|
PR BYP OTH/THN VEIN AXILLARY-AXILLARY
|
Professional
|
Both
|
$2,215.00
|
|
|
Service Code
|
HCPCS 35650
|
| Min. Negotiated Rate |
$639.43 |
| Max. Negotiated Rate |
$181,516.00 |
| Rate for Payer: Aetna Commercial |
$1,319.48
|
| Rate for Payer: Aetna Medicare |
$1,024.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,319.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,417.95
|
| Rate for Payer: BCBS Complete |
$671.40
|
| Rate for Payer: BCBS MAPPO |
$984.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.34
|
| Rate for Payer: BCN Commercial |
$1,456.75
|
| Rate for Payer: BCN Medicare Advantage |
$984.69
|
| Rate for Payer: Cash Price |
$1,772.00
|
| Rate for Payer: Cash Price |
$1,772.00
|
| Rate for Payer: Cofinity Commercial |
$1,417.95
|
| Rate for Payer: Cofinity Commercial |
$1,319.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$984.69
|
| Rate for Payer: Healthscope Commercial |
$1,821.68
|
| Rate for Payer: Healthscope Commercial |
$1,575.50
|
| Rate for Payer: Mclaren Medicaid |
$639.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,033.92
|
| Rate for Payer: Meridian Medicaid |
$671.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181,516.00
|
| Rate for Payer: Nomi Health Commercial |
$1,181.63
|
| Rate for Payer: PACE SWMI |
$984.69
|
| Rate for Payer: PHP Medicare Advantage |
$984.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$639.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,439.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,592.29
|
| Rate for Payer: Priority Health Medicare |
$984.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,592.29
|
| Rate for Payer: Priority Health SBD |
$1,592.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,483.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$984.69
|
| Rate for Payer: UHC Exchange |
$1,483.59
|
| Rate for Payer: UHC Medicare Advantage |
$984.69
|
| Rate for Payer: UHCCP Medicaid |
$639.43
|
|
|
PR BYP OTH/THN VEIN AXILLARY-FEMORAL
|
Professional
|
Both
|
$4,190.00
|
|
|
Service Code
|
HCPCS 35621
|
| Min. Negotiated Rate |
$683.73 |
| Max. Negotiated Rate |
$194,524.00 |
| Rate for Payer: Aetna Commercial |
$1,407.47
|
| Rate for Payer: Aetna Medicare |
$1,092.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,407.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,512.50
|
| Rate for Payer: BCBS Complete |
$717.92
|
| Rate for Payer: BCBS MAPPO |
$1,050.35
|
| Rate for Payer: BCBS Trust/PPO |
$2,170.78
|
| Rate for Payer: BCN Commercial |
$1,565.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,050.35
|
| Rate for Payer: Cash Price |
$3,352.00
|
| Rate for Payer: Cash Price |
$3,352.00
|
| Rate for Payer: Cofinity Commercial |
$1,512.50
|
| Rate for Payer: Cofinity Commercial |
$1,407.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,050.35
|
| Rate for Payer: Healthscope Commercial |
$1,943.15
|
| Rate for Payer: Healthscope Commercial |
$1,680.56
|
| Rate for Payer: Mclaren Medicaid |
$683.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,102.87
|
| Rate for Payer: Meridian Medicaid |
$717.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194,524.00
|
| Rate for Payer: Nomi Health Commercial |
$1,260.42
|
| Rate for Payer: PACE SWMI |
$1,050.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,050.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$683.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,723.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,707.16
|
| Rate for Payer: Priority Health Medicare |
$1,050.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,707.16
|
| Rate for Payer: Priority Health SBD |
$1,707.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,581.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,050.35
|
| Rate for Payer: UHC Exchange |
$1,581.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,050.35
|
| Rate for Payer: UHCCP Medicaid |
$683.73
|
|
|
PR BYP OTH/THN VEIN AXILLARY-FEMORAL-FEMORAL
|
Professional
|
Both
|
$4,922.00
|
|
|
Service Code
|
HCPCS 35654
|
| Min. Negotiated Rate |
$853.07 |
| Max. Negotiated Rate |
$241,643.00 |
| Rate for Payer: Aetna Commercial |
$1,756.07
|
| Rate for Payer: Aetna Medicare |
$1,362.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,756.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,887.12
|
| Rate for Payer: BCBS Complete |
$895.72
|
| Rate for Payer: BCBS MAPPO |
$1,310.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,290.11
|
| Rate for Payer: BCN Commercial |
$1,943.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,310.50
|
| Rate for Payer: Cash Price |
$3,937.60
|
| Rate for Payer: Cash Price |
$3,937.60
|
| Rate for Payer: Cofinity Commercial |
$1,887.12
|
| Rate for Payer: Cofinity Commercial |
$1,756.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,310.50
|
| Rate for Payer: Healthscope Commercial |
$2,424.42
|
| Rate for Payer: Healthscope Commercial |
$2,096.80
|
| Rate for Payer: Mclaren Medicaid |
$853.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,376.02
|
| Rate for Payer: Meridian Medicaid |
$895.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241,643.00
|
| Rate for Payer: Nomi Health Commercial |
$1,572.60
|
| Rate for Payer: PACE SWMI |
$1,310.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,310.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$853.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,199.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,122.51
|
| Rate for Payer: Priority Health Medicare |
$1,310.50
|
| Rate for Payer: Priority Health Narrow Network |
$2,122.51
|
| Rate for Payer: Priority Health SBD |
$2,122.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,953.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,310.50
|
| Rate for Payer: UHC Exchange |
$1,953.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,310.50
|
| Rate for Payer: UHCCP Medicaid |
$853.07
|
|
|
PR BYP OTH/THN VEIN CAROTID-SUBCLAVIAN
|
Professional
|
Both
|
$2,324.00
|
|
|
Service Code
|
HCPCS 35606
|
| Min. Negotiated Rate |
$733.57 |
| Max. Negotiated Rate |
$207,929.00 |
| Rate for Payer: Aetna Commercial |
$1,509.03
|
| Rate for Payer: Aetna Medicare |
$1,171.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,509.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,621.64
|
| Rate for Payer: BCBS Complete |
$770.25
|
| Rate for Payer: BCBS MAPPO |
$1,126.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,535.77
|
| Rate for Payer: BCN Commercial |
$1,673.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,126.14
|
| Rate for Payer: Cash Price |
$1,859.20
|
| Rate for Payer: Cash Price |
$1,859.20
|
| Rate for Payer: Cofinity Commercial |
$1,621.64
|
| Rate for Payer: Cofinity Commercial |
$1,509.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,126.14
|
| Rate for Payer: Healthscope Commercial |
$2,083.36
|
| Rate for Payer: Healthscope Commercial |
$1,801.82
|
| Rate for Payer: Mclaren Medicaid |
$733.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,182.45
|
| Rate for Payer: Meridian Medicaid |
$770.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207,929.00
|
| Rate for Payer: Nomi Health Commercial |
$1,351.37
|
| Rate for Payer: PACE SWMI |
$1,126.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,126.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$733.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,510.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,832.13
|
| Rate for Payer: Priority Health Medicare |
$1,126.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,832.13
|
| Rate for Payer: Priority Health SBD |
$1,832.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,834.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,126.14
|
| Rate for Payer: UHC Exchange |
$1,834.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,126.14
|
| Rate for Payer: UHCCP Medicaid |
$733.57
|
|
|
PR BYP OTH/THN VEIN COMMON-IPSILATERAL CAROTID
|
Professional
|
Both
|
$2,942.00
|
|
|
Service Code
|
HCPCS 35601
|
| Min. Negotiated Rate |
$879.05 |
| Max. Negotiated Rate |
$248,760.00 |
| Rate for Payer: Aetna Commercial |
$1,809.75
|
| Rate for Payer: Aetna Medicare |
$1,404.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,809.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,944.81
|
| Rate for Payer: BCBS Complete |
$923.00
|
| Rate for Payer: BCBS MAPPO |
$1,350.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,268.45
|
| Rate for Payer: BCN Commercial |
$2,000.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,350.56
|
| Rate for Payer: Cash Price |
$2,353.60
|
| Rate for Payer: Cash Price |
$2,353.60
|
| Rate for Payer: Cofinity Commercial |
$1,944.81
|
| Rate for Payer: Cofinity Commercial |
$1,809.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,350.56
|
| Rate for Payer: Healthscope Commercial |
$2,498.54
|
| Rate for Payer: Healthscope Commercial |
$2,160.90
|
| Rate for Payer: Mclaren Medicaid |
$879.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,418.09
|
| Rate for Payer: Meridian Medicaid |
$923.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248,760.00
|
| Rate for Payer: Nomi Health Commercial |
$1,620.67
|
| Rate for Payer: PACE SWMI |
$1,350.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,350.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$879.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,912.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,180.48
|
| Rate for Payer: Priority Health Medicare |
$1,350.56
|
| Rate for Payer: Priority Health Narrow Network |
$2,180.48
|
| Rate for Payer: Priority Health SBD |
$2,180.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,725.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,350.56
|
| Rate for Payer: UHC Exchange |
$1,725.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,350.56
|
| Rate for Payer: UHCCP Medicaid |
$879.05
|
|
|
PR BYP OTH/THN VEIN FEM-ANT TIBL PST TIBL/PRONEAL
|
Professional
|
Both
|
$4,208.00
|
|
|
Service Code
|
HCPCS 35666
|
| Min. Negotiated Rate |
$802.16 |
| Max. Negotiated Rate |
$227,815.00 |
| Rate for Payer: Aetna Commercial |
$1,644.43
|
| Rate for Payer: Aetna Medicare |
$1,276.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,644.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,767.15
|
| Rate for Payer: BCBS Complete |
$842.27
|
| Rate for Payer: BCBS MAPPO |
$1,227.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,310.71
|
| Rate for Payer: BCN Commercial |
$1,839.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,227.19
|
| Rate for Payer: Cash Price |
$3,366.40
|
| Rate for Payer: Cash Price |
$3,366.40
|
| Rate for Payer: Cofinity Commercial |
$1,767.15
|
| Rate for Payer: Cofinity Commercial |
$1,644.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,227.19
|
| Rate for Payer: Healthscope Commercial |
$2,270.30
|
| Rate for Payer: Healthscope Commercial |
$1,963.50
|
| Rate for Payer: Mclaren Medicaid |
$802.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,288.55
|
| Rate for Payer: Meridian Medicaid |
$842.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227,815.00
|
| Rate for Payer: Nomi Health Commercial |
$1,472.63
|
| Rate for Payer: PACE SWMI |
$1,227.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,227.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$802.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,735.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,005.51
|
| Rate for Payer: Priority Health Medicare |
$1,227.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,005.51
|
| Rate for Payer: Priority Health SBD |
$2,005.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,951.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,227.19
|
| Rate for Payer: UHC Exchange |
$1,951.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,227.19
|
| Rate for Payer: UHCCP Medicaid |
$802.16
|
|
|
PR BYP OTH/THN VEIN FEMORAL-FEMORAL
|
Professional
|
Both
|
$2,253.00
|
|
|
Service Code
|
HCPCS 35661
|
| Min. Negotiated Rate |
$676.49 |
| Max. Negotiated Rate |
$191,806.00 |
| Rate for Payer: Aetna Commercial |
$1,389.38
|
| Rate for Payer: Aetna Medicare |
$1,078.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,389.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,493.06
|
| Rate for Payer: BCBS Complete |
$710.31
|
| Rate for Payer: BCBS MAPPO |
$1,036.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,335.54
|
| Rate for Payer: BCN Commercial |
$1,546.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,036.85
|
| Rate for Payer: Cash Price |
$1,802.40
|
| Rate for Payer: Cash Price |
$1,802.40
|
| Rate for Payer: Cofinity Commercial |
$1,493.06
|
| Rate for Payer: Cofinity Commercial |
$1,389.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,036.85
|
| Rate for Payer: Healthscope Commercial |
$1,918.17
|
| Rate for Payer: Healthscope Commercial |
$1,658.96
|
| Rate for Payer: Mclaren Medicaid |
$676.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,088.69
|
| Rate for Payer: Meridian Medicaid |
$710.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191,806.00
|
| Rate for Payer: Nomi Health Commercial |
$1,244.22
|
| Rate for Payer: PACE SWMI |
$1,036.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,036.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$676.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,464.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,686.42
|
| Rate for Payer: Priority Health Medicare |
$1,036.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,686.42
|
| Rate for Payer: Priority Health SBD |
$1,686.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,806.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,036.85
|
| Rate for Payer: UHC Exchange |
$1,806.52
|
| Rate for Payer: UHC Medicare Advantage |
$1,036.85
|
| Rate for Payer: UHCCP Medicaid |
$676.49
|
|
|
PR BYP OTH/THN VEIN FEMORAL-POPLITEAL
|
Professional
|
Both
|
$2,278.00
|
|
|
Service Code
|
HCPCS 35656
|
| Min. Negotiated Rate |
$668.82 |
| Max. Negotiated Rate |
$190,346.00 |
| Rate for Payer: Aetna Commercial |
$1,375.97
|
| Rate for Payer: Aetna Medicare |
$1,067.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,375.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,478.65
|
| Rate for Payer: BCBS Complete |
$702.26
|
| Rate for Payer: BCBS MAPPO |
$1,026.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,054.49
|
| Rate for Payer: BCN Commercial |
$1,532.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,026.84
|
| Rate for Payer: Cash Price |
$1,822.40
|
| Rate for Payer: Cash Price |
$1,822.40
|
| Rate for Payer: Cofinity Commercial |
$1,478.65
|
| Rate for Payer: Cofinity Commercial |
$1,375.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,026.84
|
| Rate for Payer: Healthscope Commercial |
$1,899.65
|
| Rate for Payer: Healthscope Commercial |
$1,642.94
|
| Rate for Payer: Mclaren Medicaid |
$668.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,078.18
|
| Rate for Payer: Meridian Medicaid |
$702.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190,346.00
|
| Rate for Payer: Nomi Health Commercial |
$1,232.21
|
| Rate for Payer: PACE SWMI |
$1,026.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,026.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$668.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,669.93
|
| Rate for Payer: Priority Health Medicare |
$1,026.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,669.93
|
| Rate for Payer: Priority Health SBD |
$1,669.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,860.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,026.84
|
| Rate for Payer: UHC Exchange |
$1,860.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,026.84
|
| Rate for Payer: UHCCP Medicaid |
$668.82
|
|
|
PR BYP OTH/THN VEIN ILIOFEMORAL
|
Professional
|
Both
|
$4,582.00
|
|
|
Service Code
|
HCPCS 35665
|
| Min. Negotiated Rate |
$732.08 |
| Max. Negotiated Rate |
$207,774.00 |
| Rate for Payer: Aetna Commercial |
$1,505.49
|
| Rate for Payer: Aetna Medicare |
$1,168.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,505.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,617.84
|
| Rate for Payer: BCBS Complete |
$768.68
|
| Rate for Payer: BCBS MAPPO |
$1,123.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,269.50
|
| Rate for Payer: BCN Commercial |
$1,673.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,123.50
|
| Rate for Payer: Cash Price |
$3,665.60
|
| Rate for Payer: Cash Price |
$3,665.60
|
| Rate for Payer: Cofinity Commercial |
$1,617.84
|
| Rate for Payer: Cofinity Commercial |
$1,505.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,123.50
|
| Rate for Payer: Healthscope Commercial |
$2,078.48
|
| Rate for Payer: Healthscope Commercial |
$1,797.60
|
| Rate for Payer: Mclaren Medicaid |
$732.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,179.68
|
| Rate for Payer: Meridian Medicaid |
$768.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207,774.00
|
| Rate for Payer: Nomi Health Commercial |
$1,348.20
|
| Rate for Payer: PACE SWMI |
$1,123.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,123.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$732.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,978.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,828.41
|
| Rate for Payer: Priority Health Medicare |
$1,123.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,828.41
|
| Rate for Payer: Priority Health SBD |
$1,828.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,727.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,123.50
|
| Rate for Payer: UHC Exchange |
$1,727.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,123.50
|
| Rate for Payer: UHCCP Medicaid |
$732.08
|
|
|
PR BYP OTH/THN VEIN POPLITEAL-TIBIAL/-PERONEAL ART
|
Professional
|
Both
|
$2,203.00
|
|
|
Service Code
|
HCPCS 35671
|
| Min. Negotiated Rate |
$703.75 |
| Max. Negotiated Rate |
$200,693.00 |
| Rate for Payer: Aetna Commercial |
$1,442.56
|
| Rate for Payer: Aetna Medicare |
$1,119.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,442.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,550.22
|
| Rate for Payer: BCBS Complete |
$738.94
|
| Rate for Payer: BCBS MAPPO |
$1,076.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,384.67
|
| Rate for Payer: BCN Commercial |
$1,621.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,076.54
|
| Rate for Payer: Cash Price |
$1,762.40
|
| Rate for Payer: Cash Price |
$1,762.40
|
| Rate for Payer: Cofinity Commercial |
$1,550.22
|
| Rate for Payer: Cofinity Commercial |
$1,442.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,076.54
|
| Rate for Payer: Healthscope Commercial |
$1,991.60
|
| Rate for Payer: Healthscope Commercial |
$1,722.46
|
| Rate for Payer: Mclaren Medicaid |
$703.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,130.37
|
| Rate for Payer: Meridian Medicaid |
$738.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200,693.00
|
| Rate for Payer: Nomi Health Commercial |
$1,291.85
|
| Rate for Payer: PACE SWMI |
$1,076.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,076.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$703.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,431.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,765.67
|
| Rate for Payer: Priority Health Medicare |
$1,076.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,765.67
|
| Rate for Payer: Priority Health SBD |
$1,765.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,621.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,076.54
|
| Rate for Payer: UHC Exchange |
$1,621.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,076.54
|
| Rate for Payer: UHCCP Medicaid |
$703.75
|
|
|
PR BYP OTH/THN VEIN SUBCLAVIAN-SUBCLAVIAN
|
Professional
|
Both
|
$2,244.00
|
|
|
Service Code
|
HCPCS 35612
|
| Min. Negotiated Rate |
$655.19 |
| Max. Negotiated Rate |
$185,614.00 |
| Rate for Payer: Aetna Commercial |
$1,350.12
|
| Rate for Payer: Aetna Medicare |
$1,047.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,350.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,450.87
|
| Rate for Payer: BCBS Complete |
$687.95
|
| Rate for Payer: BCBS MAPPO |
$1,007.55
|
| Rate for Payer: BCBS Trust/PPO |
$2,601.35
|
| Rate for Payer: BCN Commercial |
$1,491.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,007.55
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cofinity Commercial |
$1,450.87
|
| Rate for Payer: Cofinity Commercial |
$1,350.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,007.55
|
| Rate for Payer: Healthscope Commercial |
$1,863.97
|
| Rate for Payer: Healthscope Commercial |
$1,612.08
|
| Rate for Payer: Mclaren Medicaid |
$655.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,057.93
|
| Rate for Payer: Meridian Medicaid |
$687.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185,614.00
|
| Rate for Payer: Nomi Health Commercial |
$1,209.06
|
| Rate for Payer: PACE SWMI |
$1,007.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,007.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$655.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,458.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,631.64
|
| Rate for Payer: Priority Health Medicare |
$1,007.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,631.64
|
| Rate for Payer: Priority Health SBD |
$1,631.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,582.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,007.55
|
| Rate for Payer: UHC Exchange |
$1,582.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,007.55
|
| Rate for Payer: UHCCP Medicaid |
$655.19
|
|
|
PR BYP TIBL-TIBL/PRONEAL-TIBL/TIBL/PRONEAL TRK-TIBL
|
Professional
|
Both
|
$2,798.00
|
|
|
Service Code
|
HCPCS 35570
|
| Min. Negotiated Rate |
$921.44 |
| Max. Negotiated Rate |
$261,596.00 |
| Rate for Payer: Aetna Commercial |
$1,902.06
|
| Rate for Payer: Aetna Medicare |
$1,476.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,902.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,044.01
|
| Rate for Payer: BCBS Complete |
$967.51
|
| Rate for Payer: BCBS MAPPO |
$1,419.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,043.92
|
| Rate for Payer: BCN Commercial |
$2,098.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,419.45
|
| Rate for Payer: Cash Price |
$2,238.40
|
| Rate for Payer: Cash Price |
$2,238.40
|
| Rate for Payer: Cofinity Commercial |
$2,044.01
|
| Rate for Payer: Cofinity Commercial |
$1,902.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,419.45
|
| Rate for Payer: Healthscope Commercial |
$2,271.12
|
| Rate for Payer: Healthscope Commercial |
$2,625.98
|
| Rate for Payer: Mclaren Medicaid |
$921.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,490.42
|
| Rate for Payer: Meridian Medicaid |
$967.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261,596.00
|
| Rate for Payer: Nomi Health Commercial |
$1,703.34
|
| Rate for Payer: PACE SWMI |
$1,419.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,419.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$921.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,818.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,296.41
|
| Rate for Payer: Priority Health Medicare |
$1,419.45
|
| Rate for Payer: Priority Health Narrow Network |
$2,296.41
|
| Rate for Payer: Priority Health SBD |
$2,296.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,419.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,419.45
|
| Rate for Payer: UHCCP Medicaid |
$921.44
|
|
|
PR BYP W/VEIN POP-TIBL-PRONEAL ART/OTH DSTL VSL
|
Professional
|
Both
|
$5,238.00
|
|
|
Service Code
|
HCPCS 35571
|
| Min. Negotiated Rate |
$826.01 |
| Max. Negotiated Rate |
$234,643.00 |
| Rate for Payer: Aetna Commercial |
$1,701.06
|
| Rate for Payer: Aetna Medicare |
$1,320.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,701.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,828.01
|
| Rate for Payer: BCBS Complete |
$867.31
|
| Rate for Payer: BCBS MAPPO |
$1,269.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,402.64
|
| Rate for Payer: BCN Commercial |
$1,886.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,269.45
|
| Rate for Payer: Cash Price |
$4,190.40
|
| Rate for Payer: Cash Price |
$4,190.40
|
| Rate for Payer: Cofinity Commercial |
$1,828.01
|
| Rate for Payer: Cofinity Commercial |
$1,701.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,269.45
|
| Rate for Payer: Healthscope Commercial |
$2,348.48
|
| Rate for Payer: Healthscope Commercial |
$2,031.12
|
| Rate for Payer: Mclaren Medicaid |
$826.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,332.92
|
| Rate for Payer: Meridian Medicaid |
$867.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234,643.00
|
| Rate for Payer: Nomi Health Commercial |
$1,523.34
|
| Rate for Payer: PACE SWMI |
$1,269.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,269.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$826.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,404.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,059.75
|
| Rate for Payer: Priority Health Medicare |
$1,269.45
|
| Rate for Payer: Priority Health Narrow Network |
$2,059.75
|
| Rate for Payer: Priority Health SBD |
$2,059.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,943.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,269.45
|
| Rate for Payer: UHC Exchange |
$1,943.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,269.45
|
| Rate for Payer: UHCCP Medicaid |
$826.01
|
|
|
PR CABG W/ARTERIAL GRAFT FOUR/>ARTERIAL GRAFTS
|
Professional
|
Both
|
$5,502.00
|
|
|
Service Code
|
HCPCS 33536
|
| Min. Negotiated Rate |
$1,086.18 |
| Max. Negotiated Rate |
$465,934.00 |
| Rate for Payer: Aetna Commercial |
$3,386.10
|
| Rate for Payer: Aetna Medicare |
$2,628.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,386.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,638.79
|
| Rate for Payer: BCBS Complete |
$1,738.65
|
| Rate for Payer: BCBS MAPPO |
$2,526.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.18
|
| Rate for Payer: BCN Commercial |
$3,767.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,526.94
|
| Rate for Payer: Cash Price |
$4,401.60
|
| Rate for Payer: Cash Price |
$4,401.60
|
| Rate for Payer: Cofinity Commercial |
$3,638.79
|
| Rate for Payer: Cofinity Commercial |
$3,386.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,526.94
|
| Rate for Payer: Healthscope Commercial |
$4,674.84
|
| Rate for Payer: Healthscope Commercial |
$4,043.10
|
| Rate for Payer: Mclaren Medicaid |
$1,655.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,653.29
|
| Rate for Payer: Meridian Medicaid |
$1,738.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465,934.00
|
| Rate for Payer: Nomi Health Commercial |
$3,032.33
|
| Rate for Payer: PACE SWMI |
$2,526.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,526.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,655.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,576.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,118.44
|
| Rate for Payer: Priority Health Medicare |
$2,526.94
|
| Rate for Payer: Priority Health Narrow Network |
$4,118.44
|
| Rate for Payer: Priority Health SBD |
$4,118.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,064.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,526.94
|
| Rate for Payer: UHC Exchange |
$4,064.95
|
| Rate for Payer: UHC Medicare Advantage |
$2,526.94
|
| Rate for Payer: UHCCP Medicaid |
$1,655.86
|
|
|
PR CABG W/ARTERIAL GRAFT SINGLE ARTERIAL GRAFT
|
Professional
|
Both
|
$3,911.00
|
|
|
Service Code
|
HCPCS 33533
|
| Min. Negotiated Rate |
$1,178.10 |
| Max. Negotiated Rate |
$331,333.00 |
| Rate for Payer: Aetna Commercial |
$2,405.27
|
| Rate for Payer: Aetna Medicare |
$1,866.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,405.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,584.77
|
| Rate for Payer: BCBS Complete |
$1,237.00
|
| Rate for Payer: BCBS MAPPO |
$1,794.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,225.66
|
| Rate for Payer: BCN Commercial |
$2,682.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,794.98
|
| Rate for Payer: Cash Price |
$3,128.80
|
| Rate for Payer: Cash Price |
$3,128.80
|
| Rate for Payer: Cofinity Commercial |
$2,584.77
|
| Rate for Payer: Cofinity Commercial |
$2,405.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,794.98
|
| Rate for Payer: Healthscope Commercial |
$3,320.71
|
| Rate for Payer: Healthscope Commercial |
$2,871.97
|
| Rate for Payer: Mclaren Medicaid |
$1,178.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,884.73
|
| Rate for Payer: Meridian Medicaid |
$1,237.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331,333.00
|
| Rate for Payer: Nomi Health Commercial |
$2,153.98
|
| Rate for Payer: PACE SWMI |
$1,794.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,794.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,178.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,542.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,929.82
|
| Rate for Payer: Priority Health Medicare |
$1,794.98
|
| Rate for Payer: Priority Health Narrow Network |
$2,929.82
|
| Rate for Payer: Priority Health SBD |
$2,929.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,631.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,794.98
|
| Rate for Payer: UHC Exchange |
$3,631.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,794.98
|
| Rate for Payer: UHCCP Medicaid |
$1,178.10
|
|
|
PR CABG W/ARTERIAL GRAFT THREE ARTERIAL GRAFTS
|
Professional
|
Both
|
$5,136.00
|
|
|
Service Code
|
HCPCS 33535
|
| Min. Negotiated Rate |
$1,100.98 |
| Max. Negotiated Rate |
$432,837.00 |
| Rate for Payer: Aetna Commercial |
$3,141.84
|
| Rate for Payer: Aetna Medicare |
$2,438.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,141.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,376.31
|
| Rate for Payer: BCBS Complete |
$1,614.08
|
| Rate for Payer: BCBS MAPPO |
$2,344.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,100.98
|
| Rate for Payer: BCN Commercial |
$3,501.37
|
| Rate for Payer: BCN Medicare Advantage |
$2,344.66
|
| Rate for Payer: Cash Price |
$4,108.80
|
| Rate for Payer: Cash Price |
$4,108.80
|
| Rate for Payer: Cofinity Commercial |
$3,376.31
|
| Rate for Payer: Cofinity Commercial |
$3,141.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,344.66
|
| Rate for Payer: Healthscope Commercial |
$4,337.62
|
| Rate for Payer: Healthscope Commercial |
$3,751.46
|
| Rate for Payer: Mclaren Medicaid |
$1,537.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,461.89
|
| Rate for Payer: Meridian Medicaid |
$1,614.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432,837.00
|
| Rate for Payer: Nomi Health Commercial |
$2,813.59
|
| Rate for Payer: PACE SWMI |
$2,344.66
|
| Rate for Payer: PHP Medicare Advantage |
$2,344.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,537.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,338.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,822.22
|
| Rate for Payer: Priority Health Medicare |
$2,344.66
|
| Rate for Payer: Priority Health Narrow Network |
$3,822.22
|
| Rate for Payer: Priority Health SBD |
$3,822.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,042.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,344.66
|
| Rate for Payer: UHC Exchange |
$4,042.60
|
| Rate for Payer: UHC Medicare Advantage |
$2,344.66
|
| Rate for Payer: UHCCP Medicaid |
$1,537.22
|
|
|
PR CABG W/ARTERIAL GRAFT TWO ARTERIAL GRAFTS
|
Professional
|
Both
|
$4,602.00
|
|
|
Service Code
|
HCPCS 33534
|
| Min. Negotiated Rate |
$1,126.86 |
| Max. Negotiated Rate |
$389,061.00 |
| Rate for Payer: Aetna Commercial |
$2,826.84
|
| Rate for Payer: Aetna Medicare |
$2,193.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,826.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,037.80
|
| Rate for Payer: BCBS Complete |
$1,453.05
|
| Rate for Payer: BCBS MAPPO |
$2,109.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,126.86
|
| Rate for Payer: BCN Commercial |
$3,149.04
|
| Rate for Payer: BCN Medicare Advantage |
$2,109.58
|
| Rate for Payer: Cash Price |
$3,681.60
|
| Rate for Payer: Cash Price |
$3,681.60
|
| Rate for Payer: Cofinity Commercial |
$3,037.80
|
| Rate for Payer: Cofinity Commercial |
$2,826.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,109.58
|
| Rate for Payer: Healthscope Commercial |
$3,902.72
|
| Rate for Payer: Healthscope Commercial |
$3,375.33
|
| Rate for Payer: Mclaren Medicaid |
$1,383.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,215.06
|
| Rate for Payer: Meridian Medicaid |
$1,453.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389,061.00
|
| Rate for Payer: Nomi Health Commercial |
$2,531.50
|
| Rate for Payer: PACE SWMI |
$2,109.58
|
| Rate for Payer: PHP Medicare Advantage |
$2,109.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,383.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,991.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,440.38
|
| Rate for Payer: Priority Health Medicare |
$2,109.58
|
| Rate for Payer: Priority Health Narrow Network |
$3,440.38
|
| Rate for Payer: Priority Health SBD |
$3,440.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,941.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,109.58
|
| Rate for Payer: UHC Exchange |
$3,941.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,109.58
|
| Rate for Payer: UHCCP Medicaid |
$1,383.86
|
|
|
PR CALIBRATED MICROCAP TUBE
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS A4651
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCN Commercial |
$1.86
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
|
|
PR CALORIC VESTIBULAR TEST, EACH IRRIGATION, WITH RECORDING
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS 92543
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Aetna Medicare |
$9.50
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.35
|
|
|
PR CANALITH REPOSITIONING PROCEDURE
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 95992
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$5,328.00 |
| Rate for Payer: Aetna Commercial |
$45.09
|
| Rate for Payer: Aetna Medicare |
$35.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.09
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$33.65
|
| Rate for Payer: BCBS Trust/PPO |
$189.13
|
| Rate for Payer: BCN Commercial |
$63.04
|
| Rate for Payer: BCN Medicare Advantage |
$33.65
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$45.09
|
| Rate for Payer: Cofinity Commercial |
$48.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.65
|
| Rate for Payer: Healthscope Commercial |
$62.25
|
| Rate for Payer: Healthscope Commercial |
$53.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,328.00
|
| Rate for Payer: Nomi Health Commercial |
$40.38
|
| Rate for Payer: PACE SWMI |
$33.65
|
| Rate for Payer: PHP Medicare Advantage |
$33.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.94
|
| Rate for Payer: Priority Health Medicare |
$33.65
|
| Rate for Payer: Priority Health Narrow Network |
$47.94
|
| Rate for Payer: Priority Health SBD |
$47.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.65
|
| Rate for Payer: UHC Medicare Advantage |
$33.65
|
|
|
PR CANTHOPLASTY
|
Professional
|
Both
|
$1,146.00
|
|
|
Service Code
|
HCPCS 67950
|
| Min. Negotiated Rate |
$293.09 |
| Max. Negotiated Rate |
$79,414.00 |
| Rate for Payer: Aetna Commercial |
$572.35
|
| Rate for Payer: Aetna Medicare |
$444.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$572.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.07
|
| Rate for Payer: BCBS Complete |
$307.74
|
| Rate for Payer: BCBS MAPPO |
$427.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,419.61
|
| Rate for Payer: BCN Commercial |
$850.79
|
| Rate for Payer: BCN Medicare Advantage |
$427.13
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Cofinity Commercial |
$615.07
|
| Rate for Payer: Cofinity Commercial |
$572.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$427.13
|
| Rate for Payer: Healthscope Commercial |
$790.19
|
| Rate for Payer: Healthscope Commercial |
$683.41
|
| Rate for Payer: Mclaren Medicaid |
$293.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$448.49
|
| Rate for Payer: Meridian Medicaid |
$307.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79,414.00
|
| Rate for Payer: Nomi Health Commercial |
$512.56
|
| Rate for Payer: PACE SWMI |
$427.13
|
| Rate for Payer: PHP Medicare Advantage |
$427.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$293.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$803.66
|
| Rate for Payer: Priority Health Medicare |
$427.13
|
| Rate for Payer: Priority Health Narrow Network |
$803.66
|
| Rate for Payer: Priority Health SBD |
$803.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$626.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$427.13
|
| Rate for Payer: UHC Exchange |
$626.13
|
| Rate for Payer: UHC Medicare Advantage |
$427.13
|
| Rate for Payer: UHCCP Medicaid |
$293.09
|
|
|
PR CANTHOTOMY SEPARATE PROCEDURE
|
Professional
|
Both
|
$374.00
|
|
|
Service Code
|
HCPCS 67715
|
| Min. Negotiated Rate |
$69.01 |
| Max. Negotiated Rate |
$18,707.00 |
| Rate for Payer: Aetna Commercial |
$134.76
|
| Rate for Payer: Aetna Medicare |
$104.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.82
|
| Rate for Payer: BCBS Complete |
$72.46
|
| Rate for Payer: BCBS MAPPO |
$100.57
|
| Rate for Payer: BCBS Trust/PPO |
$523.55
|
| Rate for Payer: BCN Commercial |
$388.50
|
| Rate for Payer: BCN Medicare Advantage |
$100.57
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Cofinity Commercial |
$144.82
|
| Rate for Payer: Cofinity Commercial |
$134.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.57
|
| Rate for Payer: Healthscope Commercial |
$186.05
|
| Rate for Payer: Healthscope Commercial |
$160.91
|
| Rate for Payer: Mclaren Medicaid |
$69.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.60
|
| Rate for Payer: Meridian Medicaid |
$72.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,707.00
|
| Rate for Payer: Nomi Health Commercial |
$120.68
|
| Rate for Payer: PACE SWMI |
$100.57
|
| Rate for Payer: PHP Medicare Advantage |
$100.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.75
|
| Rate for Payer: Priority Health Medicare |
$100.57
|
| Rate for Payer: Priority Health Narrow Network |
$187.75
|
| Rate for Payer: Priority Health SBD |
$187.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.57
|
| Rate for Payer: UHC Exchange |
$231.93
|
| Rate for Payer: UHC Medicare Advantage |
$100.57
|
| Rate for Payer: UHCCP Medicaid |
$69.01
|
|
|
PR CAPSLCTOMY/CAPSUL HIP W/RLS HIP FLXR MUSC
|
Professional
|
Both
|
$4,799.00
|
|
|
Service Code
|
HCPCS 27036
|
| Min. Negotiated Rate |
$197.75 |
| Max. Negotiated Rate |
$180,410.00 |
| Rate for Payer: Aetna Commercial |
$1,315.25
|
| Rate for Payer: Aetna Medicare |
$1,020.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,315.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,413.40
|
| Rate for Payer: BCBS Complete |
$694.88
|
| Rate for Payer: BCBS MAPPO |
$981.53
|
| Rate for Payer: BCBS Trust/PPO |
$197.75
|
| Rate for Payer: BCN Commercial |
$1,492.42
|
| Rate for Payer: BCN Medicare Advantage |
$981.53
|
| Rate for Payer: Cash Price |
$3,839.20
|
| Rate for Payer: Cash Price |
$3,839.20
|
| Rate for Payer: Cofinity Commercial |
$1,413.40
|
| Rate for Payer: Cofinity Commercial |
$1,315.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$981.53
|
| Rate for Payer: Healthscope Commercial |
$1,815.83
|
| Rate for Payer: Healthscope Commercial |
$1,570.45
|
| Rate for Payer: Mclaren Medicaid |
$661.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,030.61
|
| Rate for Payer: Meridian Medicaid |
$694.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180,410.00
|
| Rate for Payer: Nomi Health Commercial |
$1,177.84
|
| Rate for Payer: PACE SWMI |
$981.53
|
| Rate for Payer: PHP Medicare Advantage |
$981.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$661.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,119.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,568.31
|
| Rate for Payer: Priority Health Medicare |
$981.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,568.31
|
| Rate for Payer: Priority Health SBD |
$1,568.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,132.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$981.53
|
| Rate for Payer: UHC Exchange |
$1,132.18
|
| Rate for Payer: UHC Medicare Advantage |
$981.53
|
| Rate for Payer: UHCCP Medicaid |
$661.79
|
|
|
PR CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS
|
Professional
|
Both
|
$1,755.00
|
|
|
Service Code
|
HCPCS 25320
|
| Min. Negotiated Rate |
$400.98 |
| Max. Negotiated Rate |
$174,724.00 |
| Rate for Payer: Aetna Commercial |
$1,279.08
|
| Rate for Payer: Aetna Medicare |
$992.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,279.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.54
|
| Rate for Payer: BCBS Complete |
$681.24
|
| Rate for Payer: BCBS MAPPO |
$954.54
|
| Rate for Payer: BCBS Trust/PPO |
$400.98
|
| Rate for Payer: BCN Commercial |
$1,454.79
|
| Rate for Payer: BCN Medicare Advantage |
$954.54
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cofinity Commercial |
$1,374.54
|
| Rate for Payer: Cofinity Commercial |
$1,279.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$954.54
|
| Rate for Payer: Healthscope Commercial |
$1,765.90
|
| Rate for Payer: Healthscope Commercial |
$1,527.26
|
| Rate for Payer: Mclaren Medicaid |
$648.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,002.27
|
| Rate for Payer: Meridian Medicaid |
$681.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174,724.00
|
| Rate for Payer: Nomi Health Commercial |
$1,145.45
|
| Rate for Payer: PACE SWMI |
$954.54
|
| Rate for Payer: PHP Medicare Advantage |
$954.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$648.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,140.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,533.19
|
| Rate for Payer: Priority Health Medicare |
$954.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,533.19
|
| Rate for Payer: Priority Health SBD |
$1,533.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$954.54
|
| Rate for Payer: UHC Exchange |
$971.93
|
| Rate for Payer: UHC Medicare Advantage |
$954.54
|
| Rate for Payer: UHCCP Medicaid |
$648.80
|
|
|
PR CAPSULAR CONTRACTURE RELEASE
|
Professional
|
Both
|
$2,010.00
|
|
|
Service Code
|
HCPCS 23020
|
| Min. Negotiated Rate |
$282.11 |
| Max. Negotiated Rate |
$122,692.00 |
| Rate for Payer: Aetna Commercial |
$895.48
|
| Rate for Payer: Aetna Medicare |
$695.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$895.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$962.31
|
| Rate for Payer: BCBS Complete |
$474.59
|
| Rate for Payer: BCBS MAPPO |
$668.27
|
| Rate for Payer: BCBS Trust/PPO |
$282.11
|
| Rate for Payer: BCN Commercial |
$1,017.92
|
| Rate for Payer: BCN Medicare Advantage |
$668.27
|
| Rate for Payer: Cash Price |
$1,608.00
|
| Rate for Payer: Cash Price |
$1,608.00
|
| Rate for Payer: Cofinity Commercial |
$962.31
|
| Rate for Payer: Cofinity Commercial |
$895.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$668.27
|
| Rate for Payer: Healthscope Commercial |
$1,236.30
|
| Rate for Payer: Healthscope Commercial |
$1,069.23
|
| Rate for Payer: Mclaren Medicaid |
$451.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$701.68
|
| Rate for Payer: Meridian Medicaid |
$474.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122,692.00
|
| Rate for Payer: Nomi Health Commercial |
$801.92
|
| Rate for Payer: PACE SWMI |
$668.27
|
| Rate for Payer: PHP Medicare Advantage |
$668.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$451.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,306.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,068.61
|
| Rate for Payer: Priority Health Medicare |
$668.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,068.61
|
| Rate for Payer: Priority Health SBD |
$1,068.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$823.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$668.27
|
| Rate for Payer: UHC Exchange |
$823.01
|
| Rate for Payer: UHC Medicare Advantage |
$668.27
|
| Rate for Payer: UHCCP Medicaid |
$451.99
|
|
