|
PR TEAEC W/GRAFT POPLITEAL ARTERY
|
Professional
|
Both
|
$2,387.00
|
|
|
Service Code
|
HCPCS 35303
|
| Min. Negotiated Rate |
$954.80 |
| Max. Negotiated Rate |
$2,175.58 |
| Rate for Payer: Aetna Commercial |
$1,575.83
|
| Rate for Payer: Aetna Medicare |
$1,223.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,693.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,575.83
|
| Rate for Payer: BCBS Complete |
$954.80
|
| Rate for Payer: BCBS MAPPO |
$1,175.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,175.99
|
| Rate for Payer: Cash Price |
$1,909.60
|
| Rate for Payer: Cash Price |
$1,909.60
|
| Rate for Payer: Cofinity Commercial |
$1,693.43
|
| Rate for Payer: Cofinity Commercial |
$1,575.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,175.99
|
| Rate for Payer: Healthscope Commercial |
$1,881.58
|
| Rate for Payer: Healthscope Commercial |
$2,175.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,234.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,551.55
|
| Rate for Payer: Nomi Health Commercial |
$1,411.19
|
| Rate for Payer: PACE SWMI |
$1,175.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,175.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,551.55
|
| Rate for Payer: Priority Health Medicare |
$1,175.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,175.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,175.99
|
|
|
PR TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY
|
Professional
|
Both
|
$2,192.00
|
|
|
Service Code
|
HCPCS 35302
|
| Min. Negotiated Rate |
$876.80 |
| Max. Negotiated Rate |
$1,978.89 |
| Rate for Payer: Aetna Commercial |
$1,433.36
|
| Rate for Payer: Aetna Medicare |
$1,112.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,540.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,433.36
|
| Rate for Payer: BCBS Complete |
$876.80
|
| Rate for Payer: BCBS MAPPO |
$1,069.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,069.67
|
| Rate for Payer: Cash Price |
$1,753.60
|
| Rate for Payer: Cash Price |
$1,753.60
|
| Rate for Payer: Cofinity Commercial |
$1,540.32
|
| Rate for Payer: Cofinity Commercial |
$1,433.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,069.67
|
| Rate for Payer: Healthscope Commercial |
$1,978.89
|
| Rate for Payer: Healthscope Commercial |
$1,711.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,123.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,424.80
|
| Rate for Payer: Nomi Health Commercial |
$1,283.60
|
| Rate for Payer: PACE SWMI |
$1,069.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,069.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,424.80
|
| Rate for Payer: Priority Health Medicare |
$1,069.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,069.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,069.67
|
|
|
PR TEAEC W/GRAFT TIBIAL/PERONEAL ART 1ST VESSEL
|
Professional
|
Both
|
$2,411.00
|
|
|
Service Code
|
HCPCS 35305
|
| Min. Negotiated Rate |
$964.40 |
| Max. Negotiated Rate |
$2,170.61 |
| Rate for Payer: Aetna Commercial |
$1,572.22
|
| Rate for Payer: Aetna Medicare |
$1,220.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,689.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,572.22
|
| Rate for Payer: BCBS Complete |
$964.40
|
| Rate for Payer: BCBS MAPPO |
$1,173.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,173.30
|
| Rate for Payer: Cash Price |
$1,928.80
|
| Rate for Payer: Cash Price |
$1,928.80
|
| Rate for Payer: Cofinity Commercial |
$1,689.55
|
| Rate for Payer: Cofinity Commercial |
$1,572.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,173.30
|
| Rate for Payer: Healthscope Commercial |
$1,877.28
|
| Rate for Payer: Healthscope Commercial |
$2,170.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,231.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,567.15
|
| Rate for Payer: Nomi Health Commercial |
$1,407.96
|
| Rate for Payer: PACE SWMI |
$1,173.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,173.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,567.15
|
| Rate for Payer: Priority Health Medicare |
$1,173.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,173.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,173.30
|
|
|
PR TEAEC W/GRAFT TIBIOPERONEAL TRUNK ARTERY
|
Professional
|
Both
|
$2,509.00
|
|
|
Service Code
|
HCPCS 35304
|
| Min. Negotiated Rate |
$1,003.60 |
| Max. Negotiated Rate |
$2,262.16 |
| Rate for Payer: Aetna Commercial |
$1,638.54
|
| Rate for Payer: Aetna Medicare |
$1,271.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,760.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,638.54
|
| Rate for Payer: BCBS Complete |
$1,003.60
|
| Rate for Payer: BCBS MAPPO |
$1,222.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,222.79
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cofinity Commercial |
$1,760.82
|
| Rate for Payer: Cofinity Commercial |
$1,638.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,222.79
|
| Rate for Payer: Healthscope Commercial |
$2,262.16
|
| Rate for Payer: Healthscope Commercial |
$1,956.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,283.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,630.85
|
| Rate for Payer: Nomi Health Commercial |
$1,467.35
|
| Rate for Payer: PACE SWMI |
$1,222.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,222.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.85
|
| Rate for Payer: Priority Health Medicare |
$1,222.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,222.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,222.79
|
|
|
PR TEAEC W/PATCH GRF CAROTID VERTB SUBCLAV NECK INC
|
Professional
|
Both
|
$3,698.00
|
|
|
Service Code
|
HCPCS 35301
|
| Min. Negotiated Rate |
$1,081.80 |
| Max. Negotiated Rate |
$2,403.70 |
| Rate for Payer: Aetna Commercial |
$1,449.61
|
| Rate for Payer: Aetna Medicare |
$1,125.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,557.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,449.61
|
| Rate for Payer: BCBS Complete |
$1,479.20
|
| Rate for Payer: BCBS MAPPO |
$1,081.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,081.80
|
| Rate for Payer: Cash Price |
$2,958.40
|
| Rate for Payer: Cash Price |
$2,958.40
|
| Rate for Payer: Cofinity Commercial |
$1,557.79
|
| Rate for Payer: Cofinity Commercial |
$1,449.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,081.80
|
| Rate for Payer: Healthscope Commercial |
$1,730.88
|
| Rate for Payer: Healthscope Commercial |
$2,001.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,135.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,403.70
|
| Rate for Payer: Nomi Health Commercial |
$1,298.16
|
| Rate for Payer: PACE SWMI |
$1,081.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,081.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,403.70
|
| Rate for Payer: Priority Health Medicare |
$1,081.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,081.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.80
|
|
|
PR TEAEC W/WO PATCH GRAFT ABDOMINAL AORTA
|
Professional
|
Both
|
$4,734.00
|
|
|
Service Code
|
HCPCS 35331
|
| Min. Negotiated Rate |
$1,387.99 |
| Max. Negotiated Rate |
$3,077.10 |
| Rate for Payer: Aetna Commercial |
$1,859.91
|
| Rate for Payer: Aetna Medicare |
$1,443.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,998.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,859.91
|
| Rate for Payer: BCBS Complete |
$1,893.60
|
| Rate for Payer: BCBS MAPPO |
$1,387.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,387.99
|
| Rate for Payer: Cash Price |
$3,787.20
|
| Rate for Payer: Cash Price |
$3,787.20
|
| Rate for Payer: Cofinity Commercial |
$1,998.71
|
| Rate for Payer: Cofinity Commercial |
$1,859.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,387.99
|
| Rate for Payer: Healthscope Commercial |
$2,567.78
|
| Rate for Payer: Healthscope Commercial |
$2,220.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,457.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,077.10
|
| Rate for Payer: Nomi Health Commercial |
$1,665.59
|
| Rate for Payer: PACE SWMI |
$1,387.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,387.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,077.10
|
| Rate for Payer: Priority Health Medicare |
$1,387.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,387.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,387.99
|
|
|
PR TEAEC W/WO PATCH GRAFT COMBINED AORTOILIOFEMORAL
|
Professional
|
Both
|
$3,341.00
|
|
|
Service Code
|
HCPCS 35363
|
| Min. Negotiated Rate |
$1,336.40 |
| Max. Negotiated Rate |
$2,896.30 |
| Rate for Payer: Aetna Commercial |
$2,097.86
|
| Rate for Payer: Aetna Medicare |
$1,628.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,254.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,097.86
|
| Rate for Payer: BCBS Complete |
$1,336.40
|
| Rate for Payer: BCBS MAPPO |
$1,565.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,565.57
|
| Rate for Payer: Cash Price |
$2,672.80
|
| Rate for Payer: Cash Price |
$2,672.80
|
| Rate for Payer: Cofinity Commercial |
$2,254.42
|
| Rate for Payer: Cofinity Commercial |
$2,097.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,565.57
|
| Rate for Payer: Healthscope Commercial |
$2,504.91
|
| Rate for Payer: Healthscope Commercial |
$2,896.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,643.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,171.65
|
| Rate for Payer: Nomi Health Commercial |
$1,878.68
|
| Rate for Payer: PACE SWMI |
$1,565.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,565.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,171.65
|
| Rate for Payer: Priority Health Medicare |
$1,565.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,565.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,565.57
|
|
|
PR TEAEC W/WO PATCH GRAFT COMMON FEMORAL
|
Professional
|
Both
|
$1,751.00
|
|
|
Service Code
|
HCPCS 35371
|
| Min. Negotiated Rate |
$700.40 |
| Max. Negotiated Rate |
$1,442.85 |
| Rate for Payer: Aetna Commercial |
$1,045.09
|
| Rate for Payer: Aetna Medicare |
$811.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,123.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,045.09
|
| Rate for Payer: BCBS Complete |
$700.40
|
| Rate for Payer: BCBS MAPPO |
$779.92
|
| Rate for Payer: BCN Medicare Advantage |
$779.92
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cofinity Commercial |
$1,123.08
|
| Rate for Payer: Cofinity Commercial |
$1,045.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$779.92
|
| Rate for Payer: Healthscope Commercial |
$1,442.85
|
| Rate for Payer: Healthscope Commercial |
$1,247.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$818.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,138.15
|
| Rate for Payer: Nomi Health Commercial |
$935.90
|
| Rate for Payer: PACE SWMI |
$779.92
|
| Rate for Payer: PHP Medicare Advantage |
$779.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,138.15
|
| Rate for Payer: Priority Health Medicare |
$779.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$779.92
|
| Rate for Payer: UHC Medicare Advantage |
$779.92
|
|
|
PR TEAEC W/WO PATCH GRAFT DEEP PROFUNDA FEMORAL
|
Professional
|
Both
|
$3,773.00
|
|
|
Service Code
|
HCPCS 35372
|
| Min. Negotiated Rate |
$934.36 |
| Max. Negotiated Rate |
$2,452.45 |
| Rate for Payer: Aetna Commercial |
$1,252.04
|
| Rate for Payer: Aetna Medicare |
$971.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,345.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,252.04
|
| Rate for Payer: BCBS Complete |
$1,509.20
|
| Rate for Payer: BCBS MAPPO |
$934.36
|
| Rate for Payer: BCN Medicare Advantage |
$934.36
|
| Rate for Payer: Cash Price |
$3,018.40
|
| Rate for Payer: Cash Price |
$3,018.40
|
| Rate for Payer: Cofinity Commercial |
$1,345.48
|
| Rate for Payer: Cofinity Commercial |
$1,252.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$934.36
|
| Rate for Payer: Healthscope Commercial |
$1,494.98
|
| Rate for Payer: Healthscope Commercial |
$1,728.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$981.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,452.45
|
| Rate for Payer: Nomi Health Commercial |
$1,121.23
|
| Rate for Payer: PACE SWMI |
$934.36
|
| Rate for Payer: PHP Medicare Advantage |
$934.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,452.45
|
| Rate for Payer: Priority Health Medicare |
$934.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$934.36
|
| Rate for Payer: UHC Medicare Advantage |
$934.36
|
|
|
PR TEAEC W/WO PATCH GRAFT ILIAC
|
Professional
|
Both
|
$2,528.00
|
|
|
Service Code
|
HCPCS 35351
|
| Min. Negotiated Rate |
$1,011.20 |
| Max. Negotiated Rate |
$2,284.03 |
| Rate for Payer: Aetna Commercial |
$1,654.38
|
| Rate for Payer: Aetna Medicare |
$1,283.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,777.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,654.38
|
| Rate for Payer: BCBS Complete |
$1,011.20
|
| Rate for Payer: BCBS MAPPO |
$1,234.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,234.61
|
| Rate for Payer: Cash Price |
$2,022.40
|
| Rate for Payer: Cash Price |
$2,022.40
|
| Rate for Payer: Cofinity Commercial |
$1,777.84
|
| Rate for Payer: Cofinity Commercial |
$1,654.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,234.61
|
| Rate for Payer: Healthscope Commercial |
$2,284.03
|
| Rate for Payer: Healthscope Commercial |
$1,975.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,296.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,643.20
|
| Rate for Payer: Nomi Health Commercial |
$1,481.53
|
| Rate for Payer: PACE SWMI |
$1,234.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,234.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,643.20
|
| Rate for Payer: Priority Health Medicare |
$1,234.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,234.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,234.61
|
|
|
PR TEAEC W/WO PATCH GRAFT ILIOFEMORAL
|
Professional
|
Both
|
$2,053.00
|
|
|
Service Code
|
HCPCS 35355
|
| Min. Negotiated Rate |
$821.20 |
| Max. Negotiated Rate |
$1,826.08 |
| Rate for Payer: Aetna Commercial |
$1,322.67
|
| Rate for Payer: Aetna Medicare |
$1,026.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,421.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.67
|
| Rate for Payer: BCBS Complete |
$821.20
|
| Rate for Payer: BCBS MAPPO |
$987.07
|
| Rate for Payer: BCN Medicare Advantage |
$987.07
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cofinity Commercial |
$1,421.38
|
| Rate for Payer: Cofinity Commercial |
$1,322.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$987.07
|
| Rate for Payer: Healthscope Commercial |
$1,579.31
|
| Rate for Payer: Healthscope Commercial |
$1,826.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,036.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,334.45
|
| Rate for Payer: Nomi Health Commercial |
$1,184.48
|
| Rate for Payer: PACE SWMI |
$987.07
|
| Rate for Payer: PHP Medicare Advantage |
$987.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.45
|
| Rate for Payer: Priority Health Medicare |
$987.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$987.07
|
| Rate for Payer: UHC Medicare Advantage |
$987.07
|
|
|
PR TEAEC W/WO PATCH GRAFT MESENTERIC CELIAC/RENAL
|
Professional
|
Both
|
$4,508.00
|
|
|
Service Code
|
HCPCS 35341
|
| Min. Negotiated Rate |
$1,319.77 |
| Max. Negotiated Rate |
$2,930.20 |
| Rate for Payer: Aetna Commercial |
$1,768.49
|
| Rate for Payer: Aetna Medicare |
$1,372.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,900.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,768.49
|
| Rate for Payer: BCBS Complete |
$1,803.20
|
| Rate for Payer: BCBS MAPPO |
$1,319.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,319.77
|
| Rate for Payer: Cash Price |
$3,606.40
|
| Rate for Payer: Cash Price |
$3,606.40
|
| Rate for Payer: Cofinity Commercial |
$1,900.47
|
| Rate for Payer: Cofinity Commercial |
$1,768.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,319.77
|
| Rate for Payer: Healthscope Commercial |
$2,441.57
|
| Rate for Payer: Healthscope Commercial |
$2,111.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,385.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,930.20
|
| Rate for Payer: Nomi Health Commercial |
$1,583.72
|
| Rate for Payer: PACE SWMI |
$1,319.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,319.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,930.20
|
| Rate for Payer: Priority Health Medicare |
$1,319.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,319.77
|
| Rate for Payer: UHC Medicare Advantage |
$1,319.77
|
|
|
PR TEAEC W/WO PATCH GRF AXILLARY-BRACHIAL
|
Professional
|
Both
|
$3,855.00
|
|
|
Service Code
|
HCPCS 35321
|
| Min. Negotiated Rate |
$869.25 |
| Max. Negotiated Rate |
$2,505.75 |
| Rate for Payer: Aetna Commercial |
$1,164.80
|
| Rate for Payer: Aetna Medicare |
$904.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,251.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,164.80
|
| Rate for Payer: BCBS Complete |
$1,542.00
|
| Rate for Payer: BCBS MAPPO |
$869.25
|
| Rate for Payer: BCN Medicare Advantage |
$869.25
|
| Rate for Payer: Cash Price |
$3,084.00
|
| Rate for Payer: Cash Price |
$3,084.00
|
| Rate for Payer: Cofinity Commercial |
$1,251.72
|
| Rate for Payer: Cofinity Commercial |
$1,164.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$869.25
|
| Rate for Payer: Healthscope Commercial |
$1,390.80
|
| Rate for Payer: Healthscope Commercial |
$1,608.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$912.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,505.75
|
| Rate for Payer: Nomi Health Commercial |
$1,043.10
|
| Rate for Payer: PACE SWMI |
$869.25
|
| Rate for Payer: PHP Medicare Advantage |
$869.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,505.75
|
| Rate for Payer: Priority Health Medicare |
$869.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$869.25
|
| Rate for Payer: UHC Medicare Advantage |
$869.25
|
|
|
PR TEAEC W/WO PATCH GRF SUBCLAV INNOM THORACIC INC
|
Professional
|
Both
|
$2,846.00
|
|
|
Service Code
|
HCPCS 35311
|
| Min. Negotiated Rate |
$1,138.40 |
| Max. Negotiated Rate |
$2,747.29 |
| Rate for Payer: Aetna Commercial |
$1,989.93
|
| Rate for Payer: Aetna Medicare |
$1,544.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,138.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,989.93
|
| Rate for Payer: BCBS Complete |
$1,138.40
|
| Rate for Payer: BCBS MAPPO |
$1,485.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,485.02
|
| Rate for Payer: Cash Price |
$2,276.80
|
| Rate for Payer: Cash Price |
$2,276.80
|
| Rate for Payer: Cofinity Commercial |
$2,138.43
|
| Rate for Payer: Cofinity Commercial |
$1,989.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,485.02
|
| Rate for Payer: Healthscope Commercial |
$2,376.03
|
| Rate for Payer: Healthscope Commercial |
$2,747.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,559.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,849.90
|
| Rate for Payer: Nomi Health Commercial |
$1,782.02
|
| Rate for Payer: PACE SWMI |
$1,485.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,485.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,849.90
|
| Rate for Payer: Priority Health Medicare |
$1,485.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,485.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,485.02
|
|
|
PR TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 99368
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$38.35 |
| Rate for Payer: Aetna Medicare |
$29.50
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
|
|
PR TEAM CONFERENCE NON-FACE-TO-FACE PHYSICIAN
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 99367
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
|
PR TELEPHONE ASSMT&MGMT SVC NQHP EST PT 11-20 MIN
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 98967
|
| Min. Negotiated Rate |
$21.65 |
| Max. Negotiated Rate |
$40.05 |
| Rate for Payer: Aetna Commercial |
$29.01
|
| Rate for Payer: Aetna Medicare |
$22.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.01
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS MAPPO |
$21.65
|
| Rate for Payer: BCN Medicare Advantage |
$21.65
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$31.18
|
| Rate for Payer: Cofinity Commercial |
$29.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.65
|
| Rate for Payer: Healthscope Commercial |
$40.05
|
| Rate for Payer: Healthscope Commercial |
$34.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.40
|
| Rate for Payer: Nomi Health Commercial |
$25.98
|
| Rate for Payer: PACE SWMI |
$21.65
|
| Rate for Payer: PHP Medicare Advantage |
$21.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health Medicare |
$21.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.65
|
| Rate for Payer: UHC Medicare Advantage |
$21.65
|
|
|
PR TELEPHONE ASSMT&MGMT SVC NQHP EST PT 21-30 MIN
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 98968
|
| Min. Negotiated Rate |
$30.32 |
| Max. Negotiated Rate |
$56.09 |
| Rate for Payer: Aetna Commercial |
$40.63
|
| Rate for Payer: Aetna Medicare |
$31.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.63
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: BCBS MAPPO |
$30.32
|
| Rate for Payer: BCN Medicare Advantage |
$30.32
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$43.66
|
| Rate for Payer: Cofinity Commercial |
$40.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.32
|
| Rate for Payer: Healthscope Commercial |
$48.51
|
| Rate for Payer: Healthscope Commercial |
$56.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Nomi Health Commercial |
$36.38
|
| Rate for Payer: PACE SWMI |
$30.32
|
| Rate for Payer: PHP Medicare Advantage |
$30.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health Medicare |
$30.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.32
|
| Rate for Payer: UHC Medicare Advantage |
$30.32
|
|
|
PR TELEPHONE ASSMT&MGMT SVC NQHP EST PT 5-10 MIN
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 98966
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$20.57 |
| Rate for Payer: Aetna Commercial |
$14.90
|
| Rate for Payer: Aetna Medicare |
$11.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.90
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS MAPPO |
$11.12
|
| Rate for Payer: BCN Medicare Advantage |
$11.12
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$16.01
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.12
|
| Rate for Payer: Healthscope Commercial |
$20.57
|
| Rate for Payer: Healthscope Commercial |
$17.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.85
|
| Rate for Payer: Nomi Health Commercial |
$13.34
|
| Rate for Payer: PACE SWMI |
$11.12
|
| Rate for Payer: PHP Medicare Advantage |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health Medicare |
$11.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.12
|
| Rate for Payer: UHC Medicare Advantage |
$11.12
|
|
|
PR TEMPORARY CLOSURE EYELIDS SUTURE
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
HCPCS 67875
|
| Min. Negotiated Rate |
$89.27 |
| Max. Negotiated Rate |
$247.65 |
| Rate for Payer: Aetna Commercial |
$119.62
|
| Rate for Payer: Aetna Medicare |
$92.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.62
|
| Rate for Payer: BCBS Complete |
$152.40
|
| Rate for Payer: BCBS MAPPO |
$89.27
|
| Rate for Payer: BCN Medicare Advantage |
$89.27
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cofinity Commercial |
$128.55
|
| Rate for Payer: Cofinity Commercial |
$119.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.27
|
| Rate for Payer: Healthscope Commercial |
$142.83
|
| Rate for Payer: Healthscope Commercial |
$165.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.65
|
| Rate for Payer: Nomi Health Commercial |
$107.12
|
| Rate for Payer: PACE SWMI |
$89.27
|
| Rate for Payer: PHP Medicare Advantage |
$89.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.65
|
| Rate for Payer: Priority Health Medicare |
$89.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.27
|
| Rate for Payer: UHC Medicare Advantage |
$89.27
|
|
|
PR TENDON GRAFT FROM A DISTANCE
|
Professional
|
Both
|
$1,113.00
|
|
|
Service Code
|
HCPCS 20924
|
| Min. Negotiated Rate |
$445.20 |
| Max. Negotiated Rate |
$898.75 |
| Rate for Payer: Aetna Commercial |
$650.99
|
| Rate for Payer: Aetna Medicare |
$505.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$699.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.99
|
| Rate for Payer: BCBS Complete |
$445.20
|
| Rate for Payer: BCBS MAPPO |
$485.81
|
| Rate for Payer: BCN Medicare Advantage |
$485.81
|
| Rate for Payer: Cash Price |
$890.40
|
| Rate for Payer: Cash Price |
$890.40
|
| Rate for Payer: Cofinity Commercial |
$699.57
|
| Rate for Payer: Cofinity Commercial |
$650.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$485.81
|
| Rate for Payer: Healthscope Commercial |
$898.75
|
| Rate for Payer: Healthscope Commercial |
$777.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$510.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.45
|
| Rate for Payer: Nomi Health Commercial |
$582.97
|
| Rate for Payer: PACE SWMI |
$485.81
|
| Rate for Payer: PHP Medicare Advantage |
$485.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$723.45
|
| Rate for Payer: Priority Health Medicare |
$485.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$485.81
|
| Rate for Payer: UHC Medicare Advantage |
$485.81
|
|
|
PR TENDON LENGTHENING UPPER ARM/ELBOW EA TENDON
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
HCPCS 24305
|
| Min. Negotiated Rate |
$411.60 |
| Max. Negotiated Rate |
$1,038.83 |
| Rate for Payer: Aetna Commercial |
$752.45
|
| Rate for Payer: Aetna Medicare |
$583.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$752.45
|
| Rate for Payer: BCBS Complete |
$411.60
|
| Rate for Payer: BCBS MAPPO |
$561.53
|
| Rate for Payer: BCN Medicare Advantage |
$561.53
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cofinity Commercial |
$808.60
|
| Rate for Payer: Cofinity Commercial |
$752.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$561.53
|
| Rate for Payer: Healthscope Commercial |
$1,038.83
|
| Rate for Payer: Healthscope Commercial |
$898.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$589.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.85
|
| Rate for Payer: Nomi Health Commercial |
$673.84
|
| Rate for Payer: PACE SWMI |
$561.53
|
| Rate for Payer: PHP Medicare Advantage |
$561.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$668.85
|
| Rate for Payer: Priority Health Medicare |
$561.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$561.53
|
| Rate for Payer: UHC Medicare Advantage |
$561.53
|
|
|
PR TENDON SHEATH INCISION
|
Professional
|
Both
|
$1,180.00
|
|
|
Service Code
|
HCPCS 26055
|
| Hospital Charge Code |
26055
|
| Min. Negotiated Rate |
$282.19 |
| Max. Negotiated Rate |
$767.00 |
| Rate for Payer: Aetna Commercial |
$378.13
|
| Rate for Payer: Aetna Medicare |
$293.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$406.35
|
| Rate for Payer: BCBS Complete |
$472.00
|
| Rate for Payer: BCBS MAPPO |
$282.19
|
| Rate for Payer: BCN Medicare Advantage |
$282.19
|
| Rate for Payer: Cash Price |
$944.00
|
| Rate for Payer: Cash Price |
$944.00
|
| Rate for Payer: Cofinity Commercial |
$406.35
|
| Rate for Payer: Cofinity Commercial |
$378.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$282.19
|
| Rate for Payer: Healthscope Commercial |
$451.50
|
| Rate for Payer: Healthscope Commercial |
$522.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$296.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$767.00
|
| Rate for Payer: Nomi Health Commercial |
$338.63
|
| Rate for Payer: PACE SWMI |
$282.19
|
| Rate for Payer: PHP Medicare Advantage |
$282.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$767.00
|
| Rate for Payer: Priority Health Medicare |
$282.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$282.19
|
| Rate for Payer: UHC Medicare Advantage |
$282.19
|
|
|
PR TENDON SHEATH INCISION
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
CPT 26055
|
| Hospital Charge Code |
26055
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna Commercial |
$1,003.00
|
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$767.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Cash Price |
$944.00
|
| Rate for Payer: Cash Price |
$944.00
|
| Rate for Payer: Cofinity Commercial |
$1,014.80
|
| Rate for Payer: Cofinity Commercial |
$826.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$826.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Healthscope Commercial |
$1,062.00
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,003.00
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Commercial |
$1,003.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$767.00
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Priority Health SBD |
$743.40
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,393.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$878.76
|
| Rate for Payer: VA VA |
$1,560.85
|
|
|
PR TENDON SHEATH INCISION
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
CPT 26055
|
| Hospital Charge Code |
26055
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$1,062.00 |
| Rate for Payer: Aetna Commercial |
$1,003.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$767.00
|
| Rate for Payer: Cash Price |
$944.00
|
| Rate for Payer: Cofinity Commercial |
$1,014.80
|
| Rate for Payer: Cofinity Commercial |
$826.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$826.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.00
|
| Rate for Payer: Healthscope Commercial |
$1,062.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,003.00
|
| Rate for Payer: PHP Commercial |
$1,003.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$767.00
|
| Rate for Payer: Priority Health SBD |
$743.40
|
|
