
|
| Rate for Payer: Cofinity Commercial |
$963.78
|
| Rate for Payer: Cofinity Commercial |
$896.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$669.29
|
| Rate for Payer: Healthscope Commercial |
$1,070.86
|
| Rate for Payer: Healthscope Commercial |
$1,238.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$702.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$932.75
|
| Rate for Payer: Nomi Health Commercial |
$803.15
|
| Rate for Payer: PACE SWMI |
$669.29
|
| Rate for Payer: PHP Medicare Advantage |
$669.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$932.75
|
| Rate for Payer: Priority Health Medicare |
$669.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$669.29
|
| Rate for Payer: UHC Medicare Advantage |
$669.29
|
|
|
PR REVJ URINARY-CUTANEOUS ANASTAMOSIS
|
Professional
|
Both
|
$1,296.00
|
|
|
Service Code
|
HCPCS 50727
|
| Min. Negotiated Rate |
$487.42 |
| Max. Negotiated Rate |
$901.73 |
| Rate for Payer: Aetna Commercial |
$653.14
|
| Rate for Payer: Aetna Medicare |
$506.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$701.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$653.14
|
| Rate for Payer: BCBS Complete |
$518.40
|
| Rate for Payer: BCBS MAPPO |
$487.42
|
| Rate for Payer: BCN Medicare Advantage |
$487.42
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cofinity Commercial |
$701.88
|
| Rate for Payer: Cofinity Commercial |
$653.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$487.42
|
| Rate for Payer: Healthscope Commercial |
$901.73
|
| Rate for Payer: Healthscope Commercial |
$779.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$511.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.40
|
| Rate for Payer: Nomi Health Commercial |
$584.90
|
| Rate for Payer: PACE SWMI |
$487.42
|
| Rate for Payer: PHP Medicare Advantage |
$487.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$842.40
|
| Rate for Payer: Priority Health Medicare |
$487.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$487.42
|
| Rate for Payer: UHC Medicare Advantage |
$487.42
|
|
|
PR REV/RMV PRPH SAC/GSTRC NPG/RCV DTCH CONN ELTR RA
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
HCPCS 64595
|
| Min. Negotiated Rate |
$220.08 |
| Max. Negotiated Rate |
$452.40 |
| Rate for Payer: Aetna Commercial |
$294.91
|
| Rate for Payer: Aetna Medicare |
$228.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.91
|
| Rate for Payer: BCBS Complete |
$278.40
|
| Rate for Payer: BCBS MAPPO |
$220.08
|
| Rate for Payer: BCN Medicare Advantage |
$220.08
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cofinity Commercial |
$316.92
|
| Rate for Payer: Cofinity Commercial |
$294.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.08
|
| Rate for Payer: Healthscope Commercial |
$352.13
|
| Rate for Payer: Healthscope Commercial |
$407.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$452.40
|
| Rate for Payer: Nomi Health Commercial |
$264.10
|
| Rate for Payer: PACE SWMI |
$220.08
|
| Rate for Payer: PHP Medicare Advantage |
$220.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.40
|
| Rate for Payer: Priority Health Medicare |
$220.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.08
|
| Rate for Payer: UHC Medicare Advantage |
$220.08
|
|
|
PR REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI
|
Professional
|
Both
|
$1,066.00
|
|
|
Service Code
|
HCPCS 37224
|
| Min. Negotiated Rate |
$423.87 |
| Max. Negotiated Rate |
$784.16 |
| Rate for Payer: Aetna Commercial |
$567.99
|
| Rate for Payer: Aetna Medicare |
$440.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$610.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$567.99
|
| Rate for Payer: BCBS Complete |
$426.40
|
| Rate for Payer: BCBS MAPPO |
$423.87
|
| Rate for Payer: BCN Medicare Advantage |
$423.87
|
| Rate for Payer: Cash Price |
$852.80
|
| Rate for Payer: Cash Price |
$852.80
|
| Rate for Payer: Cofinity Commercial |
$610.37
|
| Rate for Payer: Cofinity Commercial |
$567.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$423.87
|
| Rate for Payer: Healthscope Commercial |
$784.16
|
| Rate for Payer: Healthscope Commercial |
$678.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$445.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$692.90
|
| Rate for Payer: Nomi Health Commercial |
$508.64
|
| Rate for Payer: PACE SWMI |
$423.87
|
| Rate for Payer: PHP Medicare Advantage |
$423.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$692.90
|
| Rate for Payer: Priority Health Medicare |
$423.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$423.87
|
| Rate for Payer: UHC Medicare Advantage |
$423.87
|
|
|
PR REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL
|
Professional
|
Both
|
$2,317.00
|
|
|
Service Code
|
HCPCS 37225
|
| Min. Negotiated Rate |
$567.29 |
| Max. Negotiated Rate |
$1,506.05 |
| Rate for Payer: Aetna Commercial |
$760.17
|
| Rate for Payer: Aetna Medicare |
$589.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$816.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$760.17
|
| Rate for Payer: BCBS Complete |
$926.80
|
| Rate for Payer: BCBS MAPPO |
$567.29
|
| Rate for Payer: BCN Medicare Advantage |
$567.29
|
| Rate for Payer: Cash Price |
$1,853.60
|
| Rate for Payer: Cash Price |
$1,853.60
|
| Rate for Payer: Cofinity Commercial |
$816.90
|
| Rate for Payer: Cofinity Commercial |
$760.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$567.29
|
| Rate for Payer: Healthscope Commercial |
$1,049.49
|
| Rate for Payer: Healthscope Commercial |
$907.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$595.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,506.05
|
| Rate for Payer: Nomi Health Commercial |
$680.75
|
| Rate for Payer: PACE SWMI |
$567.29
|
| Rate for Payer: PHP Medicare Advantage |
$567.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,506.05
|
| Rate for Payer: Priority Health Medicare |
$567.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$567.29
|
| Rate for Payer: UHC Medicare Advantage |
$567.29
|
|
|
PR REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 37226
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$915.88 |
| Rate for Payer: Aetna Commercial |
$663.39
|
| Rate for Payer: Aetna Medicare |
$514.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$712.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.39
|
| Rate for Payer: BCBS Complete |
$462.00
|
| Rate for Payer: BCBS MAPPO |
$495.07
|
| Rate for Payer: BCN Medicare Advantage |
$495.07
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$712.90
|
| Rate for Payer: Cofinity Commercial |
$663.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$495.07
|
| Rate for Payer: Healthscope Commercial |
$915.88
|
| Rate for Payer: Healthscope Commercial |
$792.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$519.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$750.75
|
| Rate for Payer: Nomi Health Commercial |
$594.08
|
| Rate for Payer: PACE SWMI |
$495.07
|
| Rate for Payer: PHP Medicare Advantage |
$495.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health Medicare |
$495.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$495.07
|
| Rate for Payer: UHC Medicare Advantage |
$495.07
|
|
|
PR REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL
|
Professional
|
Both
|
$1,967.00
|
|
|
Service Code
|
HCPCS 37227
|
| Min. Negotiated Rate |
$681.48 |
| Max. Negotiated Rate |
$1,278.55 |
| Rate for Payer: Aetna Commercial |
$913.18
|
| Rate for Payer: Aetna Medicare |
$708.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$981.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$913.18
|
| Rate for Payer: BCBS Complete |
$786.80
|
| Rate for Payer: BCBS MAPPO |
$681.48
|
| Rate for Payer: BCN Medicare Advantage |
$681.48
|
| Rate for Payer: Cash Price |
$1,573.60
|
| Rate for Payer: Cash Price |
$1,573.60
|
| Rate for Payer: Cofinity Commercial |
$981.33
|
| Rate for Payer: Cofinity Commercial |
$913.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$681.48
|
| Rate for Payer: Healthscope Commercial |
$1,090.37
|
| Rate for Payer: Healthscope Commercial |
$1,260.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$715.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,278.55
|
| Rate for Payer: Nomi Health Commercial |
$817.78
|
| Rate for Payer: PACE SWMI |
$681.48
|
| Rate for Payer: PHP Medicare Advantage |
$681.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,278.55
|
| Rate for Payer: Priority Health Medicare |
$681.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$681.48
|
| Rate for Payer: UHC Medicare Advantage |
$681.48
|
|
|
PR REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSILATL
|
Professional
|
Both
|
$499.00
|
|
|
Service Code
|
HCPCS 37223
|
| Min. Negotiated Rate |
$199.60 |
| Max. Negotiated Rate |
$374.90 |
| Rate for Payer: Aetna Commercial |
$271.55
|
| Rate for Payer: Aetna Medicare |
$210.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.55
|
| Rate for Payer: BCBS Complete |
$199.60
|
| Rate for Payer: BCBS MAPPO |
$202.65
|
| Rate for Payer: BCN Medicare Advantage |
$202.65
|
| Rate for Payer: Cash Price |
$399.20
|
| Rate for Payer: Cash Price |
$399.20
|
| Rate for Payer: Cofinity Commercial |
$291.82
|
| Rate for Payer: Cofinity Commercial |
$271.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.65
|
| Rate for Payer: Healthscope Commercial |
$374.90
|
| Rate for Payer: Healthscope Commercial |
$324.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.35
|
| Rate for Payer: Nomi Health Commercial |
$243.18
|
| Rate for Payer: PACE SWMI |
$202.65
|
| Rate for Payer: PHP Medicare Advantage |
$202.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.35
|
| Rate for Payer: Priority Health Medicare |
$202.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.65
|
| Rate for Payer: UHC Medicare Advantage |
$202.65
|
|
|
PR REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY
|
Professional
|
Both
|
$2,022.00
|
|
|
Service Code
|
HCPCS 37221
|
| Min. Negotiated Rate |
$470.25 |
| Max. Negotiated Rate |
$1,314.30 |
| Rate for Payer: Aetna Commercial |
$630.13
|
| Rate for Payer: Aetna Medicare |
$489.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.13
|
| Rate for Payer: BCBS Complete |
$808.80
|
| Rate for Payer: BCBS MAPPO |
$470.25
|
| Rate for Payer: BCN Medicare Advantage |
$470.25
|
| Rate for Payer: Cash Price |
$1,617.60
|
| Rate for Payer: Cash Price |
$1,617.60
|
| Rate for Payer: Cofinity Commercial |
$677.16
|
| Rate for Payer: Cofinity Commercial |
$630.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$470.25
|
| Rate for Payer: Healthscope Commercial |
$752.40
|
| Rate for Payer: Healthscope Commercial |
$869.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$493.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,314.30
|
| Rate for Payer: Nomi Health Commercial |
$564.30
|
| Rate for Payer: PACE SWMI |
$470.25
|
| Rate for Payer: PHP Medicare Advantage |
$470.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,314.30
|
| Rate for Payer: Priority Health Medicare |
$470.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$470.25
|
| Rate for Payer: UHC Medicare Advantage |
$470.25
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI
|
Professional
|
Both
|
$1,305.00
|
|
|
Service Code
|
HCPCS 37228
|
| Min. Negotiated Rate |
$516.20 |
| Max. Negotiated Rate |
$954.97 |
| Rate for Payer: Aetna Commercial |
$691.71
|
| Rate for Payer: Aetna Medicare |
$536.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$743.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$691.71
|
| Rate for Payer: BCBS Complete |
$522.00
|
| Rate for Payer: BCBS MAPPO |
$516.20
|
| Rate for Payer: BCN Medicare Advantage |
$516.20
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cofinity Commercial |
$743.33
|
| Rate for Payer: Cofinity Commercial |
$691.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$516.20
|
| Rate for Payer: Healthscope Commercial |
$954.97
|
| Rate for Payer: Healthscope Commercial |
$825.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$542.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$848.25
|
| Rate for Payer: Nomi Health Commercial |
$619.44
|
| Rate for Payer: PACE SWMI |
$516.20
|
| Rate for Payer: PHP Medicare Advantage |
$516.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.25
|
| Rate for Payer: Priority Health Medicare |
$516.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$516.20
|
| Rate for Payer: UHC Medicare Advantage |
$516.20
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL
|
Professional
|
Both
|
$4,351.00
|
|
|
Service Code
|
HCPCS 37232
|
| Min. Negotiated Rate |
$189.38 |
| Max. Negotiated Rate |
$2,828.15 |
| Rate for Payer: Aetna Commercial |
$253.77
|
| Rate for Payer: Aetna Medicare |
$196.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.77
|
| Rate for Payer: BCBS Complete |
$1,740.40
|
| Rate for Payer: BCBS MAPPO |
$189.38
|
| Rate for Payer: BCN Medicare Advantage |
$189.38
|
| Rate for Payer: Cash Price |
$3,480.80
|
| Rate for Payer: Cash Price |
$3,480.80
|
| Rate for Payer: Cofinity Commercial |
$272.71
|
| Rate for Payer: Cofinity Commercial |
$253.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.38
|
| Rate for Payer: Healthscope Commercial |
$303.01
|
| Rate for Payer: Healthscope Commercial |
$350.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,828.15
|
| Rate for Payer: Nomi Health Commercial |
$227.26
|
| Rate for Payer: PACE SWMI |
$189.38
|
| Rate for Payer: PHP Medicare Advantage |
$189.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,828.15
|
| Rate for Payer: Priority Health Medicare |
$189.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.38
|
| Rate for Payer: UHC Medicare Advantage |
$189.38
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL
|
Professional
|
Both
|
$2,733.00
|
|
|
Service Code
|
HCPCS 37229
|
| Min. Negotiated Rate |
$657.99 |
| Max. Negotiated Rate |
$1,776.45 |
| Rate for Payer: Aetna Commercial |
$881.71
|
| Rate for Payer: Aetna Medicare |
$684.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$947.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$881.71
|
| Rate for Payer: BCBS Complete |
$1,093.20
|
| Rate for Payer: BCBS MAPPO |
$657.99
|
| Rate for Payer: BCN Medicare Advantage |
$657.99
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cofinity Commercial |
$947.51
|
| Rate for Payer: Cofinity Commercial |
$881.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$657.99
|
| Rate for Payer: Healthscope Commercial |
$1,217.28
|
| Rate for Payer: Healthscope Commercial |
$1,052.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$690.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,776.45
|
| Rate for Payer: Nomi Health Commercial |
$789.59
|
| Rate for Payer: PACE SWMI |
$657.99
|
| Rate for Payer: PHP Medicare Advantage |
$657.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,776.45
|
| Rate for Payer: Priority Health Medicare |
$657.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$657.99
|
| Rate for Payer: UHC Medicare Advantage |
$657.99
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL
|
Professional
|
Both
|
$1,141.00
|
|
|
Service Code
|
HCPCS 37233
|
| Min. Negotiated Rate |
$305.92 |
| Max. Negotiated Rate |
$741.65 |
| Rate for Payer: Aetna Commercial |
$409.93
|
| Rate for Payer: Aetna Medicare |
$318.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.93
|
| Rate for Payer: BCBS Complete |
$456.40
|
| Rate for Payer: BCBS MAPPO |
$305.92
|
| Rate for Payer: BCN Medicare Advantage |
$305.92
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Cofinity Commercial |
$440.52
|
| Rate for Payer: Cofinity Commercial |
$409.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.92
|
| Rate for Payer: Healthscope Commercial |
$489.47
|
| Rate for Payer: Healthscope Commercial |
$565.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$741.65
|
| Rate for Payer: Nomi Health Commercial |
$367.10
|
| Rate for Payer: PACE SWMI |
$305.92
|
| Rate for Payer: PHP Medicare Advantage |
$305.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$741.65
|
| Rate for Payer: Priority Health Medicare |
$305.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.92
|
| Rate for Payer: UHC Medicare Advantage |
$305.92
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL
|
Professional
|
Both
|
$2,739.00
|
|
|
Service Code
|
HCPCS 37230
|
| Min. Negotiated Rate |
$661.66 |
| Max. Negotiated Rate |
$1,780.35 |
| Rate for Payer: Aetna Commercial |
$886.62
|
| Rate for Payer: Aetna Medicare |
$688.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$952.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$886.62
|
| Rate for Payer: BCBS Complete |
$1,095.60
|
| Rate for Payer: BCBS MAPPO |
$661.66
|
| Rate for Payer: BCN Medicare Advantage |
$661.66
|
| Rate for Payer: Cash Price |
$2,191.20
|
| Rate for Payer: Cash Price |
$2,191.20
|
| Rate for Payer: Cofinity Commercial |
$952.79
|
| Rate for Payer: Cofinity Commercial |
$886.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$661.66
|
| Rate for Payer: Healthscope Commercial |
$1,224.07
|
| Rate for Payer: Healthscope Commercial |
$1,058.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$694.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,780.35
|
| Rate for Payer: Nomi Health Commercial |
$793.99
|
| Rate for Payer: PACE SWMI |
$661.66
|
| Rate for Payer: PHP Medicare Advantage |
$661.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,780.35
|
| Rate for Payer: Priority Health Medicare |
$661.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$661.66
|
| Rate for Payer: UHC Medicare Advantage |
$661.66
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 37234
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$495.04 |
| Rate for Payer: Aetna Commercial |
$358.57
|
| Rate for Payer: Aetna Medicare |
$278.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.57
|
| Rate for Payer: BCBS Complete |
$208.00
|
| Rate for Payer: BCBS MAPPO |
$267.59
|
| Rate for Payer: BCN Medicare Advantage |
$267.59
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cofinity Commercial |
$385.33
|
| Rate for Payer: Cofinity Commercial |
$358.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.59
|
| Rate for Payer: Healthscope Commercial |
$428.14
|
| Rate for Payer: Healthscope Commercial |
$495.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$280.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.00
|
| Rate for Payer: Nomi Health Commercial |
$321.11
|
| Rate for Payer: PACE SWMI |
$267.59
|
| Rate for Payer: PHP Medicare Advantage |
$267.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.00
|
| Rate for Payer: Priority Health Medicare |
$267.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.59
|
| Rate for Payer: UHC Medicare Advantage |
$267.59
|
|
