|
PR DIR RPR RUPTD ANEURSM HEPATIC/CELIAC/RENAL/MESEN
|
Professional
|
Both
|
$3,859.00
|
|
|
Service Code
|
HCPCS 35122
|
| Min. Negotiated Rate |
$1,180.87 |
| Max. Negotiated Rate |
$2,943.64 |
| Rate for Payer: Aetna Commercial |
$2,441.14
|
| Rate for Payer: Aetna Medicare |
$1,894.62
|
| Rate for Payer: BCBS Complete |
$1,239.91
|
| Rate for Payer: BCBS MAPPO |
$1,821.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,197.66
|
| Rate for Payer: BCN Commercial |
$2,691.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,821.75
|
| Rate for Payer: Cash Price |
$3,087.20
|
| Rate for Payer: Cash Price |
$3,087.20
|
| Rate for Payer: Cofinity Commercial |
$2,623.32
|
| Rate for Payer: Cofinity Commercial |
$2,441.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,821.75
|
| Rate for Payer: Mclaren Medicaid |
$1,180.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,912.84
|
| Rate for Payer: Meridian Medicaid |
$1,239.91
|
| Rate for Payer: Nomi Health Commercial |
$2,186.10
|
| Rate for Payer: PACE SWMI |
$1,821.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,821.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,180.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,508.35
|
| Rate for Payer: Priority Health HMO/PPO |
$2,943.64
|
| Rate for Payer: Priority Health Medicare |
$1,839.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,943.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,821.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,821.75
|
| Rate for Payer: UHC Exchange |
$1,821.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,821.75
|
| Rate for Payer: UHCCP Medicaid |
$1,180.87
|
|
|
PR DIR RPR RUPTD ANEURYSM ABDOM AORTA W/ILIAC VSLS
|
Professional
|
Both
|
$3,560.00
|
|
|
Service Code
|
HCPCS 35103
|
| Min. Negotiated Rate |
$621.81 |
| Max. Negotiated Rate |
$3,448.88 |
| Rate for Payer: Aetna Commercial |
$2,798.04
|
| Rate for Payer: Aetna Medicare |
$2,171.61
|
| Rate for Payer: BCBS Complete |
$1,420.40
|
| Rate for Payer: BCBS MAPPO |
$2,088.09
|
| Rate for Payer: BCBS Trust/PPO |
$621.81
|
| Rate for Payer: BCN Commercial |
$3,166.15
|
| Rate for Payer: BCN Medicare Advantage |
$2,088.09
|
| Rate for Payer: Cash Price |
$2,848.00
|
| Rate for Payer: Cash Price |
$2,848.00
|
| Rate for Payer: Cofinity Commercial |
$3,006.85
|
| Rate for Payer: Cofinity Commercial |
$2,798.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,088.09
|
| Rate for Payer: Mclaren Medicaid |
$1,352.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,192.49
|
| Rate for Payer: Meridian Medicaid |
$1,420.40
|
| Rate for Payer: Nomi Health Commercial |
$2,505.71
|
| Rate for Payer: PACE SWMI |
$2,088.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,088.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,352.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,314.00
|
| Rate for Payer: Priority Health HMO/PPO |
$3,448.88
|
| Rate for Payer: Priority Health Medicare |
$2,108.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,448.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,088.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,088.09
|
| Rate for Payer: UHC Exchange |
$2,088.09
|
| Rate for Payer: UHC Medicare Advantage |
$2,088.09
|
| Rate for Payer: UHCCP Medicaid |
$1,352.76
|
|
|
PR DIR RPR RUPTD ANEURYSM ABDOMINAL AORTA
|
Professional
|
Both
|
$4,286.00
|
|
|
Service Code
|
HCPCS 35082
|
| Min. Negotiated Rate |
$750.19 |
| Max. Negotiated Rate |
$3,363.78 |
| Rate for Payer: Aetna Commercial |
$2,786.46
|
| Rate for Payer: Aetna Medicare |
$2,162.63
|
| Rate for Payer: BCBS Complete |
$1,419.96
|
| Rate for Payer: BCBS MAPPO |
$2,079.45
|
| Rate for Payer: BCBS Trust/PPO |
$750.19
|
| Rate for Payer: BCN Commercial |
$3,083.06
|
| Rate for Payer: BCN Medicare Advantage |
$2,079.45
|
| Rate for Payer: Cash Price |
$3,428.80
|
| Rate for Payer: Cash Price |
$3,428.80
|
| Rate for Payer: Cofinity Commercial |
$2,994.41
|
| Rate for Payer: Cofinity Commercial |
$2,786.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,079.45
|
| Rate for Payer: Mclaren Medicaid |
$1,352.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,183.42
|
| Rate for Payer: Meridian Medicaid |
$1,419.96
|
| Rate for Payer: Nomi Health Commercial |
$2,495.34
|
| Rate for Payer: PACE SWMI |
$2,079.45
|
| Rate for Payer: PHP Medicare Advantage |
$2,079.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,352.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,785.90
|
| Rate for Payer: Priority Health HMO/PPO |
$3,363.78
|
| Rate for Payer: Priority Health Medicare |
$2,100.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,363.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,079.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,079.45
|
| Rate for Payer: UHC Exchange |
$2,079.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,079.45
|
| Rate for Payer: UHCCP Medicaid |
$1,352.34
|
|
|
PR DIR RPR RUPTD ANEURYSM AXIL-BRACHIAL ARM INCIS
|
Professional
|
Both
|
$3,927.00
|
|
|
Service Code
|
HCPCS 35013
|
| Min. Negotiated Rate |
$741.88 |
| Max. Negotiated Rate |
$2,552.55 |
| Rate for Payer: Aetna Commercial |
$1,530.00
|
| Rate for Payer: Aetna Medicare |
$1,187.46
|
| Rate for Payer: BCBS Complete |
$778.97
|
| Rate for Payer: BCBS MAPPO |
$1,141.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,152.22
|
| Rate for Payer: BCN Commercial |
$1,815.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,141.79
|
| Rate for Payer: Cash Price |
$3,141.60
|
| Rate for Payer: Cash Price |
$3,141.60
|
| Rate for Payer: Cofinity Commercial |
$1,644.18
|
| Rate for Payer: Cofinity Commercial |
$1,530.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,141.79
|
| Rate for Payer: Mclaren Medicaid |
$741.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,198.88
|
| Rate for Payer: Meridian Medicaid |
$778.97
|
| Rate for Payer: Nomi Health Commercial |
$1,370.15
|
| Rate for Payer: PACE SWMI |
$1,141.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,141.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$741.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,552.55
|
| Rate for Payer: Priority Health HMO/PPO |
$1,981.05
|
| Rate for Payer: Priority Health Medicare |
$1,153.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,981.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,141.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,141.79
|
| Rate for Payer: UHC Exchange |
$1,141.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,141.79
|
| Rate for Payer: UHCCP Medicaid |
$741.88
|
|
|
PR DIR RPR RUPTD ANEURYSM CAROTID-SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$2,542.00
|
|
|
Service Code
|
HCPCS 35002
|
| Min. Negotiated Rate |
$712.91 |
| Max. Negotiated Rate |
$2,959.01 |
| Rate for Payer: Aetna Commercial |
$1,469.60
|
| Rate for Payer: Aetna Medicare |
$1,140.59
|
| Rate for Payer: BCBS Complete |
$748.56
|
| Rate for Payer: BCBS MAPPO |
$1,096.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,959.01
|
| Rate for Payer: BCN Commercial |
$1,623.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,096.72
|
| Rate for Payer: Cash Price |
$2,033.60
|
| Rate for Payer: Cash Price |
$2,033.60
|
| Rate for Payer: Cofinity Commercial |
$1,579.28
|
| Rate for Payer: Cofinity Commercial |
$1,469.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,096.72
|
| Rate for Payer: Mclaren Medicaid |
$712.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,151.56
|
| Rate for Payer: Meridian Medicaid |
$748.56
|
| Rate for Payer: Nomi Health Commercial |
$1,316.06
|
| Rate for Payer: PACE SWMI |
$1,096.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,096.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$712.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,652.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,775.76
|
| Rate for Payer: Priority Health Medicare |
$1,107.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,775.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,096.72
|
| Rate for Payer: UHC Exchange |
$1,096.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,096.72
|
| Rate for Payer: UHCCP Medicaid |
$712.91
|
|
|
PR DIR RPR RUPTD ANEURYSM & GRAFT ILIAC ARTERY
|
Professional
|
Both
|
$3,452.00
|
|
|
Service Code
|
HCPCS 35132
|
| Min. Negotiated Rate |
$1,021.55 |
| Max. Negotiated Rate |
$2,544.79 |
| Rate for Payer: Aetna Commercial |
$2,110.50
|
| Rate for Payer: Aetna Medicare |
$1,638.00
|
| Rate for Payer: BCBS Complete |
$1,072.63
|
| Rate for Payer: BCBS MAPPO |
$1,575.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,010.18
|
| Rate for Payer: BCN Commercial |
$2,328.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,575.00
|
| Rate for Payer: Cash Price |
$2,761.60
|
| Rate for Payer: Cash Price |
$2,761.60
|
| Rate for Payer: Cofinity Commercial |
$2,268.00
|
| Rate for Payer: Cofinity Commercial |
$2,110.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,575.00
|
| Rate for Payer: Mclaren Medicaid |
$1,021.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,653.75
|
| Rate for Payer: Meridian Medicaid |
$1,072.63
|
| Rate for Payer: Nomi Health Commercial |
$1,890.00
|
| Rate for Payer: PACE SWMI |
$1,575.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,575.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,021.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,243.80
|
| Rate for Payer: Priority Health HMO/PPO |
$2,544.79
|
| Rate for Payer: Priority Health Medicare |
$1,590.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,544.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,575.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,575.00
|
| Rate for Payer: UHC Exchange |
$1,575.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,575.00
|
| Rate for Payer: UHCCP Medicaid |
$1,021.55
|
|
|
PR DIR RPR RUPTD ANEURYSM & GRF COMMON FEMORAL ART
|
Professional
|
Both
|
$2,610.00
|
|
|
Service Code
|
HCPCS 35142
|
| Min. Negotiated Rate |
$571.62 |
| Max. Negotiated Rate |
$2,055.50 |
| Rate for Payer: Aetna Commercial |
$1,695.26
|
| Rate for Payer: Aetna Medicare |
$1,315.72
|
| Rate for Payer: BCBS Complete |
$865.53
|
| Rate for Payer: BCBS MAPPO |
$1,265.12
|
| Rate for Payer: BCBS Trust/PPO |
$571.62
|
| Rate for Payer: BCN Commercial |
$1,884.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,265.12
|
| Rate for Payer: Cash Price |
$2,088.00
|
| Rate for Payer: Cash Price |
$2,088.00
|
| Rate for Payer: Cofinity Commercial |
$1,821.77
|
| Rate for Payer: Cofinity Commercial |
$1,695.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,265.12
|
| Rate for Payer: Mclaren Medicaid |
$824.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,328.38
|
| Rate for Payer: Meridian Medicaid |
$865.53
|
| Rate for Payer: Nomi Health Commercial |
$1,518.14
|
| Rate for Payer: PACE SWMI |
$1,265.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,265.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$824.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,696.50
|
| Rate for Payer: Priority Health HMO/PPO |
$2,055.50
|
| Rate for Payer: Priority Health Medicare |
$1,277.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,055.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,265.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,265.12
|
| Rate for Payer: UHC Exchange |
$1,265.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,265.12
|
| Rate for Payer: UHCCP Medicaid |
$824.31
|
|
|
PR DIR RPR RUPTD ANEURYSM & GRF POPLITEAL ARTERY
|
Professional
|
Both
|
$2,737.00
|
|
|
Service Code
|
HCPCS 35152
|
| Min. Negotiated Rate |
$874.58 |
| Max. Negotiated Rate |
$2,435.46 |
| Rate for Payer: Aetna Commercial |
$1,805.48
|
| Rate for Payer: Aetna Medicare |
$1,401.26
|
| Rate for Payer: BCBS Complete |
$918.31
|
| Rate for Payer: BCBS MAPPO |
$1,347.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,435.46
|
| Rate for Payer: BCN Commercial |
$1,992.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,347.37
|
| Rate for Payer: Cash Price |
$2,189.60
|
| Rate for Payer: Cash Price |
$2,189.60
|
| Rate for Payer: Cofinity Commercial |
$1,805.48
|
| Rate for Payer: Cofinity Commercial |
$1,940.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,347.37
|
| Rate for Payer: Mclaren Medicaid |
$874.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,414.74
|
| Rate for Payer: Meridian Medicaid |
$918.31
|
| Rate for Payer: Nomi Health Commercial |
$1,616.84
|
| Rate for Payer: PACE SWMI |
$1,347.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,347.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$874.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,779.05
|
| Rate for Payer: Priority Health HMO/PPO |
$2,177.29
|
| Rate for Payer: Priority Health Medicare |
$1,360.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,177.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,347.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,347.37
|
| Rate for Payer: UHC Exchange |
$1,347.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,347.37
|
| Rate for Payer: UHCCP Medicaid |
$874.58
|
|
|
PR DIR RPR RUPTD ANEURYSM INNOMINATE/SUBCLAVIAN
|
Professional
|
Both
|
$2,934.00
|
|
|
Service Code
|
HCPCS 35022
|
| Min. Negotiated Rate |
$906.74 |
| Max. Negotiated Rate |
$2,253.34 |
| Rate for Payer: Aetna Commercial |
$1,846.87
|
| Rate for Payer: Aetna Medicare |
$1,433.39
|
| Rate for Payer: BCBS Complete |
$952.08
|
| Rate for Payer: BCBS MAPPO |
$1,378.26
|
| Rate for Payer: BCN Commercial |
$2,065.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,378.26
|
| Rate for Payer: Cash Price |
$2,347.20
|
| Rate for Payer: Cash Price |
$2,347.20
|
| Rate for Payer: Cofinity Commercial |
$1,984.69
|
| Rate for Payer: Cofinity Commercial |
$1,846.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,378.26
|
| Rate for Payer: Mclaren Medicaid |
$906.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,447.17
|
| Rate for Payer: Meridian Medicaid |
$952.08
|
| Rate for Payer: Nomi Health Commercial |
$1,653.91
|
| Rate for Payer: PACE SWMI |
$1,378.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,378.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$906.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,907.10
|
| Rate for Payer: Priority Health HMO/PPO |
$2,253.34
|
| Rate for Payer: Priority Health Medicare |
$1,392.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,253.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,378.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,378.26
|
| Rate for Payer: UHC Exchange |
$1,378.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,378.26
|
| Rate for Payer: UHCCP Medicaid |
$906.74
|
|
|
PR DIR RPR RUPTD ANEURYSM RADIAL/ULNAR ARTERY
|
Professional
|
Both
|
$3,424.00
|
|
|
Service Code
|
HCPCS 35045
|
| Min. Negotiated Rate |
$606.84 |
| Max. Negotiated Rate |
$2,225.60 |
| Rate for Payer: Aetna Commercial |
$1,243.73
|
| Rate for Payer: Aetna Medicare |
$965.29
|
| Rate for Payer: BCBS Complete |
$637.18
|
| Rate for Payer: BCBS MAPPO |
$928.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,582.22
|
| Rate for Payer: BCN Commercial |
$1,389.31
|
| Rate for Payer: BCN Medicare Advantage |
$928.16
|
| Rate for Payer: Cash Price |
$2,739.20
|
| Rate for Payer: Cash Price |
$2,739.20
|
| Rate for Payer: Cofinity Commercial |
$1,336.55
|
| Rate for Payer: Cofinity Commercial |
$1,243.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$928.16
|
| Rate for Payer: Mclaren Medicaid |
$606.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$974.57
|
| Rate for Payer: Meridian Medicaid |
$637.18
|
| Rate for Payer: Nomi Health Commercial |
$1,113.79
|
| Rate for Payer: PACE SWMI |
$928.16
|
| Rate for Payer: PHP Medicare Advantage |
$928.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$606.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,225.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,515.17
|
| Rate for Payer: Priority Health Medicare |
$937.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,515.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$928.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$928.16
|
| Rate for Payer: UHC Exchange |
$928.16
|
| Rate for Payer: UHC Medicare Advantage |
$928.16
|
| Rate for Payer: UHCCP Medicaid |
$606.84
|
|
|
PR DISARTICULATION HIP
|
Professional
|
Both
|
$5,432.00
|
|
|
Service Code
|
HCPCS 27295
|
| Min. Negotiated Rate |
$809.19 |
| Max. Negotiated Rate |
$3,530.80 |
| Rate for Payer: Aetna Commercial |
$1,623.18
|
| Rate for Payer: Aetna Medicare |
$1,259.78
|
| Rate for Payer: BCBS Complete |
$849.65
|
| Rate for Payer: BCBS MAPPO |
$1,211.33
|
| Rate for Payer: BCBS Trust/PPO |
$3,334.10
|
| Rate for Payer: BCN Commercial |
$1,837.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,211.33
|
| Rate for Payer: Cash Price |
$4,345.60
|
| Rate for Payer: Cash Price |
$4,345.60
|
| Rate for Payer: Cofinity Commercial |
$1,744.32
|
| Rate for Payer: Cofinity Commercial |
$1,623.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,211.33
|
| Rate for Payer: Mclaren Medicaid |
$809.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,271.90
|
| Rate for Payer: Meridian Medicaid |
$849.65
|
| Rate for Payer: Nomi Health Commercial |
$1,453.60
|
| Rate for Payer: PACE SWMI |
$1,211.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,211.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$809.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,530.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,930.62
|
| Rate for Payer: Priority Health Medicare |
$1,223.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,930.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,211.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,211.33
|
| Rate for Payer: UHC Exchange |
$1,211.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,211.33
|
| Rate for Payer: UHCCP Medicaid |
$809.19
|
|
|
PR DISARTICULATION KNEE
|
Professional
|
Both
|
$2,933.00
|
|
|
Service Code
|
HCPCS 27598
|
| Min. Negotiated Rate |
$446.87 |
| Max. Negotiated Rate |
$1,906.45 |
| Rate for Payer: Aetna Commercial |
$901.35
|
| Rate for Payer: Aetna Medicare |
$699.56
|
| Rate for Payer: BCBS Complete |
$469.21
|
| Rate for Payer: BCBS MAPPO |
$672.65
|
| Rate for Payer: BCBS Trust/PPO |
$797.73
|
| Rate for Payer: BCN Commercial |
$1,014.00
|
| Rate for Payer: BCN Medicare Advantage |
$672.65
|
| Rate for Payer: Cash Price |
$2,346.40
|
| Rate for Payer: Cash Price |
$2,346.40
|
| Rate for Payer: Cofinity Commercial |
$968.62
|
| Rate for Payer: Cofinity Commercial |
$901.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$672.65
|
| Rate for Payer: Mclaren Medicaid |
$446.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$706.28
|
| Rate for Payer: Meridian Medicaid |
$469.21
|
| Rate for Payer: Nomi Health Commercial |
$807.18
|
| Rate for Payer: PACE SWMI |
$672.65
|
| Rate for Payer: PHP Medicare Advantage |
$672.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$446.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,906.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,057.93
|
| Rate for Payer: Priority Health Medicare |
$679.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,057.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$672.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$672.65
|
| Rate for Payer: UHC Exchange |
$672.65
|
| Rate for Payer: UHC Medicare Advantage |
$672.65
|
| Rate for Payer: UHCCP Medicaid |
$446.87
|
|
|
PR DISARTICULATION SHOULDER
|
Professional
|
Both
|
$1,996.00
|
|
|
Service Code
|
HCPCS 23920
|
| Min. Negotiated Rate |
$491.15 |
| Max. Negotiated Rate |
$1,727.08 |
| Rate for Payer: Aetna Commercial |
$1,451.43
|
| Rate for Payer: Aetna Medicare |
$1,126.49
|
| Rate for Payer: BCBS Complete |
$765.33
|
| Rate for Payer: BCBS MAPPO |
$1,083.16
|
| Rate for Payer: BCBS Trust/PPO |
$491.15
|
| Rate for Payer: BCN Commercial |
$1,644.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,083.16
|
| Rate for Payer: Cash Price |
$1,596.80
|
| Rate for Payer: Cash Price |
$1,596.80
|
| Rate for Payer: Cofinity Commercial |
$1,559.75
|
| Rate for Payer: Cofinity Commercial |
$1,451.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,083.16
|
| Rate for Payer: Mclaren Medicaid |
$728.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,137.32
|
| Rate for Payer: Meridian Medicaid |
$765.33
|
| Rate for Payer: Nomi Health Commercial |
$1,299.79
|
| Rate for Payer: PACE SWMI |
$1,083.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,083.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$728.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,297.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,727.08
|
| Rate for Payer: Priority Health Medicare |
$1,093.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,727.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,083.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,083.16
|
| Rate for Payer: UHC Exchange |
$1,083.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,083.16
|
| Rate for Payer: UHCCP Medicaid |
$728.89
|
|
|
PR DISARTICULATION THROUGH WRIST
|
Professional
|
Both
|
$1,432.00
|
|
|
Service Code
|
HCPCS 25920
|
| Min. Negotiated Rate |
$129.43 |
| Max. Negotiated Rate |
$1,130.19 |
| Rate for Payer: Aetna Commercial |
$938.20
|
| Rate for Payer: Aetna Medicare |
$728.16
|
| Rate for Payer: BCBS Complete |
$499.63
|
| Rate for Payer: BCBS MAPPO |
$700.15
|
| Rate for Payer: BCBS Trust/PPO |
$129.43
|
| Rate for Payer: BCN Commercial |
$1,079.48
|
| Rate for Payer: BCN Medicare Advantage |
$700.15
|
| Rate for Payer: Cash Price |
$1,145.60
|
| Rate for Payer: Cash Price |
$1,145.60
|
| Rate for Payer: Cofinity Commercial |
$938.20
|
| Rate for Payer: Cofinity Commercial |
$1,008.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$700.15
|
| Rate for Payer: Mclaren Medicaid |
$475.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$735.16
|
| Rate for Payer: Meridian Medicaid |
$499.63
|
| Rate for Payer: Nomi Health Commercial |
$840.18
|
| Rate for Payer: PACE SWMI |
$700.15
|
| Rate for Payer: PHP Medicare Advantage |
$700.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$475.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$930.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,130.19
|
| Rate for Payer: Priority Health Medicare |
$707.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,130.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$700.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$700.15
|
| Rate for Payer: UHC Exchange |
$700.15
|
| Rate for Payer: UHC Medicare Advantage |
$700.15
|
| Rate for Payer: UHCCP Medicaid |
$475.84
|
|
|
PR DISARTICULATION THRU WRIST RE-AMPUTATION
|
Professional
|
Both
|
$2,359.00
|
|
|
Service Code
|
HCPCS 25924
|
| Min. Negotiated Rate |
$69.19 |
| Max. Negotiated Rate |
$1,533.35 |
| Rate for Payer: Aetna Commercial |
$915.23
|
| Rate for Payer: Aetna Medicare |
$710.33
|
| Rate for Payer: BCBS Complete |
$487.56
|
| Rate for Payer: BCBS MAPPO |
$683.01
|
| Rate for Payer: BCBS Trust/PPO |
$69.19
|
| Rate for Payer: BCN Commercial |
$1,054.56
|
| Rate for Payer: BCN Medicare Advantage |
$683.01
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Cofinity Commercial |
$983.53
|
| Rate for Payer: Cofinity Commercial |
$915.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.01
|
| Rate for Payer: Mclaren Medicaid |
$464.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$717.16
|
| Rate for Payer: Meridian Medicaid |
$487.56
|
| Rate for Payer: Nomi Health Commercial |
$819.61
|
| Rate for Payer: PACE SWMI |
$683.01
|
| Rate for Payer: PHP Medicare Advantage |
$683.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$464.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,533.35
|
| Rate for Payer: Priority Health HMO/PPO |
$1,104.23
|
| Rate for Payer: Priority Health Medicare |
$689.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,104.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$683.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$683.01
|
| Rate for Payer: UHC Exchange |
$683.01
|
| Rate for Payer: UHC Medicare Advantage |
$683.01
|
| Rate for Payer: UHCCP Medicaid |
$464.34
|
|
|
PR DISCECTOMY ANT DCMPRN CORD CERVICAL 1 NTRSPC
|
Professional
|
Both
|
$5,746.00
|
|
|
Service Code
|
HCPCS 63075
|
| Min. Negotiated Rate |
$170.11 |
| Max. Negotiated Rate |
$3,734.90 |
| Rate for Payer: Aetna Commercial |
$1,779.94
|
| Rate for Payer: Aetna Medicare |
$1,381.44
|
| Rate for Payer: BCBS Complete |
$923.90
|
| Rate for Payer: BCBS MAPPO |
$1,328.31
|
| Rate for Payer: BCBS Trust/PPO |
$170.11
|
| Rate for Payer: BCN Commercial |
$2,197.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,328.31
|
| Rate for Payer: Cash Price |
$4,596.80
|
| Rate for Payer: Cash Price |
$4,596.80
|
| Rate for Payer: Cofinity Commercial |
$1,912.77
|
| Rate for Payer: Cofinity Commercial |
$1,779.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,328.31
|
| Rate for Payer: Mclaren Medicaid |
$879.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,394.73
|
| Rate for Payer: Meridian Medicaid |
$923.90
|
| Rate for Payer: Nomi Health Commercial |
$1,593.97
|
| Rate for Payer: PACE SWMI |
$1,328.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,328.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$879.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,734.90
|
| Rate for Payer: Priority Health HMO/PPO |
$2,334.01
|
| Rate for Payer: Priority Health Medicare |
$1,341.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,334.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,328.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,328.31
|
| Rate for Payer: UHC Exchange |
$1,328.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,328.31
|
| Rate for Payer: UHCCP Medicaid |
$879.90
|
|
|
PR DISCECTOMY ANT DCMPRN CORD CERVICAL EA NTRSPC
|
Professional
|
Both
|
$1,928.00
|
|
|
Service Code
|
HCPCS 63076
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$1,253.20 |
| Rate for Payer: Aetna Commercial |
$319.34
|
| Rate for Payer: Aetna Medicare |
$247.84
|
| Rate for Payer: BCBS Complete |
$163.94
|
| Rate for Payer: BCBS MAPPO |
$238.31
|
| Rate for Payer: BCBS Trust/PPO |
$174.34
|
| Rate for Payer: BCN Commercial |
$389.03
|
| Rate for Payer: BCN Medicare Advantage |
$238.31
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cofinity Commercial |
$343.17
|
| Rate for Payer: Cofinity Commercial |
$319.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.31
|
| Rate for Payer: Mclaren Medicaid |
$156.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.23
|
| Rate for Payer: Meridian Medicaid |
$163.94
|
| Rate for Payer: Nomi Health Commercial |
$285.97
|
| Rate for Payer: PACE SWMI |
$238.31
|
| Rate for Payer: PHP Medicare Advantage |
$238.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.20
|
| Rate for Payer: Priority Health HMO/PPO |
$410.62
|
| Rate for Payer: Priority Health Medicare |
$240.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$410.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.31
|
| Rate for Payer: UHC Exchange |
$238.31
|
| Rate for Payer: UHC Medicare Advantage |
$238.31
|
| Rate for Payer: UHCCP Medicaid |
$156.13
|
|
|
PR DISCECTOMY ANT DCMPRN CORD THORACIC 1 NTRSPC
|
Professional
|
Both
|
$5,692.00
|
|
|
Service Code
|
HCPCS 63077
|
| Min. Negotiated Rate |
$145.28 |
| Max. Negotiated Rate |
$3,699.80 |
| Rate for Payer: Aetna Commercial |
$1,888.58
|
| Rate for Payer: Aetna Medicare |
$1,465.77
|
| Rate for Payer: BCBS Complete |
$989.66
|
| Rate for Payer: BCBS MAPPO |
$1,409.39
|
| Rate for Payer: BCBS Trust/PPO |
$145.28
|
| Rate for Payer: BCN Commercial |
$2,469.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,409.39
|
| Rate for Payer: Cash Price |
$4,553.60
|
| Rate for Payer: Cash Price |
$4,553.60
|
| Rate for Payer: Cofinity Commercial |
$1,888.58
|
| Rate for Payer: Cofinity Commercial |
$2,029.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,409.39
|
| Rate for Payer: Mclaren Medicaid |
$942.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,479.86
|
| Rate for Payer: Meridian Medicaid |
$989.66
|
| Rate for Payer: Nomi Health Commercial |
$1,691.27
|
| Rate for Payer: PACE SWMI |
$1,409.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,409.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$942.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,699.80
|
| Rate for Payer: Priority Health HMO/PPO |
$2,497.22
|
| Rate for Payer: Priority Health Medicare |
$1,423.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,497.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,409.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,409.39
|
| Rate for Payer: UHC Exchange |
$1,409.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,409.39
|
| Rate for Payer: UHCCP Medicaid |
$942.53
|
|
|
PR DISEASE MANAGEMENT PROGRAM
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS S0315
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: BCBS Trust/PPO |
$111.47
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
|
|
PR DISEASE MGMT PER DIEM
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS S0317
|
| Min. Negotiated Rate |
$58.11 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$175.00
|
| Rate for Payer: Aetna Commercial |
$175.00
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS Trust/PPO |
$58.11
|
| Rate for Payer: BCBS Trust/PPO |
$58.11
|
| Rate for Payer: BCN Commercial |
$1,000.00
|
| Rate for Payer: BCN Commercial |
$1,000.00
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
|
PR DISE DYN EVAL SLEEP DISORDERED BREATHING FLX DX
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 42975
|
| Min. Negotiated Rate |
$62.20 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Aetna Commercial |
$123.90
|
| Rate for Payer: Aetna Medicare |
$96.16
|
| Rate for Payer: BCBS Complete |
$65.31
|
| Rate for Payer: BCBS MAPPO |
$92.46
|
| Rate for Payer: BCBS Trust/PPO |
$284.23
|
| Rate for Payer: BCN Commercial |
$139.76
|
| Rate for Payer: BCN Medicare Advantage |
$92.46
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cofinity Commercial |
$133.14
|
| Rate for Payer: Cofinity Commercial |
$123.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.46
|
| Rate for Payer: Mclaren Medicaid |
$62.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.08
|
| Rate for Payer: Meridian Medicaid |
$65.31
|
| Rate for Payer: Nomi Health Commercial |
$110.95
|
| Rate for Payer: PACE SWMI |
$92.46
|
| Rate for Payer: PHP Medicare Advantage |
$92.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.55
|
| Rate for Payer: Priority Health HMO/PPO |
$173.61
|
| Rate for Payer: Priority Health Medicare |
$93.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.46
|
| Rate for Payer: UHC Exchange |
$92.46
|
| Rate for Payer: UHC Medicare Advantage |
$92.46
|
| Rate for Payer: UHCCP Medicaid |
$62.20
|
|
|
PR DISPENSING FEE BINAURAL
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS V5160
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$315.25 |
| Rate for Payer: Aetna Commercial |
$289.59
|
| Rate for Payer: Aetna Medicare |
$242.50
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
|
|
PR DISPENSING FEE, MONAURAL
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS V5241
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
|
|
PR DISP FEE CONTRALATERAL BINAU
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS V5240
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$315.25 |
| Rate for Payer: Aetna Commercial |
$248.26
|
| Rate for Payer: Aetna Medicare |
$242.50
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
|
|
PR DISP FEE CONTRALATERAL MONAU
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS V5200
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$239.68 |
| Rate for Payer: Aetna Commercial |
$239.68
|
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
|
