|
PR DIR RPR ANEURYSM ABDOM AORTA W/VISCERAL VESSELS
|
Professional
|
Both
|
$3,573.00
|
|
|
Service Code
|
HCPCS 35091
|
| Min. Negotiated Rate |
$1,111.22 |
| Max. Negotiated Rate |
$2,767.61 |
| Rate for Payer: Aetna Commercial |
$2,294.84
|
| Rate for Payer: Aetna Medicare |
$1,781.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,294.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,466.10
|
| Rate for Payer: BCBS Complete |
$1,166.78
|
| Rate for Payer: BCBS MAPPO |
$1,712.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.81
|
| Rate for Payer: BCN Commercial |
$2,536.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,712.57
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cofinity Commercial |
$2,294.84
|
| Rate for Payer: Cofinity Commercial |
$2,466.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,712.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,798.20
|
| Rate for Payer: Meridian Medicaid |
$1,166.78
|
| Rate for Payer: Nomi Health Commercial |
$2,055.08
|
| Rate for Payer: PACE SWMI |
$1,712.57
|
| Rate for Payer: PHP Commercial |
$2,397.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,712.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,111.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,322.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,767.61
|
| Rate for Payer: Priority Health Medicare |
$1,712.57
|
| Rate for Payer: Priority Health Narrow Network |
$2,767.61
|
| Rate for Payer: Priority Health SBD |
$2,767.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,712.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,712.57
|
| Rate for Payer: UHCCP Medicaid |
$1,111.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,643.58
|
|
|
PR DIR RPR ANEURYSM ABDOMINAL AORTA
|
Professional
|
Both
|
$5,682.00
|
|
|
Service Code
|
HCPCS 35081
|
| Min. Negotiated Rate |
$1,079.27 |
| Max. Negotiated Rate |
$3,693.30 |
| Rate for Payer: Aetna Commercial |
$2,223.14
|
| Rate for Payer: Aetna Medicare |
$1,725.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,223.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,389.05
|
| Rate for Payer: BCBS Complete |
$1,133.23
|
| Rate for Payer: BCBS MAPPO |
$1,659.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,076.67
|
| Rate for Payer: BCN Commercial |
$2,467.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,659.06
|
| Rate for Payer: Cash Price |
$4,545.60
|
| Rate for Payer: Cash Price |
$4,545.60
|
| Rate for Payer: Cofinity Commercial |
$2,223.14
|
| Rate for Payer: Cofinity Commercial |
$2,389.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,659.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,742.01
|
| Rate for Payer: Meridian Medicaid |
$1,133.23
|
| Rate for Payer: Nomi Health Commercial |
$1,990.87
|
| Rate for Payer: PACE SWMI |
$1,659.06
|
| Rate for Payer: PHP Commercial |
$2,322.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,659.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,079.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,693.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,694.76
|
| Rate for Payer: Priority Health Medicare |
$1,659.06
|
| Rate for Payer: Priority Health Narrow Network |
$2,694.76
|
| Rate for Payer: Priority Health SBD |
$2,694.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,659.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,659.06
|
| Rate for Payer: UHCCP Medicaid |
$1,079.27
|
| Rate for Payer: UMR Bronson Commercial |
$2,613.72
|
|
|
PR DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION
|
Professional
|
Both
|
$3,720.00
|
|
|
Service Code
|
HCPCS 35011
|
| Min. Negotiated Rate |
$631.55 |
| Max. Negotiated Rate |
$2,418.00 |
| Rate for Payer: Aetna Commercial |
$1,294.47
|
| Rate for Payer: Aetna Medicare |
$1,004.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,294.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,391.07
|
| Rate for Payer: BCBS Complete |
$663.13
|
| Rate for Payer: BCBS MAPPO |
$966.02
|
| Rate for Payer: BCBS Trust/PPO |
$767.09
|
| Rate for Payer: BCN Commercial |
$1,445.02
|
| Rate for Payer: BCN Medicare Advantage |
$966.02
|
| Rate for Payer: Cash Price |
$2,976.00
|
| Rate for Payer: Cash Price |
$2,976.00
|
| Rate for Payer: Cofinity Commercial |
$1,294.47
|
| Rate for Payer: Cofinity Commercial |
$1,391.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$966.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,014.32
|
| Rate for Payer: Meridian Medicaid |
$663.13
|
| Rate for Payer: Nomi Health Commercial |
$1,159.22
|
| Rate for Payer: PACE SWMI |
$966.02
|
| Rate for Payer: PHP Commercial |
$1,352.43
|
| Rate for Payer: PHP Medicare Advantage |
$966.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$631.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,418.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,578.45
|
| Rate for Payer: Priority Health Medicare |
$966.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,578.45
|
| Rate for Payer: Priority Health SBD |
$1,578.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$966.02
|
| Rate for Payer: UHC Medicare Advantage |
$966.02
|
| Rate for Payer: UHCCP Medicaid |
$631.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,711.20
|
|
|
PR DIR RPR ANEURYSM CAROTID-SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$2,213.00
|
|
|
Service Code
|
HCPCS 35001
|
| Min. Negotiated Rate |
$694.17 |
| Max. Negotiated Rate |
$2,601.88 |
| Rate for Payer: Aetna Commercial |
$1,424.73
|
| Rate for Payer: Aetna Medicare |
$1,105.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,424.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,531.05
|
| Rate for Payer: BCBS Complete |
$728.88
|
| Rate for Payer: BCBS MAPPO |
$1,063.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,601.88
|
| Rate for Payer: BCN Commercial |
$1,607.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,063.23
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cofinity Commercial |
$1,424.73
|
| Rate for Payer: Cofinity Commercial |
$1,531.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,063.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,116.39
|
| Rate for Payer: Meridian Medicaid |
$728.88
|
| Rate for Payer: Nomi Health Commercial |
$1,275.88
|
| Rate for Payer: PACE SWMI |
$1,063.23
|
| Rate for Payer: PHP Commercial |
$1,488.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,063.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$694.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,438.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,751.30
|
| Rate for Payer: Priority Health Medicare |
$1,063.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,751.30
|
| Rate for Payer: Priority Health SBD |
$1,751.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,063.23
|
| Rate for Payer: UHC Medicare Advantage |
$1,063.23
|
| Rate for Payer: UHCCP Medicaid |
$694.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,017.98
|
|
|
PR DIR RPR ANEURYSM & GRAFT COMMON FEMORAL ARTERY
|
Professional
|
Both
|
$2,176.00
|
|
|
Service Code
|
HCPCS 35141
|
| Min. Negotiated Rate |
$381.43 |
| Max. Negotiated Rate |
$1,701.84 |
| Rate for Payer: Aetna Commercial |
$1,404.08
|
| Rate for Payer: Aetna Medicare |
$1,089.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,404.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,508.86
|
| Rate for Payer: BCBS Complete |
$716.57
|
| Rate for Payer: BCBS MAPPO |
$1,047.82
|
| Rate for Payer: BCBS Trust/PPO |
$381.43
|
| Rate for Payer: BCN Commercial |
$1,560.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,047.82
|
| Rate for Payer: Cash Price |
$1,740.80
|
| Rate for Payer: Cash Price |
$1,740.80
|
| Rate for Payer: Cofinity Commercial |
$1,404.08
|
| Rate for Payer: Cofinity Commercial |
$1,508.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,047.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,100.21
|
| Rate for Payer: Meridian Medicaid |
$716.57
|
| Rate for Payer: Nomi Health Commercial |
$1,257.38
|
| Rate for Payer: PACE SWMI |
$1,047.82
|
| Rate for Payer: PHP Commercial |
$1,466.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,047.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$682.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,701.84
|
| Rate for Payer: Priority Health Medicare |
$1,047.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,701.84
|
| Rate for Payer: Priority Health SBD |
$1,701.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,047.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,047.82
|
| Rate for Payer: UHCCP Medicaid |
$682.45
|
| Rate for Payer: UMR Bronson Commercial |
$1,000.96
|
|
|
PR DIR RPR ANEURYSM & GRAFT ILIAC ARTERY
|
Professional
|
Both
|
$4,955.00
|
|
|
Service Code
|
HCPCS 35131
|
| Min. Negotiated Rate |
$866.27 |
| Max. Negotiated Rate |
$3,220.75 |
| Rate for Payer: Aetna Commercial |
$1,780.90
|
| Rate for Payer: Aetna Medicare |
$1,382.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,780.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,913.80
|
| Rate for Payer: BCBS Complete |
$909.58
|
| Rate for Payer: BCBS MAPPO |
$1,329.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,490.86
|
| Rate for Payer: BCN Commercial |
$1,965.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,329.03
|
| Rate for Payer: Cash Price |
$3,964.00
|
| Rate for Payer: Cash Price |
$3,964.00
|
| Rate for Payer: Cofinity Commercial |
$1,780.90
|
| Rate for Payer: Cofinity Commercial |
$1,913.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,329.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,395.48
|
| Rate for Payer: Meridian Medicaid |
$909.58
|
| Rate for Payer: Nomi Health Commercial |
$1,594.84
|
| Rate for Payer: PACE SWMI |
$1,329.03
|
| Rate for Payer: PHP Commercial |
$1,860.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,329.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$866.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,220.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,152.83
|
| Rate for Payer: Priority Health Medicare |
$1,329.03
|
| Rate for Payer: Priority Health Narrow Network |
$2,152.83
|
| Rate for Payer: Priority Health SBD |
$2,152.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,329.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,329.03
|
| Rate for Payer: UHCCP Medicaid |
$866.27
|
| Rate for Payer: UMR Bronson Commercial |
$2,279.30
|
|
|
PR DIR RPR ANEURYSM & GRAFT POPLITEAL ARTERY
|
Professional
|
Both
|
$2,457.00
|
|
|
Service Code
|
HCPCS 35151
|
| Min. Negotiated Rate |
$773.40 |
| Max. Negotiated Rate |
$1,934.78 |
| Rate for Payer: Aetna Commercial |
$1,591.46
|
| Rate for Payer: Aetna Medicare |
$1,235.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,591.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,710.23
|
| Rate for Payer: BCBS Complete |
$812.07
|
| Rate for Payer: BCBS MAPPO |
$1,187.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,760.30
|
| Rate for Payer: BCN Commercial |
$1,767.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,187.66
|
| Rate for Payer: Cash Price |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,965.60
|
| Rate for Payer: Cofinity Commercial |
$1,591.46
|
| Rate for Payer: Cofinity Commercial |
$1,710.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,187.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,247.04
|
| Rate for Payer: Meridian Medicaid |
$812.07
|
| Rate for Payer: Nomi Health Commercial |
$1,425.19
|
| Rate for Payer: PACE SWMI |
$1,187.66
|
| Rate for Payer: PHP Commercial |
$1,662.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,187.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$773.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,597.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,934.78
|
| Rate for Payer: Priority Health Medicare |
$1,187.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,934.78
|
| Rate for Payer: Priority Health SBD |
$1,934.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,187.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,187.66
|
| Rate for Payer: UHCCP Medicaid |
$773.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,130.22
|
|
|
PR DIR RPR ANEURYSM HEPATIC/CELIAC/RENAL/MESENTERIC
|
Professional
|
Both
|
$3,196.00
|
|
|
Service Code
|
HCPCS 35121
|
| Min. Negotiated Rate |
$283.70 |
| Max. Negotiated Rate |
$2,461.29 |
| Rate for Payer: Aetna Commercial |
$2,042.01
|
| Rate for Payer: Aetna Medicare |
$1,584.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,042.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,194.40
|
| Rate for Payer: BCBS Complete |
$1,037.74
|
| Rate for Payer: BCBS MAPPO |
$1,523.89
|
| Rate for Payer: BCBS Trust/PPO |
$283.70
|
| Rate for Payer: BCN Commercial |
$2,251.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,523.89
|
| Rate for Payer: Cash Price |
$2,556.80
|
| Rate for Payer: Cash Price |
$2,556.80
|
| Rate for Payer: Cofinity Commercial |
$2,042.01
|
| Rate for Payer: Cofinity Commercial |
$2,194.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,523.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,600.08
|
| Rate for Payer: Meridian Medicaid |
$1,037.74
|
| Rate for Payer: Nomi Health Commercial |
$1,828.67
|
| Rate for Payer: PACE SWMI |
$1,523.89
|
| Rate for Payer: PHP Commercial |
$2,133.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,523.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$988.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,077.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,461.29
|
| Rate for Payer: Priority Health Medicare |
$1,523.89
|
| Rate for Payer: Priority Health Narrow Network |
$2,461.29
|
| Rate for Payer: Priority Health SBD |
$2,461.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,523.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,523.89
|
| Rate for Payer: UHCCP Medicaid |
$988.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,470.16
|
|
|
PR DIR RPR ANEURYSM SPLENIC ARTERY
|
Professional
|
Both
|
$2,774.00
|
|
|
Service Code
|
HCPCS 35111
|
| Min. Negotiated Rate |
$831.55 |
| Max. Negotiated Rate |
$2,070.93 |
| Rate for Payer: Aetna Commercial |
$1,716.63
|
| Rate for Payer: Aetna Medicare |
$1,332.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,716.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,844.74
|
| Rate for Payer: BCBS Complete |
$873.13
|
| Rate for Payer: BCBS MAPPO |
$1,281.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.86
|
| Rate for Payer: BCN Commercial |
$1,895.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,281.07
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Cofinity Commercial |
$1,716.63
|
| Rate for Payer: Cofinity Commercial |
$1,844.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,281.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,345.12
|
| Rate for Payer: Meridian Medicaid |
$873.13
|
| Rate for Payer: Nomi Health Commercial |
$1,537.28
|
| Rate for Payer: PACE SWMI |
$1,281.07
|
| Rate for Payer: PHP Commercial |
$1,793.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,281.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$831.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,070.93
|
| Rate for Payer: Priority Health Medicare |
$1,281.07
|
| Rate for Payer: Priority Health Narrow Network |
$2,070.93
|
| Rate for Payer: Priority Health SBD |
$2,070.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,281.07
|
| Rate for Payer: UHC Medicare Advantage |
$1,281.07
|
| Rate for Payer: UHCCP Medicaid |
$831.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,276.04
|
|
|
PR DIR RPR RUPTD ANEURSM ABDOM AORTA W/VISCERA VSLS
|
Professional
|
Both
|
$5,498.00
|
|
|
Service Code
|
HCPCS 35092
|
| Min. Negotiated Rate |
$1,619.44 |
| Max. Negotiated Rate |
$4,038.14 |
| Rate for Payer: Aetna Commercial |
$3,339.84
|
| Rate for Payer: Aetna Medicare |
$2,592.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,339.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,589.08
|
| Rate for Payer: BCBS Complete |
$1,700.41
|
| Rate for Payer: BCBS MAPPO |
$2,492.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,136.58
|
| Rate for Payer: BCN Commercial |
$3,681.69
|
| Rate for Payer: BCN Medicare Advantage |
$2,492.42
|
| Rate for Payer: Cash Price |
$4,398.40
|
| Rate for Payer: Cash Price |
$4,398.40
|
| Rate for Payer: Cofinity Commercial |
$3,339.84
|
| Rate for Payer: Cofinity Commercial |
$3,589.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,492.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,617.04
|
| Rate for Payer: Meridian Medicaid |
$1,700.41
|
| Rate for Payer: Nomi Health Commercial |
$2,990.90
|
| Rate for Payer: PACE SWMI |
$2,492.42
|
| Rate for Payer: PHP Commercial |
$3,489.39
|
| Rate for Payer: PHP Medicare Advantage |
$2,492.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,619.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,573.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,038.14
|
| Rate for Payer: Priority Health Medicare |
$2,492.42
|
| Rate for Payer: Priority Health Narrow Network |
$4,038.14
|
| Rate for Payer: Priority Health SBD |
$4,038.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,492.42
|
| Rate for Payer: UHC Medicare Advantage |
$2,492.42
|
| Rate for Payer: UHCCP Medicaid |
$1,619.44
|
| Rate for Payer: UMR Bronson Commercial |
$2,529.08
|
|
|
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: Aetna New Business (MI Preferred) |
$2,441.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,623.32
|
| 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 |
$2,441.14
|
| Rate for Payer: Cofinity Commercial |
$2,623.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,821.75
|
| 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 Commercial |
$2,550.45
|
| 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/Tiered Network |
$2,943.64
|
| Rate for Payer: Priority Health Medicare |
$1,821.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,943.64
|
| Rate for Payer: Priority Health SBD |
$2,943.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,821.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,821.75
|
| Rate for Payer: UHCCP Medicaid |
$1,180.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,775.14
|
|
|
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: Aetna New Business (MI Preferred) |
$2,798.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,006.85
|
| 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 |
$2,798.04
|
| Rate for Payer: Cofinity Commercial |
$3,006.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,088.09
|
| 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 Commercial |
$2,923.33
|
| 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/Tiered Network |
$3,448.88
|
| Rate for Payer: Priority Health Medicare |
$2,088.09
|
| Rate for Payer: Priority Health Narrow Network |
$3,448.88
|
| Rate for Payer: Priority Health SBD |
$3,448.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,088.09
|
| Rate for Payer: UHC Medicare Advantage |
$2,088.09
|
| Rate for Payer: UHCCP Medicaid |
$1,352.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,637.60
|
|
|
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: Aetna New Business (MI Preferred) |
$2,786.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,994.41
|
| 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 |
$2,786.46
|
| Rate for Payer: Cofinity Commercial |
$2,994.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,079.45
|
| 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 Commercial |
$2,911.23
|
| 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/Tiered Network |
$3,363.78
|
| Rate for Payer: Priority Health Medicare |
$2,079.45
|
| Rate for Payer: Priority Health Narrow Network |
$3,363.78
|
| Rate for Payer: Priority Health SBD |
$3,363.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,079.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,079.45
|
| Rate for Payer: UHCCP Medicaid |
$1,352.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,971.56
|
|
|
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: Aetna New Business (MI Preferred) |
$1,530.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,644.18
|
| 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 |
$1,530.00
|
| Rate for Payer: Cofinity Commercial |
$1,644.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,141.79
|
| 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 Commercial |
$1,598.51
|
| 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/Tiered Network |
$1,981.05
|
| Rate for Payer: Priority Health Medicare |
$1,141.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,981.05
|
| Rate for Payer: Priority Health SBD |
$1,981.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,141.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,141.79
|
| Rate for Payer: UHCCP Medicaid |
$741.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,806.42
|
|
|
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: Aetna New Business (MI Preferred) |
$1,469.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,579.28
|
| 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 |
$1,469.60
|
| Rate for Payer: Cofinity Commercial |
$1,579.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,096.72
|
| 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 Commercial |
$1,535.41
|
| 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/Tiered Network |
$1,775.76
|
| Rate for Payer: Priority Health Medicare |
$1,096.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,775.76
|
| Rate for Payer: Priority Health SBD |
$1,775.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,096.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,096.72
|
| Rate for Payer: UHCCP Medicaid |
$712.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,169.32
|
|
|
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: Aetna New Business (MI Preferred) |
$2,110.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,268.00
|
| 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 |
$2,110.50
|
| Rate for Payer: Cofinity Commercial |
$2,268.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,575.00
|
| 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 Commercial |
$2,205.00
|
| 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/Tiered Network |
$2,544.79
|
| Rate for Payer: Priority Health Medicare |
$1,575.00
|
| Rate for Payer: Priority Health Narrow Network |
$2,544.79
|
| Rate for Payer: Priority Health SBD |
$2,544.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,575.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,575.00
|
| Rate for Payer: UHCCP Medicaid |
$1,021.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,587.92
|
|
|
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: Aetna New Business (MI Preferred) |
$1,695.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,821.77
|
| 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 |
$1,695.26
|
| Rate for Payer: Cofinity Commercial |
$1,821.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,265.12
|
| 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 Commercial |
$1,771.17
|
| 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/Tiered Network |
$2,055.50
|
| Rate for Payer: Priority Health Medicare |
$1,265.12
|
| Rate for Payer: Priority Health Narrow Network |
$2,055.50
|
| Rate for Payer: Priority Health SBD |
$2,055.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,265.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,265.12
|
| Rate for Payer: UHCCP Medicaid |
$824.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,200.60
|
|
|
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: Aetna New Business (MI Preferred) |
$1,805.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,940.21
|
| 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: 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 Commercial |
$1,886.32
|
| 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/Tiered Network |
$2,177.29
|
| Rate for Payer: Priority Health Medicare |
$1,347.37
|
| Rate for Payer: Priority Health Narrow Network |
$2,177.29
|
| Rate for Payer: Priority Health SBD |
$2,177.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,347.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,347.37
|
| Rate for Payer: UHCCP Medicaid |
$874.58
|
| Rate for Payer: UMR Bronson Commercial |
$1,259.02
|
|
|
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: Aetna New Business (MI Preferred) |
$1,846.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,984.69
|
| 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 |
$1,846.87
|
| Rate for Payer: Cofinity Commercial |
$1,984.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,378.26
|
| 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 Commercial |
$1,929.56
|
| 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/Tiered Network |
$2,253.34
|
| Rate for Payer: Priority Health Medicare |
$1,378.26
|
| Rate for Payer: Priority Health Narrow Network |
$2,253.34
|
| Rate for Payer: Priority Health SBD |
$2,253.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,378.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,378.26
|
| Rate for Payer: UHCCP Medicaid |
$906.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,349.64
|
|
|
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: Aetna New Business (MI Preferred) |
$1,243.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,336.55
|
| 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 |
$1,243.73
|
| Rate for Payer: Cofinity Commercial |
$1,336.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$928.16
|
| 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 Commercial |
$1,299.42
|
| 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/Tiered Network |
$1,515.17
|
| Rate for Payer: Priority Health Medicare |
$928.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,515.17
|
| Rate for Payer: Priority Health SBD |
$1,515.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$928.16
|
| Rate for Payer: UHC Medicare Advantage |
$928.16
|
| Rate for Payer: UHCCP Medicaid |
$606.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,575.04
|
|
|
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: Aetna New Business (MI Preferred) |
$1,623.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,744.32
|
| 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 |
$1,623.18
|
| Rate for Payer: Cofinity Commercial |
$1,744.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,211.33
|
| 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 Commercial |
$1,695.86
|
| 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/Tiered Network |
$1,930.62
|
| Rate for Payer: Priority Health Medicare |
$1,211.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,930.62
|
| Rate for Payer: Priority Health SBD |
$1,930.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,211.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,211.33
|
| Rate for Payer: UHCCP Medicaid |
$809.19
|
| Rate for Payer: UMR Bronson Commercial |
$2,498.72
|
|
|
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: Aetna New Business (MI Preferred) |
$901.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$968.62
|
| 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 |
$901.35
|
| Rate for Payer: Cofinity Commercial |
$968.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$672.65
|
| 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 Commercial |
$941.71
|
| 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/Tiered Network |
$1,057.93
|
| Rate for Payer: Priority Health Medicare |
$672.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,057.93
|
| Rate for Payer: Priority Health SBD |
$1,057.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$672.65
|
| Rate for Payer: UHC Medicare Advantage |
$672.65
|
| Rate for Payer: UHCCP Medicaid |
$446.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,349.18
|
|
|
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: Aetna New Business (MI Preferred) |
$1,451.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,559.75
|
| 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 |
$1,451.43
|
| Rate for Payer: Cofinity Commercial |
$1,559.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,083.16
|
| 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 Commercial |
$1,516.42
|
| 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/Tiered Network |
$1,727.08
|
| Rate for Payer: Priority Health Medicare |
$1,083.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,727.08
|
| Rate for Payer: Priority Health SBD |
$1,727.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,083.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,083.16
|
| Rate for Payer: UHCCP Medicaid |
$728.89
|
| Rate for Payer: UMR Bronson Commercial |
$918.16
|
|
|
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: Aetna New Business (MI Preferred) |
$1,008.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$938.20
|
| 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 |
$1,008.22
|
| Rate for Payer: Cofinity Commercial |
$938.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$700.15
|
| 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 Commercial |
$980.21
|
| 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/Tiered Network |
$1,130.19
|
| Rate for Payer: Priority Health Medicare |
$700.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,130.19
|
| Rate for Payer: Priority Health SBD |
$1,130.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$700.15
|
| Rate for Payer: UHC Medicare Advantage |
$700.15
|
| Rate for Payer: UHCCP Medicaid |
$475.84
|
| Rate for Payer: UMR Bronson Commercial |
$658.72
|
|
|
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: Aetna New Business (MI Preferred) |
$915.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$983.53
|
| 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 |
$915.23
|
| Rate for Payer: Cofinity Commercial |
$983.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.01
|
| 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 Commercial |
$956.21
|
| 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/Tiered Network |
$1,104.23
|
| Rate for Payer: Priority Health Medicare |
$683.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,104.23
|
| Rate for Payer: Priority Health SBD |
$1,104.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$683.01
|
| Rate for Payer: UHC Medicare Advantage |
$683.01
|
| Rate for Payer: UHCCP Medicaid |
$464.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,085.14
|
|
