|
PR BOTOX UNIT
|
Professional
|
Both
|
$13.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: BCBS Complete |
$5.20
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.75
|
|
|
PR BPG OTH/THN VEIN AORTOBIFEMORAL
|
Professional
|
Both
|
$5,955.00
|
|
|
Service Code
|
HCPCS 35646
|
| Min. Negotiated Rate |
$984.06 |
| Max. Negotiated Rate |
$4,466.25 |
| Rate for Payer: Aetna Commercial |
$2,092.10
|
| Rate for Payer: Aetna Medicare |
$1,623.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,092.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,248.23
|
| Rate for Payer: BCBS Complete |
$1,033.26
|
| Rate for Payer: BCBS MAPPO |
$1,561.27
|
| Rate for Payer: BCN Commercial |
$2,482.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,561.27
|
| Rate for Payer: Cash Price |
$4,764.00
|
| Rate for Payer: Cash Price |
$4,764.00
|
| Rate for Payer: Cofinity Commercial |
$2,248.23
|
| Rate for Payer: Cofinity Commercial |
$2,092.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,561.27
|
| Rate for Payer: Healthscope Commercial |
$2,498.03
|
| Rate for Payer: Healthscope Commercial |
$2,888.35
|
| Rate for Payer: Mclaren Medicaid |
$984.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,639.33
|
| Rate for Payer: Meridian Medicaid |
$1,033.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,717.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,023.12
|
| Rate for Payer: Nomi Health Commercial |
$1,873.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,466.25
|
| Rate for Payer: PACE SWMI |
$1,561.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,561.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$984.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,669.54
|
| Rate for Payer: Priority Health Medicare |
$1,561.27
|
| Rate for Payer: Priority Health SBD |
$2,669.54
|
| Rate for Payer: Priority Health Tiered Network |
$2,669.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,561.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,084.39
|
| Rate for Payer: UHC Core |
$3,084.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,561.27
|
| Rate for Payer: UHC Exchange |
$3,084.39
|
| Rate for Payer: UHC Medicaid |
$984.06
|
| Rate for Payer: UHCCP Medicaid |
$984.06
|
|
|
PR BPG OTH/THN VEIN AORTOBI-ILIAC
|
Professional
|
Both
|
$5,091.00
|
|
|
Service Code
|
HCPCS 35638
|
| Min. Negotiated Rate |
$1,008.34 |
| Max. Negotiated Rate |
$3,818.25 |
| Rate for Payer: Aetna Commercial |
$2,142.08
|
| Rate for Payer: Aetna Medicare |
$1,662.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,142.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,301.94
|
| Rate for Payer: BCBS Complete |
$1,058.76
|
| Rate for Payer: BCBS MAPPO |
$1,598.57
|
| Rate for Payer: BCN Commercial |
$2,549.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,598.57
|
| Rate for Payer: Cash Price |
$4,072.80
|
| Rate for Payer: Cash Price |
$4,072.80
|
| Rate for Payer: Cofinity Commercial |
$2,301.94
|
| Rate for Payer: Cofinity Commercial |
$2,142.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,598.57
|
| Rate for Payer: Healthscope Commercial |
$2,957.35
|
| Rate for Payer: Healthscope Commercial |
$2,557.71
|
| Rate for Payer: Mclaren Medicaid |
$1,008.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,678.50
|
| Rate for Payer: Meridian Medicaid |
$1,058.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,758.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,076.54
|
| Rate for Payer: Nomi Health Commercial |
$1,918.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,818.25
|
| Rate for Payer: PACE SWMI |
$1,598.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,598.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,008.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,741.31
|
| Rate for Payer: Priority Health Medicare |
$1,598.57
|
| Rate for Payer: Priority Health SBD |
$2,741.31
|
| Rate for Payer: Priority Health Tiered Network |
$2,741.31
|
| Rate for Payer: Railroad Medicare Medicare |
$1,598.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,134.31
|
| Rate for Payer: UHC Core |
$3,134.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,598.57
|
| Rate for Payer: UHC Exchange |
$3,134.31
|
| Rate for Payer: UHC Medicaid |
$1,008.34
|
| Rate for Payer: UHCCP Medicaid |
$1,008.34
|
|
|
PR BPG OTH/THN VEIN AORTOCELIAC AORTOMSN AORTORNL
|
Professional
|
Both
|
$5,218.00
|
|
|
Service Code
|
HCPCS 35631
|
| Min. Negotiated Rate |
$1,067.56 |
| Max. Negotiated Rate |
$3,913.50 |
| Rate for Payer: Aetna Commercial |
$2,271.19
|
| Rate for Payer: Aetna Medicare |
$1,762.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,271.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,440.68
|
| Rate for Payer: BCBS Complete |
$1,120.94
|
| Rate for Payer: BCBS MAPPO |
$1,694.92
|
| Rate for Payer: BCN Commercial |
$2,694.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,694.92
|
| Rate for Payer: Cash Price |
$4,174.40
|
| Rate for Payer: Cash Price |
$4,174.40
|
| Rate for Payer: Cofinity Commercial |
$2,440.68
|
| Rate for Payer: Cofinity Commercial |
$2,271.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,694.92
|
| Rate for Payer: Healthscope Commercial |
$3,135.60
|
| Rate for Payer: Healthscope Commercial |
$2,711.87
|
| Rate for Payer: Mclaren Medicaid |
$1,067.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,779.67
|
| Rate for Payer: Meridian Medicaid |
$1,120.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,864.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,277.64
|
| Rate for Payer: Nomi Health Commercial |
$2,033.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,913.50
|
| Rate for Payer: PACE SWMI |
$1,694.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,694.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,067.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,897.15
|
| Rate for Payer: Priority Health Medicare |
$1,694.92
|
| Rate for Payer: Priority Health SBD |
$2,897.15
|
| Rate for Payer: Priority Health Tiered Network |
$2,897.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1,694.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,331.28
|
| Rate for Payer: UHC Core |
$3,331.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,694.92
|
| Rate for Payer: UHC Exchange |
$3,331.28
|
| Rate for Payer: UHC Medicaid |
$1,067.56
|
| Rate for Payer: UHCCP Medicaid |
$1,067.56
|
|
|
PR BPG OTH/THN VEIN AORTOFEMORAL
|
Professional
|
Both
|
$3,159.00
|
|
|
Service Code
|
HCPCS 35647
|
| Min. Negotiated Rate |
$866.70 |
| Max. Negotiated Rate |
$2,780.92 |
| Rate for Payer: Aetna Commercial |
$1,847.35
|
| Rate for Payer: Aetna Medicare |
$1,433.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,847.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,985.21
|
| Rate for Payer: BCBS Complete |
$910.03
|
| Rate for Payer: BCBS MAPPO |
$1,378.62
|
| Rate for Payer: BCN Commercial |
$2,240.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,378.62
|
| Rate for Payer: Cash Price |
$2,527.20
|
| Rate for Payer: Cash Price |
$2,527.20
|
| Rate for Payer: Cofinity Commercial |
$1,985.21
|
| Rate for Payer: Cofinity Commercial |
$1,847.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,378.62
|
| Rate for Payer: Healthscope Commercial |
$2,550.45
|
| Rate for Payer: Healthscope Commercial |
$2,205.79
|
| Rate for Payer: Mclaren Medicaid |
$866.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,447.55
|
| Rate for Payer: Meridian Medicaid |
$910.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,516.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,748.78
|
| Rate for Payer: Nomi Health Commercial |
$1,654.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,369.25
|
| Rate for Payer: PACE SWMI |
$1,378.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,378.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$866.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,409.29
|
| Rate for Payer: Priority Health Medicare |
$1,378.62
|
| Rate for Payer: Priority Health SBD |
$2,409.29
|
| Rate for Payer: Priority Health Tiered Network |
$2,409.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,378.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,780.92
|
| Rate for Payer: UHC Core |
$2,780.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,378.62
|
| Rate for Payer: UHC Exchange |
$2,780.92
|
| Rate for Payer: UHC Medicaid |
$866.70
|
| Rate for Payer: UHCCP Medicaid |
$866.70
|
|
|
PR BPG OTH/THN VEIN AORTOILIAC
|
Professional
|
Both
|
$3,744.00
|
|
|
Service Code
|
HCPCS 35637
|
| Min. Negotiated Rate |
$961.48 |
| Max. Negotiated Rate |
$2,988.99 |
| Rate for Payer: Aetna Commercial |
$2,049.78
|
| Rate for Payer: Aetna Medicare |
$1,590.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,049.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,202.75
|
| Rate for Payer: BCBS Complete |
$1,009.55
|
| Rate for Payer: BCBS MAPPO |
$1,529.69
|
| Rate for Payer: BCN Commercial |
$2,423.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,529.69
|
| Rate for Payer: Cash Price |
$2,995.20
|
| Rate for Payer: Cash Price |
$2,995.20
|
| Rate for Payer: Cofinity Commercial |
$2,202.75
|
| Rate for Payer: Cofinity Commercial |
$2,049.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,529.69
|
| Rate for Payer: Healthscope Commercial |
$2,829.93
|
| Rate for Payer: Healthscope Commercial |
$2,447.50
|
| Rate for Payer: Mclaren Medicaid |
$961.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,606.17
|
| Rate for Payer: Meridian Medicaid |
$1,009.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,682.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,946.20
|
| Rate for Payer: Nomi Health Commercial |
$1,835.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,808.00
|
| Rate for Payer: PACE SWMI |
$1,529.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,529.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$961.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,606.35
|
| Rate for Payer: Priority Health Medicare |
$1,529.69
|
| Rate for Payer: Priority Health SBD |
$2,606.35
|
| Rate for Payer: Priority Health Tiered Network |
$2,606.35
|
| Rate for Payer: Railroad Medicare Medicare |
$1,529.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,988.99
|
| Rate for Payer: UHC Core |
$2,988.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,529.69
|
| Rate for Payer: UHC Exchange |
$2,988.99
|
| Rate for Payer: UHC Medicaid |
$961.48
|
| Rate for Payer: UHCCP Medicaid |
$961.48
|
|
|
PR BPG OTH/THN VEIN AORTOSUBCLA/INNOMINATE/CAROTID
|
Professional
|
Both
|
$4,903.00
|
|
|
Service Code
|
HCPCS 35626
|
| Min. Negotiated Rate |
$944.66 |
| Max. Negotiated Rate |
$3,677.25 |
| Rate for Payer: Aetna Commercial |
$1,991.07
|
| Rate for Payer: Aetna Medicare |
$1,545.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,991.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,139.65
|
| Rate for Payer: BCBS Complete |
$991.89
|
| Rate for Payer: BCBS MAPPO |
$1,485.87
|
| Rate for Payer: BCN Commercial |
$2,338.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,485.87
|
| Rate for Payer: Cash Price |
$3,922.40
|
| Rate for Payer: Cash Price |
$3,922.40
|
| Rate for Payer: Cofinity Commercial |
$2,139.65
|
| Rate for Payer: Cofinity Commercial |
$1,991.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,485.87
|
| Rate for Payer: Healthscope Commercial |
$2,748.86
|
| Rate for Payer: Healthscope Commercial |
$2,377.39
|
| Rate for Payer: Mclaren Medicaid |
$944.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,560.16
|
| Rate for Payer: Meridian Medicaid |
$991.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,634.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,814.03
|
| Rate for Payer: Nomi Health Commercial |
$1,783.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,677.25
|
| Rate for Payer: PACE SWMI |
$1,485.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,485.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$944.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,514.78
|
| Rate for Payer: Priority Health Medicare |
$1,485.87
|
| Rate for Payer: Priority Health SBD |
$2,514.78
|
| Rate for Payer: Priority Health Tiered Network |
$2,514.78
|
| Rate for Payer: Railroad Medicare Medicare |
$1,485.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,840.86
|
| Rate for Payer: UHC Core |
$2,840.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,485.87
|
| Rate for Payer: UHC Exchange |
$2,840.86
|
| Rate for Payer: UHC Medicaid |
$944.66
|
| Rate for Payer: UHCCP Medicaid |
$944.66
|
|
|
PR BPG OTH/THN VEIN AXILLARY-AXILLARY
|
Professional
|
Both
|
$2,281.00
|
|
|
Service Code
|
HCPCS 35650
|
| Min. Negotiated Rate |
$593.84 |
| Max. Negotiated Rate |
$1,837.88 |
| Rate for Payer: Aetna Commercial |
$1,264.36
|
| Rate for Payer: Aetna Medicare |
$981.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,264.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,358.71
|
| Rate for Payer: BCBS Complete |
$623.53
|
| Rate for Payer: BCBS MAPPO |
$943.55
|
| Rate for Payer: BCN Commercial |
$1,494.94
|
| Rate for Payer: BCN Medicare Advantage |
$943.55
|
| Rate for Payer: Cash Price |
$1,824.80
|
| Rate for Payer: Cash Price |
$1,824.80
|
| Rate for Payer: Cofinity Commercial |
$1,358.71
|
| Rate for Payer: Cofinity Commercial |
$1,264.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$943.55
|
| Rate for Payer: Healthscope Commercial |
$1,745.57
|
| Rate for Payer: Healthscope Commercial |
$1,509.68
|
| Rate for Payer: Mclaren Medicaid |
$593.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$990.73
|
| Rate for Payer: Meridian Medicaid |
$623.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,037.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,815.16
|
| Rate for Payer: Nomi Health Commercial |
$1,132.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,710.75
|
| Rate for Payer: PACE SWMI |
$943.55
|
| Rate for Payer: PHP Medicare Advantage |
$943.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$593.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,607.61
|
| Rate for Payer: Priority Health Medicare |
$943.55
|
| Rate for Payer: Priority Health SBD |
$1,607.61
|
| Rate for Payer: Priority Health Tiered Network |
$1,607.61
|
| Rate for Payer: Railroad Medicare Medicare |
$943.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,837.88
|
| Rate for Payer: UHC Core |
$1,837.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$943.55
|
| Rate for Payer: UHC Exchange |
$1,837.88
|
| Rate for Payer: UHC Medicaid |
$593.84
|
| Rate for Payer: UHCCP Medicaid |
$593.84
|
|
|
PR BPG OTH/THN VEIN AXILLARY-FEMORAL
|
Professional
|
Both
|
$4,316.00
|
|
|
Service Code
|
HCPCS 35621
|
| Min. Negotiated Rate |
$631.55 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Aetna Commercial |
$1,341.89
|
| Rate for Payer: Aetna Medicare |
$1,041.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,341.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,442.03
|
| Rate for Payer: BCBS Complete |
$663.13
|
| Rate for Payer: BCBS MAPPO |
$1,001.41
|
| Rate for Payer: BCN Commercial |
$1,598.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,001.41
|
| Rate for Payer: Cash Price |
$3,452.80
|
| Rate for Payer: Cash Price |
$3,452.80
|
| Rate for Payer: Cofinity Commercial |
$1,442.03
|
| Rate for Payer: Cofinity Commercial |
$1,341.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,001.41
|
| Rate for Payer: Healthscope Commercial |
$1,852.61
|
| Rate for Payer: Healthscope Commercial |
$1,602.26
|
| Rate for Payer: Mclaren Medicaid |
$631.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,051.48
|
| Rate for Payer: Meridian Medicaid |
$663.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,101.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,945.24
|
| Rate for Payer: Nomi Health Commercial |
$1,201.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,237.00
|
| Rate for Payer: PACE SWMI |
$1,001.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,001.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$631.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,719.00
|
| Rate for Payer: Priority Health Medicare |
$1,001.41
|
| Rate for Payer: Priority Health SBD |
$1,719.00
|
| Rate for Payer: Priority Health Tiered Network |
$1,719.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,001.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,970.97
|
| Rate for Payer: UHC Core |
$1,970.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,001.41
|
| Rate for Payer: UHC Exchange |
$1,970.97
|
| Rate for Payer: UHC Medicaid |
$631.55
|
| Rate for Payer: UHCCP Medicaid |
$631.55
|
|
|
PR BPG OTH/THN VEIN AXILLARY-FEMORAL-FEMORAL
|
Professional
|
Both
|
$5,070.00
|
|
|
Service Code
|
HCPCS 35654
|
| Min. Negotiated Rate |
$788.53 |
| Max. Negotiated Rate |
$3,802.50 |
| Rate for Payer: Aetna Commercial |
$1,675.55
|
| Rate for Payer: Aetna Medicare |
$1,300.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,675.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,800.59
|
| Rate for Payer: BCBS Complete |
$827.96
|
| Rate for Payer: BCBS MAPPO |
$1,250.41
|
| Rate for Payer: BCN Commercial |
$1,994.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,250.41
|
| Rate for Payer: Cash Price |
$4,056.00
|
| Rate for Payer: Cash Price |
$4,056.00
|
| Rate for Payer: Cofinity Commercial |
$1,800.59
|
| Rate for Payer: Cofinity Commercial |
$1,675.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,250.41
|
| Rate for Payer: Healthscope Commercial |
$2,313.26
|
| Rate for Payer: Healthscope Commercial |
$2,000.66
|
| Rate for Payer: Mclaren Medicaid |
$788.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,312.93
|
| Rate for Payer: Meridian Medicaid |
$827.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,375.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,416.43
|
| Rate for Payer: Nomi Health Commercial |
$1,500.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,802.50
|
| Rate for Payer: PACE SWMI |
$1,250.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,250.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,144.74
|
| Rate for Payer: Priority Health Medicare |
$1,250.41
|
| Rate for Payer: Priority Health SBD |
$2,144.74
|
| Rate for Payer: Priority Health Tiered Network |
$2,144.74
|
| Rate for Payer: Railroad Medicare Medicare |
$1,250.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,461.75
|
| Rate for Payer: UHC Core |
$2,461.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,250.41
|
| Rate for Payer: UHC Exchange |
$2,461.75
|
| Rate for Payer: UHC Medicaid |
$788.53
|
| Rate for Payer: UHCCP Medicaid |
$788.53
|
|
|
PR BPG OTH/THN VEIN CAROTID-SUBCLAVIAN
|
Professional
|
Both
|
$2,394.00
|
|
|
Service Code
|
HCPCS 35606
|
| Min. Negotiated Rate |
$679.04 |
| Max. Negotiated Rate |
$2,106.60 |
| Rate for Payer: Aetna Commercial |
$1,441.85
|
| Rate for Payer: Aetna Medicare |
$1,119.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,441.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,549.45
|
| Rate for Payer: BCBS Complete |
$712.99
|
| Rate for Payer: BCBS MAPPO |
$1,076.01
|
| Rate for Payer: BCN Commercial |
$1,715.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,076.01
|
| Rate for Payer: Cash Price |
$1,915.20
|
| Rate for Payer: Cash Price |
$1,915.20
|
| Rate for Payer: Cofinity Commercial |
$1,549.45
|
| Rate for Payer: Cofinity Commercial |
$1,441.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,076.01
|
| Rate for Payer: Healthscope Commercial |
$1,990.62
|
| Rate for Payer: Healthscope Commercial |
$1,721.62
|
| Rate for Payer: Mclaren Medicaid |
$679.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,129.81
|
| Rate for Payer: Meridian Medicaid |
$712.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,183.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,079.29
|
| Rate for Payer: Nomi Health Commercial |
$1,291.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,795.50
|
| Rate for Payer: PACE SWMI |
$1,076.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,076.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$679.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,844.31
|
| Rate for Payer: Priority Health Medicare |
$1,076.01
|
| Rate for Payer: Priority Health SBD |
$1,844.31
|
| Rate for Payer: Priority Health Tiered Network |
$1,844.31
|
| Rate for Payer: Railroad Medicare Medicare |
$1,076.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,106.60
|
| Rate for Payer: UHC Core |
$2,106.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,076.01
|
| Rate for Payer: UHC Exchange |
$2,106.60
|
| Rate for Payer: UHC Medicaid |
$679.04
|
| Rate for Payer: UHCCP Medicaid |
$679.04
|
|
|
PR BPG OTH/THN VEIN COM CRTD-IPSILATERAL INT CRTD
|
Professional
|
Both
|
$3,030.00
|
|
|
Service Code
|
HCPCS 35601
|
| Min. Negotiated Rate |
$809.40 |
| Max. Negotiated Rate |
$2,515.03 |
| Rate for Payer: Aetna Commercial |
$1,721.28
|
| Rate for Payer: Aetna Medicare |
$1,335.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,721.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,849.74
|
| Rate for Payer: BCBS Complete |
$849.87
|
| Rate for Payer: BCBS MAPPO |
$1,284.54
|
| Rate for Payer: BCN Commercial |
$2,055.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,284.54
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cofinity Commercial |
$1,849.74
|
| Rate for Payer: Cofinity Commercial |
$1,721.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,284.54
|
| Rate for Payer: Healthscope Commercial |
$2,376.40
|
| Rate for Payer: Healthscope Commercial |
$2,055.26
|
| Rate for Payer: Mclaren Medicaid |
$809.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,348.77
|
| Rate for Payer: Meridian Medicaid |
$849.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,412.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,487.60
|
| Rate for Payer: Nomi Health Commercial |
$1,541.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,272.50
|
| Rate for Payer: PACE SWMI |
$1,284.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,284.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$809.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,210.07
|
| Rate for Payer: Priority Health Medicare |
$1,284.54
|
| Rate for Payer: Priority Health SBD |
$2,210.07
|
| Rate for Payer: Priority Health Tiered Network |
$2,210.07
|
| Rate for Payer: Railroad Medicare Medicare |
$1,284.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,515.03
|
| Rate for Payer: UHC Core |
$2,515.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,284.54
|
| Rate for Payer: UHC Exchange |
$2,515.03
|
| Rate for Payer: UHC Medicaid |
$809.40
|
| Rate for Payer: UHCCP Medicaid |
$809.40
|
|
|
PR BPG OTH/THN VEIN FEM-ANT TIBL PST TIBL/PRNL ART
|
Professional
|
Both
|
$4,334.00
|
|
|
Service Code
|
HCPCS 35666
|
| Min. Negotiated Rate |
$744.65 |
| Max. Negotiated Rate |
$3,250.50 |
| Rate for Payer: Aetna Commercial |
$1,575.36
|
| Rate for Payer: Aetna Medicare |
$1,222.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,575.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,692.92
|
| Rate for Payer: BCBS Complete |
$781.88
|
| Rate for Payer: BCBS MAPPO |
$1,175.64
|
| Rate for Payer: BCN Commercial |
$1,875.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,175.64
|
| Rate for Payer: Cash Price |
$3,467.20
|
| Rate for Payer: Cash Price |
$3,467.20
|
| Rate for Payer: Cofinity Commercial |
$1,692.92
|
| Rate for Payer: Cofinity Commercial |
$1,575.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,175.64
|
| Rate for Payer: Healthscope Commercial |
$2,174.93
|
| Rate for Payer: Healthscope Commercial |
$1,881.02
|
| Rate for Payer: Mclaren Medicaid |
$744.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,234.42
|
| Rate for Payer: Meridian Medicaid |
$781.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,293.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,278.15
|
| Rate for Payer: Nomi Health Commercial |
$1,410.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,250.50
|
| Rate for Payer: PACE SWMI |
$1,175.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,175.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$744.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,016.75
|
| Rate for Payer: Priority Health Medicare |
$1,175.64
|
| Rate for Payer: Priority Health SBD |
$2,016.75
|
| Rate for Payer: Priority Health Tiered Network |
$2,016.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,175.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,282.98
|
| Rate for Payer: UHC Core |
$2,282.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,175.64
|
| Rate for Payer: UHC Exchange |
$2,282.98
|
| Rate for Payer: UHC Medicaid |
$744.65
|
| Rate for Payer: UHCCP Medicaid |
$744.65
|
|
|
PR BPG OTH/THN VEIN FEMORAL-FEMORAL
|
Professional
|
Both
|
$2,321.00
|
|
|
Service Code
|
HCPCS 35661
|
| Min. Negotiated Rate |
$626.43 |
| Max. Negotiated Rate |
$1,944.55 |
| Rate for Payer: Aetna Commercial |
$1,327.77
|
| Rate for Payer: Aetna Medicare |
$1,030.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,327.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,426.85
|
| Rate for Payer: BCBS Complete |
$657.75
|
| Rate for Payer: BCBS MAPPO |
$990.87
|
| Rate for Payer: BCN Commercial |
$1,581.59
|
| Rate for Payer: BCN Medicare Advantage |
$990.87
|
| Rate for Payer: Cash Price |
$1,856.80
|
| Rate for Payer: Cash Price |
$1,856.80
|
| Rate for Payer: Cofinity Commercial |
$1,426.85
|
| Rate for Payer: Cofinity Commercial |
$1,327.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$990.87
|
| Rate for Payer: Healthscope Commercial |
$1,833.11
|
| Rate for Payer: Healthscope Commercial |
$1,585.39
|
| Rate for Payer: Mclaren Medicaid |
$626.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,040.41
|
| Rate for Payer: Meridian Medicaid |
$657.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,089.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,918.06
|
| Rate for Payer: Nomi Health Commercial |
$1,189.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,740.75
|
| Rate for Payer: PACE SWMI |
$990.87
|
| Rate for Payer: PHP Medicare Advantage |
$990.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$626.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,700.79
|
| Rate for Payer: Priority Health Medicare |
$990.87
|
| Rate for Payer: Priority Health SBD |
$1,700.79
|
| Rate for Payer: Priority Health Tiered Network |
$1,700.79
|
| Rate for Payer: Railroad Medicare Medicare |
$990.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,944.55
|
| Rate for Payer: UHC Core |
$1,944.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$990.87
|
| Rate for Payer: UHC Exchange |
$1,944.55
|
| Rate for Payer: UHC Medicaid |
$626.43
|
| Rate for Payer: UHCCP Medicaid |
$626.43
|
|
|
PR BPG OTH/THN VEIN FEMORAL-POPLITEAL
|
Professional
|
Both
|
$2,346.00
|
|
|
Service Code
|
HCPCS 35656
|
| Min. Negotiated Rate |
$619.83 |
| Max. Negotiated Rate |
$1,939.56 |
| Rate for Payer: Aetna Commercial |
$1,315.85
|
| Rate for Payer: Aetna Medicare |
$1,021.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,414.05
|
| Rate for Payer: BCBS Complete |
$650.82
|
| Rate for Payer: BCBS MAPPO |
$981.98
|
| Rate for Payer: BCN Commercial |
$1,563.66
|
| Rate for Payer: BCN Medicare Advantage |
$981.98
|
| Rate for Payer: Cash Price |
$1,876.80
|
| Rate for Payer: Cash Price |
$1,876.80
|
| Rate for Payer: Cofinity Commercial |
$1,414.05
|
| Rate for Payer: Cofinity Commercial |
$1,315.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$981.98
|
| Rate for Payer: Healthscope Commercial |
$1,816.66
|
| Rate for Payer: Healthscope Commercial |
$1,571.17
|
| Rate for Payer: Mclaren Medicaid |
$619.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,031.08
|
| Rate for Payer: Meridian Medicaid |
$650.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,080.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,903.46
|
| Rate for Payer: Nomi Health Commercial |
$1,178.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,759.50
|
| Rate for Payer: PACE SWMI |
$981.98
|
| Rate for Payer: PHP Medicare Advantage |
$981.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,681.52
|
| Rate for Payer: Priority Health Medicare |
$981.98
|
| Rate for Payer: Priority Health SBD |
$1,681.52
|
| Rate for Payer: Priority Health Tiered Network |
$1,681.52
|
| Rate for Payer: Railroad Medicare Medicare |
$981.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,939.56
|
| Rate for Payer: UHC Core |
$1,939.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$981.98
|
| Rate for Payer: UHC Exchange |
$1,939.56
|
| Rate for Payer: UHC Medicaid |
$619.83
|
| Rate for Payer: UHCCP Medicaid |
$619.83
|
|
|
PR BPG OTH/THN VEIN ILIOFEMORAL
|
Professional
|
Both
|
$4,719.00
|
|
|
Service Code
|
HCPCS 35665
|
| Min. Negotiated Rate |
$679.90 |
| Max. Negotiated Rate |
$3,539.25 |
| Rate for Payer: Aetna Commercial |
$1,442.47
|
| Rate for Payer: Aetna Medicare |
$1,119.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,442.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,550.12
|
| Rate for Payer: BCBS Complete |
$713.89
|
| Rate for Payer: BCBS MAPPO |
$1,076.47
|
| Rate for Payer: BCN Commercial |
$1,711.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,076.47
|
| Rate for Payer: Cash Price |
$3,775.20
|
| Rate for Payer: Cash Price |
$3,775.20
|
| Rate for Payer: Cofinity Commercial |
$1,550.12
|
| Rate for Payer: Cofinity Commercial |
$1,442.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,076.47
|
| Rate for Payer: Healthscope Commercial |
$1,991.47
|
| Rate for Payer: Healthscope Commercial |
$1,722.35
|
| Rate for Payer: Mclaren Medicaid |
$679.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,130.29
|
| Rate for Payer: Meridian Medicaid |
$713.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,184.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,077.74
|
| Rate for Payer: Nomi Health Commercial |
$1,291.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,539.25
|
| Rate for Payer: PACE SWMI |
$1,076.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,076.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$679.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,840.57
|
| Rate for Payer: Priority Health Medicare |
$1,076.47
|
| Rate for Payer: Priority Health SBD |
$1,840.57
|
| Rate for Payer: Priority Health Tiered Network |
$1,840.57
|
| Rate for Payer: Railroad Medicare Medicare |
$1,076.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,108.31
|
| Rate for Payer: UHC Core |
$2,108.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,076.47
|
| Rate for Payer: UHC Exchange |
$2,108.31
|
| Rate for Payer: UHC Medicaid |
$679.90
|
| Rate for Payer: UHCCP Medicaid |
$679.90
|
|
|
PR BPG OTH/THN VEIN POPLITEAL-TIBIAL/-PERONEAL ART
|
Professional
|
Both
|
$2,269.00
|
|
|
Service Code
|
HCPCS 35671
|
| Min. Negotiated Rate |
$656.04 |
| Max. Negotiated Rate |
$2,012.94 |
| Rate for Payer: Aetna Commercial |
$1,387.33
|
| Rate for Payer: Aetna Medicare |
$1,076.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,387.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,490.86
|
| Rate for Payer: BCBS Complete |
$688.84
|
| Rate for Payer: BCBS MAPPO |
$1,035.32
|
| Rate for Payer: BCN Commercial |
$1,645.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,035.32
|
| Rate for Payer: Cash Price |
$1,815.20
|
| Rate for Payer: Cash Price |
$1,815.20
|
| Rate for Payer: Cofinity Commercial |
$1,490.86
|
| Rate for Payer: Cofinity Commercial |
$1,387.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,035.32
|
| Rate for Payer: Healthscope Commercial |
$1,915.34
|
| Rate for Payer: Healthscope Commercial |
$1,656.51
|
| Rate for Payer: Mclaren Medicaid |
$656.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,087.09
|
| Rate for Payer: Meridian Medicaid |
$688.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,138.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,006.93
|
| Rate for Payer: Nomi Health Commercial |
$1,242.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,701.75
|
| Rate for Payer: PACE SWMI |
$1,035.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,035.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$656.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,769.35
|
| Rate for Payer: Priority Health Medicare |
$1,035.32
|
| Rate for Payer: Priority Health SBD |
$1,769.35
|
| Rate for Payer: Priority Health Tiered Network |
$1,769.35
|
| Rate for Payer: Railroad Medicare Medicare |
$1,035.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,012.94
|
| Rate for Payer: UHC Core |
$2,012.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,035.32
|
| Rate for Payer: UHC Exchange |
$2,012.94
|
| Rate for Payer: UHC Medicaid |
$656.04
|
| Rate for Payer: UHCCP Medicaid |
$656.04
|
|
|
PR BPG OTH/THN VEIN SUBCLAVIAN-SUBCLAVIAN
|
Professional
|
Both
|
$2,311.00
|
|
|
Service Code
|
HCPCS 35612
|
| Min. Negotiated Rate |
$607.90 |
| Max. Negotiated Rate |
$1,875.25 |
| Rate for Payer: Aetna Commercial |
$1,292.42
|
| Rate for Payer: Aetna Medicare |
$1,003.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,292.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,388.87
|
| Rate for Payer: BCBS Complete |
$638.29
|
| Rate for Payer: BCBS MAPPO |
$964.49
|
| Rate for Payer: BCN Commercial |
$1,531.79
|
| Rate for Payer: BCN Medicare Advantage |
$964.49
|
| Rate for Payer: Cash Price |
$1,848.80
|
| Rate for Payer: Cash Price |
$1,848.80
|
| Rate for Payer: Cofinity Commercial |
$1,388.87
|
| Rate for Payer: Cofinity Commercial |
$1,292.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$964.49
|
| Rate for Payer: Healthscope Commercial |
$1,784.31
|
| Rate for Payer: Healthscope Commercial |
$1,543.18
|
| Rate for Payer: Mclaren Medicaid |
$607.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,012.71
|
| Rate for Payer: Meridian Medicaid |
$638.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,060.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,856.14
|
| Rate for Payer: Nomi Health Commercial |
$1,157.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,733.25
|
| Rate for Payer: PACE SWMI |
$964.49
|
| Rate for Payer: PHP Medicare Advantage |
$964.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$607.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,647.25
|
| Rate for Payer: Priority Health Medicare |
$964.49
|
| Rate for Payer: Priority Health SBD |
$1,647.25
|
| Rate for Payer: Priority Health Tiered Network |
$1,647.25
|
| Rate for Payer: Railroad Medicare Medicare |
$964.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,875.25
|
| Rate for Payer: UHC Core |
$1,875.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$964.49
|
| Rate for Payer: UHC Exchange |
$1,875.25
|
| Rate for Payer: UHC Medicaid |
$607.90
|
| Rate for Payer: UHCCP Medicaid |
$607.90
|
|
|
PR BRACHIOPLASTY
|
Professional
|
Both
|
$6,309.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,523.60 |
| Max. Negotiated Rate |
$4,731.75 |
| Rate for Payer: Aetna Medicare |
$3,154.50
|
| Rate for Payer: BCBS Complete |
$2,523.60
|
| Rate for Payer: Cash Price |
$5,047.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,100.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,731.75
|
|
|
PR BREAST AUGMENTATION WITH IMPLANT
|
Professional
|
Both
|
$2,101.00
|
|
|
Service Code
|
HCPCS 19325
|
| Min. Negotiated Rate |
$361.04 |
| Max. Negotiated Rate |
$1,575.75 |
| Rate for Payer: Aetna Commercial |
$737.78
|
| Rate for Payer: Aetna Medicare |
$572.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$737.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$792.84
|
| Rate for Payer: BCBS Complete |
$379.09
|
| Rate for Payer: BCBS MAPPO |
$550.58
|
| Rate for Payer: BCN Commercial |
$933.72
|
| Rate for Payer: BCN Medicare Advantage |
$550.58
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Cofinity Commercial |
$792.84
|
| Rate for Payer: Cofinity Commercial |
$737.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.58
|
| Rate for Payer: Healthscope Commercial |
$1,018.57
|
| Rate for Payer: Healthscope Commercial |
$880.93
|
| Rate for Payer: Mclaren Medicaid |
$361.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.11
|
| Rate for Payer: Meridian Medicaid |
$379.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$605.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,083.65
|
| Rate for Payer: Nomi Health Commercial |
$660.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,575.75
|
| Rate for Payer: PACE SWMI |
$550.58
|
| Rate for Payer: PHP Medicare Advantage |
$550.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$361.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$854.59
|
| Rate for Payer: Priority Health Medicare |
$550.58
|
| Rate for Payer: Priority Health SBD |
$854.59
|
| Rate for Payer: Priority Health Tiered Network |
$854.59
|
| Rate for Payer: Railroad Medicare Medicare |
$550.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,128.02
|
| Rate for Payer: UHC Core |
$1,128.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$550.58
|
| Rate for Payer: UHC Exchange |
$1,128.02
|
| Rate for Payer: UHC Medicaid |
$361.04
|
| Rate for Payer: UHCCP Medicaid |
$361.04
|
|
|
PR BREAST AUGMENT W MASTOPEXY-GEL 2.5
|
Professional
|
Both
|
$4,506.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,802.40 |
| Max. Negotiated Rate |
$3,379.50 |
| Rate for Payer: Aetna Medicare |
$2,253.00
|
| Rate for Payer: BCBS Complete |
$1,802.40
|
| Rate for Payer: Cash Price |
$3,604.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,928.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,379.50
|
|
|
PR BREAST AUGMENT W MASTOPEXY-GEL 3.5
|
Professional
|
Both
|
$6,309.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,523.60 |
| Max. Negotiated Rate |
$4,731.75 |
| Rate for Payer: Aetna Medicare |
$3,154.50
|
| Rate for Payer: BCBS Complete |
$2,523.60
|
| Rate for Payer: Cash Price |
$5,047.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,100.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,731.75
|
|
|
PR BREAST AUGMENT W MASTOPEXY-SALINE 3.5
|
Professional
|
Both
|
$5,408.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,163.20 |
| Max. Negotiated Rate |
$4,056.00 |
| Rate for Payer: Aetna Medicare |
$2,704.00
|
| Rate for Payer: BCBS Complete |
$2,163.20
|
| Rate for Payer: Cash Price |
$4,326.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,515.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,056.00
|
|
|
PR BREAST RECONSTRUCTION 1PEDICLED TRAM FLAP ANAST
|
Professional
|
Both
|
$4,953.00
|
|
|
Service Code
|
HCPCS 19368
|
| Min. Negotiated Rate |
$1,203.02 |
| Max. Negotiated Rate |
$3,863.24 |
| Rate for Payer: Aetna Commercial |
$2,496.11
|
| Rate for Payer: Aetna Medicare |
$1,937.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,496.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,682.39
|
| Rate for Payer: BCBS Complete |
$1,263.17
|
| Rate for Payer: BCBS MAPPO |
$1,862.77
|
| Rate for Payer: BCN Commercial |
$3,253.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,862.77
|
| Rate for Payer: Cash Price |
$3,962.40
|
| Rate for Payer: Cash Price |
$3,962.40
|
| Rate for Payer: Cofinity Commercial |
$2,682.39
|
| Rate for Payer: Cofinity Commercial |
$2,496.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,862.77
|
| Rate for Payer: Healthscope Commercial |
$3,446.12
|
| Rate for Payer: Healthscope Commercial |
$2,980.43
|
| Rate for Payer: Mclaren Medicaid |
$1,203.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,955.91
|
| Rate for Payer: Meridian Medicaid |
$1,263.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,049.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,842.91
|
| Rate for Payer: Nomi Health Commercial |
$2,235.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,714.75
|
| Rate for Payer: PACE SWMI |
$1,862.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,862.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,203.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,978.08
|
| Rate for Payer: Priority Health Medicare |
$1,862.77
|
| Rate for Payer: Priority Health SBD |
$2,978.08
|
| Rate for Payer: Priority Health Tiered Network |
$2,978.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1,862.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,863.24
|
| Rate for Payer: UHC Core |
$3,863.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,862.77
|
| Rate for Payer: UHC Exchange |
$3,863.24
|
| Rate for Payer: UHC Medicaid |
$1,203.02
|
| Rate for Payer: UHCCP Medicaid |
$1,203.02
|
|
|
PR BREAST RECONSTRUCTION BIPEDICLED TRAM FLAP
|
Professional
|
Both
|
$4,339.00
|
|
|
Service Code
|
HCPCS 19369
|
| Min. Negotiated Rate |
$1,119.74 |
| Max. Negotiated Rate |
$3,586.85 |
| Rate for Payer: Aetna Commercial |
$2,321.98
|
| Rate for Payer: Aetna Medicare |
$1,802.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,321.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,495.26
|
| Rate for Payer: BCBS Complete |
$1,175.73
|
| Rate for Payer: BCBS MAPPO |
$1,732.82
|
| Rate for Payer: BCN Commercial |
$3,023.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,732.82
|
| Rate for Payer: Cash Price |
$3,471.20
|
| Rate for Payer: Cash Price |
$3,471.20
|
| Rate for Payer: Cofinity Commercial |
$2,495.26
|
| Rate for Payer: Cofinity Commercial |
$2,321.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,732.82
|
| Rate for Payer: Healthscope Commercial |
$3,205.72
|
| Rate for Payer: Healthscope Commercial |
$2,772.51
|
| Rate for Payer: Mclaren Medicaid |
$1,119.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,819.46
|
| Rate for Payer: Meridian Medicaid |
$1,175.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,906.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,569.72
|
| Rate for Payer: Nomi Health Commercial |
$2,079.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,254.25
|
| Rate for Payer: PACE SWMI |
$1,732.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,732.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,119.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,767.51
|
| Rate for Payer: Priority Health Medicare |
$1,732.82
|
| Rate for Payer: Priority Health SBD |
$2,767.51
|
| Rate for Payer: Priority Health Tiered Network |
$2,767.51
|
| Rate for Payer: Railroad Medicare Medicare |
$1,732.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,586.85
|
| Rate for Payer: UHC Core |
$3,586.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,732.82
|
| Rate for Payer: UHC Exchange |
$3,586.85
|
| Rate for Payer: UHC Medicaid |
$1,119.74
|
| Rate for Payer: UHCCP Medicaid |
$1,119.74
|
|
