|
PR TCAT MITRAL VALVE REPAIR INITIAL PROSTHESIS
|
Professional
|
Both
|
$3,872.00
|
|
|
Service Code
|
HCPCS 33418
|
| Min. Negotiated Rate |
$1,008.13 |
| Max. Negotiated Rate |
$3,206.25 |
| Rate for Payer: Aetna Commercial |
$2,128.31
|
| Rate for Payer: Aetna Medicare |
$1,651.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,128.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,287.14
|
| Rate for Payer: BCBS Complete |
$1,058.54
|
| Rate for Payer: BCBS MAPPO |
$1,588.29
|
| Rate for Payer: BCN Commercial |
$2,635.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,588.29
|
| Rate for Payer: Cash Price |
$3,097.60
|
| Rate for Payer: Cash Price |
$3,097.60
|
| Rate for Payer: Cofinity Commercial |
$2,287.14
|
| Rate for Payer: Cofinity Commercial |
$2,128.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,588.29
|
| Rate for Payer: Healthscope Commercial |
$2,938.34
|
| Rate for Payer: Healthscope Commercial |
$2,541.26
|
| Rate for Payer: Mclaren Medicaid |
$1,008.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,667.70
|
| Rate for Payer: Meridian Medicaid |
$1,058.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,747.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,166.34
|
| Rate for Payer: Nomi Health Commercial |
$1,905.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,904.00
|
| Rate for Payer: PACE SWMI |
$1,588.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,588.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,008.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,834.48
|
| Rate for Payer: Priority Health Medicare |
$1,588.29
|
| Rate for Payer: Priority Health SBD |
$2,834.48
|
| Rate for Payer: Priority Health Tiered Network |
$2,834.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,588.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,206.25
|
| Rate for Payer: UHC Core |
$3,206.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,588.29
|
| Rate for Payer: UHC Exchange |
$3,206.25
|
| Rate for Payer: UHC Medicaid |
$1,008.13
|
| Rate for Payer: UHCCP Medicaid |
$1,008.13
|
|
|
PR TCAT PERM OCCLS/EMBOLIZATION PERQ CNS
|
Professional
|
Both
|
$4,763.00
|
|
|
Service Code
|
HCPCS 61624
|
| Min. Negotiated Rate |
$666.26 |
| Max. Negotiated Rate |
$3,572.25 |
| Rate for Payer: Aetna Commercial |
$1,415.72
|
| Rate for Payer: Aetna Medicare |
$1,098.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,415.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,521.37
|
| Rate for Payer: BCBS Complete |
$699.57
|
| Rate for Payer: BCBS MAPPO |
$1,056.51
|
| Rate for Payer: BCN Commercial |
$2,407.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,056.51
|
| Rate for Payer: Cash Price |
$3,810.40
|
| Rate for Payer: Cash Price |
$3,810.40
|
| Rate for Payer: Cofinity Commercial |
$1,521.37
|
| Rate for Payer: Cofinity Commercial |
$1,415.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,056.51
|
| Rate for Payer: Healthscope Commercial |
$1,954.54
|
| Rate for Payer: Healthscope Commercial |
$1,690.42
|
| Rate for Payer: Mclaren Medicaid |
$666.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,109.34
|
| Rate for Payer: Meridian Medicaid |
$699.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,162.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,090.11
|
| Rate for Payer: Nomi Health Commercial |
$1,267.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,572.25
|
| Rate for Payer: PACE SWMI |
$1,056.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,056.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$666.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,023.80
|
| Rate for Payer: Priority Health Medicare |
$1,056.51
|
| Rate for Payer: Priority Health SBD |
$2,023.80
|
| Rate for Payer: Priority Health Tiered Network |
$2,023.80
|
| Rate for Payer: Railroad Medicare Medicare |
$1,056.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,050.28
|
| Rate for Payer: UHC Core |
$2,050.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,056.51
|
| Rate for Payer: UHC Exchange |
$2,050.28
|
| Rate for Payer: UHC Medicaid |
$666.26
|
| Rate for Payer: UHCCP Medicaid |
$666.26
|
|
|
PR TCAT PERM OCCLS/EMBOLJ PERQ NON-CNS HEAD/NECK
|
Professional
|
Both
|
$1,904.00
|
|
|
Service Code
|
HCPCS 61626
|
| Min. Negotiated Rate |
$480.95 |
| Max. Negotiated Rate |
$1,607.94 |
| Rate for Payer: Aetna Commercial |
$1,019.98
|
| Rate for Payer: Aetna Medicare |
$791.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,019.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,096.10
|
| Rate for Payer: BCBS Complete |
$505.00
|
| Rate for Payer: BCBS MAPPO |
$761.18
|
| Rate for Payer: BCN Commercial |
$1,351.52
|
| Rate for Payer: BCN Medicare Advantage |
$761.18
|
| Rate for Payer: Cash Price |
$1,523.20
|
| Rate for Payer: Cash Price |
$1,523.20
|
| Rate for Payer: Cofinity Commercial |
$1,096.10
|
| Rate for Payer: Cofinity Commercial |
$1,019.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$761.18
|
| Rate for Payer: Healthscope Commercial |
$1,408.18
|
| Rate for Payer: Healthscope Commercial |
$1,217.89
|
| Rate for Payer: Mclaren Medicaid |
$480.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$799.24
|
| Rate for Payer: Meridian Medicaid |
$505.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$837.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,607.94
|
| Rate for Payer: Nomi Health Commercial |
$913.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,428.00
|
| Rate for Payer: PACE SWMI |
$761.18
|
| Rate for Payer: PHP Medicare Advantage |
$761.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$480.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,569.76
|
| Rate for Payer: Priority Health Medicare |
$761.18
|
| Rate for Payer: Priority Health SBD |
$1,569.76
|
| Rate for Payer: Priority Health Tiered Network |
$1,569.76
|
| Rate for Payer: Railroad Medicare Medicare |
$761.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,575.83
|
| Rate for Payer: UHC Core |
$1,575.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$761.18
|
| Rate for Payer: UHC Exchange |
$1,575.83
|
| Rate for Payer: UHC Medicaid |
$480.95
|
| Rate for Payer: UHCCP Medicaid |
$480.95
|
|
|
PR TCAT PLMT IV STENT ICRA W/BALO ANGIOP IF PFRMD
|
Professional
|
Both
|
$6,997.00
|
|
|
Service Code
|
HCPCS 61635
|
| Min. Negotiated Rate |
$1,359.71 |
| Max. Negotiated Rate |
$5,247.75 |
| Rate for Payer: Aetna Commercial |
$1,822.01
|
| Rate for Payer: Aetna Medicare |
$1,414.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,822.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,957.98
|
| Rate for Payer: BCBS Complete |
$2,798.80
|
| Rate for Payer: BCBS MAPPO |
$1,359.71
|
| Rate for Payer: BCN Commercial |
$2,241.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,359.71
|
| Rate for Payer: Cash Price |
$5,597.60
|
| Rate for Payer: Cash Price |
$5,597.60
|
| Rate for Payer: Cofinity Commercial |
$1,957.98
|
| Rate for Payer: Cofinity Commercial |
$1,822.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,359.71
|
| Rate for Payer: Healthscope Commercial |
$2,515.46
|
| Rate for Payer: Healthscope Commercial |
$2,175.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,427.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,495.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,651.92
|
| Rate for Payer: Nomi Health Commercial |
$1,631.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,247.75
|
| Rate for Payer: PACE SWMI |
$1,359.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,359.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,603.37
|
| Rate for Payer: Priority Health Medicare |
$1,359.71
|
| Rate for Payer: Priority Health SBD |
$2,603.37
|
| Rate for Payer: Priority Health Tiered Network |
$2,603.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,359.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,573.86
|
| Rate for Payer: UHC Core |
$2,573.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,359.71
|
| Rate for Payer: UHC Exchange |
$2,573.86
|
|
|
PR TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL
|
Professional
|
Both
|
$10,169.00
|
|
|
Service Code
|
HCPCS 0075T
|
| Min. Negotiated Rate |
$1,381.29 |
| Max. Negotiated Rate |
$10,427.07 |
| Rate for Payer: Aetna Commercial |
$1,381.29
|
| Rate for Payer: Aetna Medicare |
$5,084.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,381.29
|
| Rate for Payer: BCBS Complete |
$4,067.60
|
| Rate for Payer: BCN Commercial |
$6,509.92
|
| Rate for Payer: Cash Price |
$8,135.20
|
| Rate for Payer: Cash Price |
$8,135.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,023.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,626.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,900.00
|
| Rate for Payer: Priority Health SBD |
$5,900.00
|
| Rate for Payer: Priority Health Tiered Network |
$5,900.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,427.07
|
| Rate for Payer: UHC Core |
$10,427.07
|
| Rate for Payer: UHC Exchange |
$10,427.07
|
|
|
PR TCAT REMOVAL PERM LEADLESS PM RIGHT VENTR W/IMG
|
Professional
|
Both
|
$1,781.00
|
|
|
Service Code
|
HCPCS 33275
|
| Min. Negotiated Rate |
$285.21 |
| Max. Negotiated Rate |
$1,335.75 |
| Rate for Payer: Aetna Commercial |
$599.13
|
| Rate for Payer: Aetna Medicare |
$464.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$643.84
|
| Rate for Payer: BCBS Complete |
$299.47
|
| Rate for Payer: BCBS MAPPO |
$447.11
|
| Rate for Payer: BCN Commercial |
$742.99
|
| Rate for Payer: BCN Medicare Advantage |
$447.11
|
| Rate for Payer: Cash Price |
$1,424.80
|
| Rate for Payer: Cash Price |
$1,424.80
|
| Rate for Payer: Cofinity Commercial |
$643.84
|
| Rate for Payer: Cofinity Commercial |
$599.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.11
|
| Rate for Payer: Healthscope Commercial |
$827.15
|
| Rate for Payer: Healthscope Commercial |
$715.38
|
| Rate for Payer: Mclaren Medicaid |
$285.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.47
|
| Rate for Payer: Meridian Medicaid |
$299.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$491.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$888.01
|
| Rate for Payer: Nomi Health Commercial |
$536.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,335.75
|
| Rate for Payer: PACE SWMI |
$447.11
|
| Rate for Payer: PHP Medicare Advantage |
$447.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$285.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$798.99
|
| Rate for Payer: Priority Health Medicare |
$447.11
|
| Rate for Payer: Priority Health SBD |
$798.99
|
| Rate for Payer: Priority Health Tiered Network |
$798.99
|
| Rate for Payer: Railroad Medicare Medicare |
$447.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$943.76
|
| Rate for Payer: UHC Core |
$943.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$447.11
|
| Rate for Payer: UHC Exchange |
$943.76
|
| Rate for Payer: UHC Medicaid |
$285.21
|
| Rate for Payer: UHCCP Medicaid |
$285.21
|
|
|
PR TCD STD ICR ART VEN-ARTL SHNT DETCJ IV MBUBB NJX
|
Professional
|
Both
|
$695.00
|
|
|
Service Code
|
HCPCS 93893
|
| Min. Negotiated Rate |
$233.33 |
| Max. Negotiated Rate |
$625.12 |
| Rate for Payer: Aetna Commercial |
$452.79
|
| Rate for Payer: Aetna Medicare |
$351.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.58
|
| Rate for Payer: BCBS MAPPO |
$337.90
|
| Rate for Payer: BCN Commercial |
$498.48
|
| Rate for Payer: BCN Medicare Advantage |
$337.90
|
| Rate for Payer: Cash Price |
$556.00
|
| Rate for Payer: Cash Price |
$556.00
|
| Rate for Payer: Cofinity Commercial |
$452.79
|
| Rate for Payer: Cofinity Commercial |
$486.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.90
|
| Rate for Payer: Healthscope Commercial |
$625.12
|
| Rate for Payer: Healthscope Commercial |
$540.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$354.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$371.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.33
|
| Rate for Payer: Nomi Health Commercial |
$405.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$521.25
|
| Rate for Payer: PACE SWMI |
$337.90
|
| Rate for Payer: PHP Medicare Advantage |
$337.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$459.71
|
| Rate for Payer: Priority Health Medicare |
$337.90
|
| Rate for Payer: Priority Health SBD |
$459.71
|
| Rate for Payer: Priority Health Tiered Network |
$459.71
|
| Rate for Payer: Railroad Medicare Medicare |
$337.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.09
|
| Rate for Payer: UHC Core |
$543.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$337.90
|
| Rate for Payer: UHC Exchange |
$543.09
|
|
|
PR TDAP VACCINE 7 YRS/> IM
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 90715
|
| Min. Negotiated Rate |
$38.67 |
| Max. Negotiated Rate |
$73.04 |
| Rate for Payer: Aetna Commercial |
$52.90
|
| Rate for Payer: Aetna Medicare |
$41.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.90
|
| Rate for Payer: BCBS MAPPO |
$39.48
|
| Rate for Payer: BCBS Trust/PPO |
$48.75
|
| Rate for Payer: BCN Commercial |
$48.04
|
| Rate for Payer: BCN Medicare Advantage |
$39.48
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$56.85
|
| Rate for Payer: Cofinity Commercial |
$52.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$63.17
|
| Rate for Payer: Healthscope Commercial |
$73.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.67
|
| Rate for Payer: Nomi Health Commercial |
$47.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.50
|
| Rate for Payer: PACE SWMI |
$39.48
|
| Rate for Payer: PHP Medicare Advantage |
$39.48
|
| Rate for Payer: Priority Health Medicare |
$39.48
|
| Rate for Payer: Railroad Medicare Medicare |
$39.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.86
|
| Rate for Payer: UHC Core |
$49.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$39.48
|
| Rate for Payer: UHC Exchange |
$49.86
|
|
|
PR TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN
|
Professional
|
Both
|
$2,712.00
|
|
|
Service Code
|
HCPCS 25310
|
| Min. Negotiated Rate |
$426.21 |
| Max. Negotiated Rate |
$2,034.00 |
| Rate for Payer: Aetna Commercial |
$868.01
|
| Rate for Payer: Aetna Medicare |
$673.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$868.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$932.79
|
| Rate for Payer: BCBS Complete |
$447.52
|
| Rate for Payer: BCBS MAPPO |
$647.77
|
| Rate for Payer: BCN Commercial |
$1,093.07
|
| Rate for Payer: BCN Medicare Advantage |
$647.77
|
| Rate for Payer: Cash Price |
$2,169.60
|
| Rate for Payer: Cash Price |
$2,169.60
|
| Rate for Payer: Cofinity Commercial |
$932.79
|
| Rate for Payer: Cofinity Commercial |
$868.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.77
|
| Rate for Payer: Healthscope Commercial |
$1,198.37
|
| Rate for Payer: Healthscope Commercial |
$1,036.43
|
| Rate for Payer: Mclaren Medicaid |
$426.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$680.16
|
| Rate for Payer: Meridian Medicaid |
$447.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$712.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,104.19
|
| Rate for Payer: Nomi Health Commercial |
$777.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,034.00
|
| Rate for Payer: PACE SWMI |
$647.77
|
| Rate for Payer: PHP Medicare Advantage |
$647.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$426.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,168.47
|
| Rate for Payer: Priority Health Medicare |
$647.77
|
| Rate for Payer: Priority Health SBD |
$1,168.47
|
| Rate for Payer: Priority Health Tiered Network |
$1,168.47
|
| Rate for Payer: Railroad Medicare Medicare |
$647.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,076.29
|
| Rate for Payer: UHC Core |
$1,076.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$647.77
|
| Rate for Payer: UHC Exchange |
$1,076.29
|
| Rate for Payer: UHC Medicaid |
$426.21
|
| Rate for Payer: UHCCP Medicaid |
$426.21
|
|
|
PR TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1/TDN GR
|
Professional
|
Both
|
$1,630.00
|
|
|
Service Code
|
HCPCS 25312
|
| Min. Negotiated Rate |
$423.44 |
| Max. Negotiated Rate |
$1,276.09 |
| Rate for Payer: Aetna Commercial |
$867.80
|
| Rate for Payer: Aetna Medicare |
$673.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$867.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$932.56
|
| Rate for Payer: BCBS Complete |
$444.61
|
| Rate for Payer: BCBS MAPPO |
$647.61
|
| Rate for Payer: BCN Commercial |
$1,099.54
|
| Rate for Payer: BCN Medicare Advantage |
$647.61
|
| Rate for Payer: Cash Price |
$1,304.00
|
| Rate for Payer: Cash Price |
$1,304.00
|
| Rate for Payer: Cofinity Commercial |
$932.56
|
| Rate for Payer: Cofinity Commercial |
$867.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.61
|
| Rate for Payer: Healthscope Commercial |
$1,198.08
|
| Rate for Payer: Healthscope Commercial |
$1,036.18
|
| Rate for Payer: Mclaren Medicaid |
$423.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.99
|
| Rate for Payer: Meridian Medicaid |
$444.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$712.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,276.09
|
| Rate for Payer: Nomi Health Commercial |
$777.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,222.50
|
| Rate for Payer: PACE SWMI |
$647.61
|
| Rate for Payer: PHP Medicare Advantage |
$647.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$423.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,175.38
|
| Rate for Payer: Priority Health Medicare |
$647.61
|
| Rate for Payer: Priority Health SBD |
$1,175.38
|
| Rate for Payer: Priority Health Tiered Network |
$1,175.38
|
| Rate for Payer: Railroad Medicare Medicare |
$647.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,251.65
|
| Rate for Payer: UHC Core |
$1,251.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$647.61
|
| Rate for Payer: UHC Exchange |
$1,251.65
|
| Rate for Payer: UHC Medicaid |
$423.44
|
| Rate for Payer: UHCCP Medicaid |
$423.44
|
|
|
PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 90714
|
| Min. Negotiated Rate |
$28.65 |
| Max. Negotiated Rate |
$71.69 |
| Rate for Payer: Aetna Commercial |
$51.92
|
| Rate for Payer: Aetna Medicare |
$40.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.80
|
| Rate for Payer: BCBS MAPPO |
$38.75
|
| Rate for Payer: BCBS Trust/PPO |
$45.91
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: BCN Medicare Advantage |
$38.75
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$55.80
|
| Rate for Payer: Cofinity Commercial |
$51.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.75
|
| Rate for Payer: Healthscope Commercial |
$71.69
|
| Rate for Payer: Healthscope Commercial |
$62.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.65
|
| Rate for Payer: Nomi Health Commercial |
$46.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.00
|
| Rate for Payer: PACE SWMI |
$38.75
|
| Rate for Payer: PHP Medicare Advantage |
$38.75
|
| Rate for Payer: Priority Health Medicare |
$38.75
|
| Rate for Payer: Railroad Medicare Medicare |
$38.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.91
|
| Rate for Payer: UHC Core |
$45.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.75
|
| Rate for Payer: UHC Exchange |
$45.91
|
|
|
PR TEAEC W/GRAFT EA ADDL TIBIAL/PERONEAL ART
|
Professional
|
Both
|
$970.00
|
|
|
Service Code
|
HCPCS 35306
|
| Min. Negotiated Rate |
$256.67 |
| Max. Negotiated Rate |
$805.69 |
| Rate for Payer: Aetna Commercial |
$549.86
|
| Rate for Payer: Aetna Medicare |
$426.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.89
|
| Rate for Payer: BCBS Complete |
$269.50
|
| Rate for Payer: BCBS MAPPO |
$410.34
|
| Rate for Payer: BCN Commercial |
$647.87
|
| Rate for Payer: BCN Medicare Advantage |
$410.34
|
| Rate for Payer: Cash Price |
$776.00
|
| Rate for Payer: Cash Price |
$776.00
|
| Rate for Payer: Cofinity Commercial |
$590.89
|
| Rate for Payer: Cofinity Commercial |
$549.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$410.34
|
| Rate for Payer: Healthscope Commercial |
$759.13
|
| Rate for Payer: Healthscope Commercial |
$656.54
|
| Rate for Payer: Mclaren Medicaid |
$256.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$430.86
|
| Rate for Payer: Meridian Medicaid |
$269.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$451.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$793.67
|
| Rate for Payer: Nomi Health Commercial |
$492.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$727.50
|
| Rate for Payer: PACE SWMI |
$410.34
|
| Rate for Payer: PHP Medicare Advantage |
$410.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$256.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$696.71
|
| Rate for Payer: Priority Health Medicare |
$410.34
|
| Rate for Payer: Priority Health SBD |
$696.71
|
| Rate for Payer: Priority Health Tiered Network |
$696.71
|
| Rate for Payer: Railroad Medicare Medicare |
$410.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$805.69
|
| Rate for Payer: UHC Core |
$805.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$410.34
|
| Rate for Payer: UHC Exchange |
$805.69
|
| Rate for Payer: UHC Medicaid |
$256.67
|
| Rate for Payer: UHCCP Medicaid |
$256.67
|
|
|
PR TEAEC W/GRAFT POPLITEAL ARTERY
|
Professional
|
Both
|
$2,459.00
|
|
|
Service Code
|
HCPCS 35303
|
| Min. Negotiated Rate |
$710.14 |
| Max. Negotiated Rate |
$2,223.89 |
| Rate for Payer: Aetna Commercial |
$1,508.53
|
| Rate for Payer: Aetna Medicare |
$1,170.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,508.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,621.11
|
| Rate for Payer: BCBS Complete |
$745.65
|
| Rate for Payer: BCBS MAPPO |
$1,125.77
|
| Rate for Payer: BCN Commercial |
$1,789.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,125.77
|
| Rate for Payer: Cash Price |
$1,967.20
|
| Rate for Payer: Cash Price |
$1,967.20
|
| Rate for Payer: Cofinity Commercial |
$1,621.11
|
| Rate for Payer: Cofinity Commercial |
$1,508.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,125.77
|
| Rate for Payer: Healthscope Commercial |
$2,082.67
|
| Rate for Payer: Healthscope Commercial |
$1,801.23
|
| Rate for Payer: Mclaren Medicaid |
$710.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,182.06
|
| Rate for Payer: Meridian Medicaid |
$745.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,238.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,192.81
|
| Rate for Payer: Nomi Health Commercial |
$1,350.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,844.25
|
| Rate for Payer: PACE SWMI |
$1,125.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,125.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$710.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,924.64
|
| Rate for Payer: Priority Health Medicare |
$1,125.77
|
| Rate for Payer: Priority Health SBD |
$1,924.64
|
| Rate for Payer: Priority Health Tiered Network |
$1,924.64
|
| Rate for Payer: Railroad Medicare Medicare |
$1,125.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,223.89
|
| Rate for Payer: UHC Core |
$2,223.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,125.77
|
| Rate for Payer: UHC Exchange |
$2,223.89
|
| Rate for Payer: UHC Medicaid |
$710.14
|
| Rate for Payer: UHCCP Medicaid |
$710.14
|
|
|
PR TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY
|
Professional
|
Both
|
$2,258.00
|
|
|
Service Code
|
HCPCS 35302
|
| Min. Negotiated Rate |
$645.60 |
| Max. Negotiated Rate |
$2,013.84 |
| Rate for Payer: Aetna Commercial |
$1,370.87
|
| Rate for Payer: Aetna Medicare |
$1,063.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,370.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,473.18
|
| Rate for Payer: BCBS Complete |
$677.88
|
| Rate for Payer: BCBS MAPPO |
$1,023.04
|
| Rate for Payer: BCN Commercial |
$1,628.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,023.04
|
| Rate for Payer: Cash Price |
$1,806.40
|
| Rate for Payer: Cash Price |
$1,806.40
|
| Rate for Payer: Cofinity Commercial |
$1,473.18
|
| Rate for Payer: Cofinity Commercial |
$1,370.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,023.04
|
| Rate for Payer: Healthscope Commercial |
$1,892.62
|
| Rate for Payer: Healthscope Commercial |
$1,636.86
|
| Rate for Payer: Mclaren Medicaid |
$645.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,074.19
|
| Rate for Payer: Meridian Medicaid |
$677.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,125.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,983.71
|
| Rate for Payer: Nomi Health Commercial |
$1,227.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,693.50
|
| Rate for Payer: PACE SWMI |
$1,023.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,023.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$645.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,751.66
|
| Rate for Payer: Priority Health Medicare |
$1,023.04
|
| Rate for Payer: Priority Health SBD |
$1,751.66
|
| Rate for Payer: Priority Health Tiered Network |
$1,751.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1,023.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,013.84
|
| Rate for Payer: UHC Core |
$2,013.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,023.04
|
| Rate for Payer: UHC Exchange |
$2,013.84
|
| Rate for Payer: UHC Medicaid |
$645.60
|
| Rate for Payer: UHCCP Medicaid |
$645.60
|
|
|
PR TEAEC W/GRAFT TIBIAL/PERONEAL ART 1ST VESSEL
|
Professional
|
Both
|
$2,483.00
|
|
|
Service Code
|
HCPCS 35305
|
| Min. Negotiated Rate |
$702.05 |
| Max. Negotiated Rate |
$2,201.48 |
| Rate for Payer: Aetna Commercial |
$1,493.11
|
| Rate for Payer: Aetna Medicare |
$1,158.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,493.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,604.53
|
| Rate for Payer: BCBS Complete |
$737.15
|
| Rate for Payer: BCBS MAPPO |
$1,114.26
|
| Rate for Payer: BCN Commercial |
$1,784.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,114.26
|
| Rate for Payer: Cash Price |
$1,986.40
|
| Rate for Payer: Cash Price |
$1,986.40
|
| Rate for Payer: Cofinity Commercial |
$1,604.53
|
| Rate for Payer: Cofinity Commercial |
$1,493.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,114.26
|
| Rate for Payer: Healthscope Commercial |
$2,061.38
|
| Rate for Payer: Healthscope Commercial |
$1,782.82
|
| Rate for Payer: Mclaren Medicaid |
$702.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,169.97
|
| Rate for Payer: Meridian Medicaid |
$737.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,225.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,169.16
|
| Rate for Payer: Nomi Health Commercial |
$1,337.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,862.25
|
| Rate for Payer: PACE SWMI |
$1,114.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,114.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$702.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,919.29
|
| Rate for Payer: Priority Health Medicare |
$1,114.26
|
| Rate for Payer: Priority Health SBD |
$1,919.29
|
| Rate for Payer: Priority Health Tiered Network |
$1,919.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,114.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,201.48
|
| Rate for Payer: UHC Core |
$2,201.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,114.26
|
| Rate for Payer: UHC Exchange |
$2,201.48
|
| Rate for Payer: UHC Medicaid |
$702.05
|
| Rate for Payer: UHCCP Medicaid |
$702.05
|
|
|
PR TEAEC W/GRAFT TIBIOPERONEAL TRUNK ARTERY
|
Professional
|
Both
|
$2,584.00
|
|
|
Service Code
|
HCPCS 35304
|
| Min. Negotiated Rate |
$736.98 |
| Max. Negotiated Rate |
$2,292.14 |
| Rate for Payer: Aetna Commercial |
$1,566.84
|
| Rate for Payer: Aetna Medicare |
$1,216.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,566.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,683.76
|
| Rate for Payer: BCBS Complete |
$773.83
|
| Rate for Payer: BCBS MAPPO |
$1,169.28
|
| Rate for Payer: BCN Commercial |
$1,859.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,169.28
|
| Rate for Payer: Cash Price |
$2,067.20
|
| Rate for Payer: Cash Price |
$2,067.20
|
| Rate for Payer: Cofinity Commercial |
$1,683.76
|
| Rate for Payer: Cofinity Commercial |
$1,566.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,169.28
|
| Rate for Payer: Healthscope Commercial |
$2,163.17
|
| Rate for Payer: Healthscope Commercial |
$1,870.85
|
| Rate for Payer: Mclaren Medicaid |
$736.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,227.74
|
| Rate for Payer: Meridian Medicaid |
$773.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,286.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,255.11
|
| Rate for Payer: Nomi Health Commercial |
$1,403.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,938.00
|
| Rate for Payer: PACE SWMI |
$1,169.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,169.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$736.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,000.15
|
| Rate for Payer: Priority Health Medicare |
$1,169.28
|
| Rate for Payer: Priority Health SBD |
$2,000.15
|
| Rate for Payer: Priority Health Tiered Network |
$2,000.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1,169.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,292.14
|
| Rate for Payer: UHC Core |
$2,292.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,169.28
|
| Rate for Payer: UHC Exchange |
$2,292.14
|
| Rate for Payer: UHC Medicaid |
$736.98
|
| Rate for Payer: UHCCP Medicaid |
$736.98
|
|
|
PR TEAEC W/PATCH GRF CAROTID VERTB SUBCLAV NECK INC
|
Professional
|
Both
|
$3,809.00
|
|
|
Service Code
|
HCPCS 35301
|
| Min. Negotiated Rate |
$654.12 |
| Max. Negotiated Rate |
$2,856.75 |
| Rate for Payer: Aetna Commercial |
$1,387.06
|
| Rate for Payer: Aetna Medicare |
$1,076.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,387.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,490.57
|
| Rate for Payer: BCBS Complete |
$686.83
|
| Rate for Payer: BCBS MAPPO |
$1,035.12
|
| Rate for Payer: BCN Commercial |
$1,649.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,035.12
|
| Rate for Payer: Cash Price |
$3,047.20
|
| Rate for Payer: Cash Price |
$3,047.20
|
| Rate for Payer: Cofinity Commercial |
$1,490.57
|
| Rate for Payer: Cofinity Commercial |
$1,387.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,035.12
|
| Rate for Payer: Healthscope Commercial |
$1,914.97
|
| Rate for Payer: Healthscope Commercial |
$1,656.19
|
| Rate for Payer: Mclaren Medicaid |
$654.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,086.88
|
| Rate for Payer: Meridian Medicaid |
$686.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,138.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,001.62
|
| Rate for Payer: Nomi Health Commercial |
$1,242.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,856.75
|
| Rate for Payer: PACE SWMI |
$1,035.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,035.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$654.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,773.63
|
| Rate for Payer: Priority Health Medicare |
$1,035.12
|
| Rate for Payer: Priority Health SBD |
$1,773.63
|
| Rate for Payer: Priority Health Tiered Network |
$1,773.63
|
| Rate for Payer: Railroad Medicare Medicare |
$1,035.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,030.06
|
| Rate for Payer: UHC Core |
$2,030.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,035.12
|
| Rate for Payer: UHC Exchange |
$2,030.06
|
| Rate for Payer: UHC Medicaid |
$654.12
|
| Rate for Payer: UHCCP Medicaid |
$654.12
|
|
|
PR TEAEC W/WO PATCH GRAFT ABDOMINAL AORTA
|
Professional
|
Both
|
$4,876.00
|
|
|
Service Code
|
HCPCS 35331
|
| Min. Negotiated Rate |
$810.47 |
| Max. Negotiated Rate |
$3,657.00 |
| Rate for Payer: Aetna Commercial |
$1,726.80
|
| Rate for Payer: Aetna Medicare |
$1,340.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,726.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,855.67
|
| Rate for Payer: BCBS Complete |
$850.99
|
| Rate for Payer: BCBS MAPPO |
$1,288.66
|
| Rate for Payer: BCN Commercial |
$2,113.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,288.66
|
| Rate for Payer: Cash Price |
$3,900.80
|
| Rate for Payer: Cash Price |
$3,900.80
|
| Rate for Payer: Cofinity Commercial |
$1,855.67
|
| Rate for Payer: Cofinity Commercial |
$1,726.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,288.66
|
| Rate for Payer: Healthscope Commercial |
$2,384.02
|
| Rate for Payer: Healthscope Commercial |
$2,061.86
|
| Rate for Payer: Mclaren Medicaid |
$810.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,353.09
|
| Rate for Payer: Meridian Medicaid |
$850.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,417.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,588.45
|
| Rate for Payer: Nomi Health Commercial |
$1,546.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,657.00
|
| Rate for Payer: PACE SWMI |
$1,288.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,288.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$810.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,273.27
|
| Rate for Payer: Priority Health Medicare |
$1,288.66
|
| Rate for Payer: Priority Health SBD |
$2,273.27
|
| Rate for Payer: Priority Health Tiered Network |
$2,273.27
|
| Rate for Payer: Railroad Medicare Medicare |
$1,288.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,609.18
|
| Rate for Payer: UHC Core |
$2,609.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,288.66
|
| Rate for Payer: UHC Exchange |
$2,609.18
|
| Rate for Payer: UHC Medicaid |
$810.47
|
| Rate for Payer: UHCCP Medicaid |
$810.47
|
|
|
PR TEAEC W/WO PATCH GRAFT COMBINED AORTOILIOFEMORAL
|
Professional
|
Both
|
$3,441.00
|
|
|
Service Code
|
HCPCS 35363
|
| Min. Negotiated Rate |
$941.25 |
| Max. Negotiated Rate |
$2,925.22 |
| Rate for Payer: Aetna Commercial |
$2,006.58
|
| Rate for Payer: Aetna Medicare |
$1,557.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,006.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,156.33
|
| Rate for Payer: BCBS Complete |
$988.31
|
| Rate for Payer: BCBS MAPPO |
$1,497.45
|
| Rate for Payer: BCN Commercial |
$2,373.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,497.45
|
| Rate for Payer: Cash Price |
$2,752.80
|
| Rate for Payer: Cash Price |
$2,752.80
|
| Rate for Payer: Cofinity Commercial |
$2,156.33
|
| Rate for Payer: Cofinity Commercial |
$2,006.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,497.45
|
| Rate for Payer: Healthscope Commercial |
$2,770.28
|
| Rate for Payer: Healthscope Commercial |
$2,395.92
|
| Rate for Payer: Mclaren Medicaid |
$941.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,572.32
|
| Rate for Payer: Meridian Medicaid |
$988.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,647.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,883.91
|
| Rate for Payer: Nomi Health Commercial |
$1,796.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,580.75
|
| Rate for Payer: PACE SWMI |
$1,497.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,497.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$941.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,552.81
|
| Rate for Payer: Priority Health Medicare |
$1,497.45
|
| Rate for Payer: Priority Health SBD |
$2,552.81
|
| Rate for Payer: Priority Health Tiered Network |
$2,552.81
|
| Rate for Payer: Railroad Medicare Medicare |
$1,497.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,925.22
|
| Rate for Payer: UHC Core |
$2,925.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,497.45
|
| Rate for Payer: UHC Exchange |
$2,925.22
|
| Rate for Payer: UHC Medicaid |
$941.25
|
| Rate for Payer: UHCCP Medicaid |
$941.25
|
|
|
PR TEAEC W/WO PATCH GRAFT COMMON FEMORAL
|
Professional
|
Both
|
$1,804.00
|
|
|
Service Code
|
HCPCS 35371
|
| Min. Negotiated Rate |
$471.80 |
| Max. Negotiated Rate |
$1,465.55 |
| Rate for Payer: Aetna Commercial |
$999.99
|
| Rate for Payer: Aetna Medicare |
$776.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,074.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.99
|
| Rate for Payer: BCBS Complete |
$495.39
|
| Rate for Payer: BCBS MAPPO |
$746.26
|
| Rate for Payer: BCN Commercial |
$1,189.68
|
| Rate for Payer: BCN Medicare Advantage |
$746.26
|
| Rate for Payer: Cash Price |
$1,443.20
|
| Rate for Payer: Cash Price |
$1,443.20
|
| Rate for Payer: Cofinity Commercial |
$999.99
|
| Rate for Payer: Cofinity Commercial |
$1,074.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$746.26
|
| Rate for Payer: Healthscope Commercial |
$1,380.58
|
| Rate for Payer: Healthscope Commercial |
$1,194.02
|
| Rate for Payer: Mclaren Medicaid |
$471.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$783.57
|
| Rate for Payer: Meridian Medicaid |
$495.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$820.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,443.44
|
| Rate for Payer: Nomi Health Commercial |
$895.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,353.00
|
| Rate for Payer: PACE SWMI |
$746.26
|
| Rate for Payer: PHP Medicare Advantage |
$746.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$471.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,279.35
|
| Rate for Payer: Priority Health Medicare |
$746.26
|
| Rate for Payer: Priority Health SBD |
$1,279.35
|
| Rate for Payer: Priority Health Tiered Network |
$1,279.35
|
| Rate for Payer: Railroad Medicare Medicare |
$746.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,465.55
|
| Rate for Payer: UHC Core |
$1,465.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$746.26
|
| Rate for Payer: UHC Exchange |
$1,465.55
|
| Rate for Payer: UHC Medicaid |
$471.80
|
| Rate for Payer: UHCCP Medicaid |
$471.80
|
|
|
PR TEAEC W/WO PATCH GRAFT DEEP PROFUNDA FEMORAL
|
Professional
|
Both
|
$3,886.00
|
|
|
Service Code
|
HCPCS 35372
|
| Min. Negotiated Rate |
$564.66 |
| Max. Negotiated Rate |
$2,914.50 |
| Rate for Payer: PHP Medicare Advantage |
$894.41
|
| Rate for Payer: Aetna Commercial |
$1,198.51
|
| Rate for Payer: Aetna Medicare |
$930.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,198.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,287.95
|
| Rate for Payer: BCBS Complete |
$592.89
|
| Rate for Payer: BCBS MAPPO |
$894.41
|
| Rate for Payer: BCN Commercial |
$1,423.72
|
| Rate for Payer: BCN Medicare Advantage |
$894.41
|
| Rate for Payer: Cash Price |
$3,108.80
|
| Rate for Payer: Cash Price |
$3,108.80
|
| Rate for Payer: Cofinity Commercial |
$1,287.95
|
| Rate for Payer: Cofinity Commercial |
$1,198.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$894.41
|
| Rate for Payer: Healthscope Commercial |
$1,654.66
|
| Rate for Payer: Healthscope Commercial |
$1,431.06
|
| Rate for Payer: Mclaren Medicaid |
$564.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$939.13
|
| Rate for Payer: Meridian Medicaid |
$592.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$983.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.30
|
| Rate for Payer: Nomi Health Commercial |
$1,073.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,914.50
|
| Rate for Payer: PACE SWMI |
$894.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$564.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,531.04
|
| Rate for Payer: Priority Health Medicare |
$894.41
|
| Rate for Payer: Priority Health SBD |
$1,531.04
|
| Rate for Payer: Priority Health Tiered Network |
$1,531.04
|
| Rate for Payer: Railroad Medicare Medicare |
$894.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,757.17
|
| Rate for Payer: UHC Core |
$1,757.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$894.41
|
| Rate for Payer: UHC Exchange |
$1,757.17
|
| Rate for Payer: UHC Medicaid |
$564.66
|
| Rate for Payer: UHCCP Medicaid |
$564.66
|
|
|
PR TEAEC W/WO PATCH GRAFT ILIAC
|
Professional
|
Both
|
$2,604.00
|
|
|
Service Code
|
HCPCS 35351
|
| Min. Negotiated Rate |
$745.93 |
| Max. Negotiated Rate |
$2,305.88 |
| Rate for Payer: Aetna Commercial |
$1,584.00
|
| Rate for Payer: Aetna Medicare |
$1,229.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,584.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,702.21
|
| Rate for Payer: BCBS Complete |
$783.23
|
| Rate for Payer: BCBS MAPPO |
$1,182.09
|
| Rate for Payer: BCN Commercial |
$1,879.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,182.09
|
| Rate for Payer: Cash Price |
$2,083.20
|
| Rate for Payer: Cash Price |
$2,083.20
|
| Rate for Payer: Cofinity Commercial |
$1,702.21
|
| Rate for Payer: Cofinity Commercial |
$1,584.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,182.09
|
| Rate for Payer: Healthscope Commercial |
$2,186.87
|
| Rate for Payer: Healthscope Commercial |
$1,891.34
|
| Rate for Payer: Mclaren Medicaid |
$745.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,241.19
|
| Rate for Payer: Meridian Medicaid |
$783.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,300.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,275.88
|
| Rate for Payer: Nomi Health Commercial |
$1,418.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,953.00
|
| Rate for Payer: PACE SWMI |
$1,182.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,182.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,021.57
|
| Rate for Payer: Priority Health Medicare |
$1,182.09
|
| Rate for Payer: Priority Health SBD |
$2,021.57
|
| Rate for Payer: Priority Health Tiered Network |
$2,021.57
|
| Rate for Payer: Railroad Medicare Medicare |
$1,182.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,305.88
|
| Rate for Payer: UHC Core |
$2,305.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,182.09
|
| Rate for Payer: UHC Exchange |
$2,305.88
|
| Rate for Payer: UHC Medicaid |
$745.93
|
| Rate for Payer: UHCCP Medicaid |
$745.93
|
|
|
PR TEAEC W/WO PATCH GRAFT ILIOFEMORAL
|
Professional
|
Both
|
$2,115.00
|
|
|
Service Code
|
HCPCS 35355
|
| Min. Negotiated Rate |
$594.70 |
| Max. Negotiated Rate |
$1,854.18 |
| Rate for Payer: Aetna Commercial |
$1,263.95
|
| Rate for Payer: Aetna Medicare |
$980.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,263.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,358.28
|
| Rate for Payer: BCBS Complete |
$624.43
|
| Rate for Payer: BCBS MAPPO |
$943.25
|
| Rate for Payer: BCN Commercial |
$1,501.41
|
| Rate for Payer: BCN Medicare Advantage |
$943.25
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cofinity Commercial |
$1,358.28
|
| Rate for Payer: Cofinity Commercial |
$1,263.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$943.25
|
| Rate for Payer: Healthscope Commercial |
$1,745.01
|
| Rate for Payer: Healthscope Commercial |
$1,509.20
|
| Rate for Payer: Mclaren Medicaid |
$594.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$990.41
|
| Rate for Payer: Meridian Medicaid |
$624.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,037.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,823.72
|
| Rate for Payer: Nomi Health Commercial |
$1,131.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,586.25
|
| Rate for Payer: PACE SWMI |
$943.25
|
| Rate for Payer: PHP Medicare Advantage |
$943.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$594.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,614.58
|
| Rate for Payer: Priority Health Medicare |
$943.25
|
| Rate for Payer: Priority Health SBD |
$1,614.58
|
| Rate for Payer: Priority Health Tiered Network |
$1,614.58
|
| Rate for Payer: Railroad Medicare Medicare |
$943.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,854.18
|
| Rate for Payer: UHC Core |
$1,854.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$943.25
|
| Rate for Payer: UHC Exchange |
$1,854.18
|
| Rate for Payer: UHC Medicaid |
$594.70
|
| Rate for Payer: UHCCP Medicaid |
$594.70
|
|
|
PR TEAEC W/WO PATCH GRAFT MESENTERIC CELIAC/RENAL
|
Professional
|
Both
|
$4,643.00
|
|
|
Service Code
|
HCPCS 35341
|
| Min. Negotiated Rate |
$793.21 |
| Max. Negotiated Rate |
$3,482.25 |
| Rate for Payer: Aetna Commercial |
$1,683.70
|
| Rate for Payer: Aetna Medicare |
$1,306.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,683.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,809.35
|
| Rate for Payer: BCBS Complete |
$832.87
|
| Rate for Payer: BCBS MAPPO |
$1,256.49
|
| Rate for Payer: BCN Commercial |
$2,009.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,256.49
|
| Rate for Payer: Cash Price |
$3,714.40
|
| Rate for Payer: Cash Price |
$3,714.40
|
| Rate for Payer: Cofinity Commercial |
$1,809.35
|
| Rate for Payer: Cofinity Commercial |
$1,683.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,256.49
|
| Rate for Payer: Healthscope Commercial |
$2,324.51
|
| Rate for Payer: Healthscope Commercial |
$2,010.38
|
| Rate for Payer: Mclaren Medicaid |
$793.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,319.31
|
| Rate for Payer: Meridian Medicaid |
$832.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,382.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,448.94
|
| Rate for Payer: Nomi Health Commercial |
$1,507.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,482.25
|
| Rate for Payer: PACE SWMI |
$1,256.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,256.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$793.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,161.33
|
| Rate for Payer: Priority Health Medicare |
$1,256.49
|
| Rate for Payer: Priority Health SBD |
$2,161.33
|
| Rate for Payer: Priority Health Tiered Network |
$2,161.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,256.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,470.10
|
| Rate for Payer: UHC Core |
$2,470.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,256.49
|
| Rate for Payer: UHC Exchange |
$2,470.10
|
| Rate for Payer: UHC Medicaid |
$793.21
|
| Rate for Payer: UHCCP Medicaid |
$793.21
|
|
|
PR TEAEC W/WO PATCH GRF AXILLARY-BRACHIAL
|
Professional
|
Both
|
$3,971.00
|
|
|
Service Code
|
HCPCS 35321
|
| Min. Negotiated Rate |
$526.75 |
| Max. Negotiated Rate |
$2,978.25 |
| Rate for Payer: Aetna Commercial |
$1,113.58
|
| Rate for Payer: Aetna Medicare |
$864.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,113.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,196.68
|
| Rate for Payer: BCBS Complete |
$553.09
|
| Rate for Payer: BCBS MAPPO |
$831.03
|
| Rate for Payer: BCN Commercial |
$1,329.11
|
| Rate for Payer: BCN Medicare Advantage |
$831.03
|
| Rate for Payer: Cash Price |
$3,176.80
|
| Rate for Payer: Cash Price |
$3,176.80
|
| Rate for Payer: Cofinity Commercial |
$1,196.68
|
| Rate for Payer: Cofinity Commercial |
$1,113.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$831.03
|
| Rate for Payer: Healthscope Commercial |
$1,537.41
|
| Rate for Payer: Healthscope Commercial |
$1,329.65
|
| Rate for Payer: Mclaren Medicaid |
$526.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$872.58
|
| Rate for Payer: Meridian Medicaid |
$553.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$914.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,586.21
|
| Rate for Payer: Nomi Health Commercial |
$997.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,978.25
|
| Rate for Payer: PACE SWMI |
$831.03
|
| Rate for Payer: PHP Medicare Advantage |
$831.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$526.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,429.29
|
| Rate for Payer: Priority Health Medicare |
$831.03
|
| Rate for Payer: Priority Health SBD |
$1,429.29
|
| Rate for Payer: Priority Health Tiered Network |
$1,429.29
|
| Rate for Payer: Railroad Medicare Medicare |
$831.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,599.81
|
| Rate for Payer: UHC Core |
$1,599.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$831.03
|
| Rate for Payer: UHC Exchange |
$1,599.81
|
| Rate for Payer: UHC Medicaid |
$526.75
|
| Rate for Payer: UHCCP Medicaid |
$526.75
|
|
