|
PR ETONOGESTREL IMPLANT SYSTEM
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS J7307
|
| Min. Negotiated Rate |
$545.20 |
| Max. Negotiated Rate |
$885.95 |
| Rate for Payer: Aetna Medicare |
$681.50
|
| Rate for Payer: BCBS Complete |
$545.20
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.95
|
| Rate for Payer: UMR Bronson Commercial |
$626.98
|
|
|
PR EUFLEXXA INJ PER DOSE
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS J7323
|
| Min. Negotiated Rate |
$112.45 |
| Max. Negotiated Rate |
$191.75 |
| Rate for Payer: Aetna Commercial |
$150.68
|
| Rate for Payer: Aetna Medicare |
$116.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.93
|
| Rate for Payer: BCBS Complete |
$118.00
|
| Rate for Payer: BCBS MAPPO |
$112.45
|
| Rate for Payer: BCN Medicare Advantage |
$112.45
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cofinity Commercial |
$150.68
|
| Rate for Payer: Cofinity Commercial |
$161.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.07
|
| Rate for Payer: Nomi Health Commercial |
$134.94
|
| Rate for Payer: PACE SWMI |
$112.45
|
| Rate for Payer: PHP Commercial |
$157.43
|
| Rate for Payer: PHP Medicare Advantage |
$112.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.75
|
| Rate for Payer: Priority Health Medicare |
$112.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.45
|
| Rate for Payer: UHC Medicare Advantage |
$112.45
|
| Rate for Payer: UMR Bronson Commercial |
$135.70
|
|
|
PR EVACUATION SUBUNGUAL HEMATOMA
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 11740
|
| Min. Negotiated Rate |
$30.49 |
| Max. Negotiated Rate |
$53.30 |
| Rate for Payer: Aetna Commercial |
$40.86
|
| Rate for Payer: Aetna Medicare |
$31.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.86
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: BCBS MAPPO |
$30.49
|
| Rate for Payer: BCN Medicare Advantage |
$30.49
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$43.91
|
| Rate for Payer: Cofinity Commercial |
$40.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.01
|
| Rate for Payer: Nomi Health Commercial |
$36.59
|
| Rate for Payer: PACE SWMI |
$30.49
|
| Rate for Payer: PHP Commercial |
$42.69
|
| Rate for Payer: PHP Medicare Advantage |
$30.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health Medicare |
$30.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.49
|
| Rate for Payer: UHC Medicare Advantage |
$30.49
|
| Rate for Payer: UMR Bronson Commercial |
$37.72
|
|
|
PR EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 92626
|
| Min. Negotiated Rate |
$69.79 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$93.52
|
| Rate for Payer: Aetna Medicare |
$72.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.50
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS MAPPO |
$69.79
|
| Rate for Payer: BCN Medicare Advantage |
$69.79
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$93.52
|
| Rate for Payer: Cofinity Commercial |
$100.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.28
|
| Rate for Payer: Nomi Health Commercial |
$83.75
|
| Rate for Payer: PACE SWMI |
$69.79
|
| Rate for Payer: PHP Commercial |
$97.71
|
| Rate for Payer: PHP Medicare Advantage |
$69.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health Medicare |
$69.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.79
|
| Rate for Payer: UHC Medicare Advantage |
$69.79
|
| Rate for Payer: UMR Bronson Commercial |
$84.64
|
|
|
PR EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 92627
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$28.60 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna Medicare |
$17.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.92
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS MAPPO |
$16.36
|
| Rate for Payer: BCN Medicare Advantage |
$16.36
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$23.56
|
| Rate for Payer: Cofinity Commercial |
$21.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.18
|
| Rate for Payer: Nomi Health Commercial |
$19.63
|
| Rate for Payer: PACE SWMI |
$16.36
|
| Rate for Payer: PHP Commercial |
$22.90
|
| Rate for Payer: PHP Medicare Advantage |
$16.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.60
|
| Rate for Payer: Priority Health Medicare |
$16.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.36
|
| Rate for Payer: UHC Medicare Advantage |
$16.36
|
| Rate for Payer: UMR Bronson Commercial |
$20.24
|
|
|
PR EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 92620
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$109.20 |
| Rate for Payer: Aetna Commercial |
$99.83
|
| Rate for Payer: Aetna Medicare |
$77.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.28
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS MAPPO |
$74.50
|
| Rate for Payer: BCN Medicare Advantage |
$74.50
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$99.83
|
| Rate for Payer: Cofinity Commercial |
$107.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.22
|
| Rate for Payer: Nomi Health Commercial |
$89.40
|
| Rate for Payer: PACE SWMI |
$74.50
|
| Rate for Payer: PHP Commercial |
$104.30
|
| Rate for Payer: PHP Medicare Advantage |
$74.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health Medicare |
$74.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.50
|
| Rate for Payer: UHC Medicare Advantage |
$74.50
|
| Rate for Payer: UMR Bronson Commercial |
$77.28
|
|
|
PR EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 92621
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: Aetna Medicare |
$18.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.57
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS MAPPO |
$17.59
|
| Rate for Payer: BCN Medicare Advantage |
$17.59
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$25.33
|
| Rate for Payer: Cofinity Commercial |
$23.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.47
|
| Rate for Payer: Nomi Health Commercial |
$21.11
|
| Rate for Payer: PACE SWMI |
$17.59
|
| Rate for Payer: PHP Commercial |
$24.63
|
| Rate for Payer: PHP Medicare Advantage |
$17.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.00
|
| Rate for Payer: Priority Health Medicare |
$17.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.59
|
| Rate for Payer: UHC Medicare Advantage |
$17.59
|
| Rate for Payer: UMR Bronson Commercial |
$18.40
|
|
|
PR EVAL OF ORTHOTIC/PROSTH USE, EA 15 MIN
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 97762
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: UMR Bronson Commercial |
$34.50
|
|
|
PR EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 92523
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$310.35 |
| Rate for Payer: Aetna Commercial |
$288.80
|
| Rate for Payer: Aetna Medicare |
$224.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.35
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS MAPPO |
$215.52
|
| Rate for Payer: BCN Medicare Advantage |
$215.52
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$310.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.30
|
| Rate for Payer: Nomi Health Commercial |
$258.62
|
| Rate for Payer: PACE SWMI |
$215.52
|
| Rate for Payer: PHP Commercial |
$301.73
|
| Rate for Payer: PHP Medicare Advantage |
$215.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health Medicare |
$215.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.52
|
| Rate for Payer: UHC Medicare Advantage |
$215.52
|
| Rate for Payer: UMR Bronson Commercial |
$164.22
|
|
|
PR EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 92521
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$181.32 |
| Rate for Payer: Aetna Commercial |
$168.73
|
| Rate for Payer: Aetna Medicare |
$130.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.73
|
| Rate for Payer: BCBS Complete |
$84.40
|
| Rate for Payer: BCBS MAPPO |
$125.92
|
| Rate for Payer: BCN Medicare Advantage |
$125.92
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cofinity Commercial |
$181.32
|
| Rate for Payer: Cofinity Commercial |
$168.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.22
|
| Rate for Payer: Nomi Health Commercial |
$151.10
|
| Rate for Payer: PACE SWMI |
$125.92
|
| Rate for Payer: PHP Commercial |
$176.29
|
| Rate for Payer: PHP Medicare Advantage |
$125.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.15
|
| Rate for Payer: Priority Health Medicare |
$125.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.92
|
| Rate for Payer: UHC Medicare Advantage |
$125.92
|
| Rate for Payer: UMR Bronson Commercial |
$97.06
|
|
|
PR EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 92522
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$151.27 |
| Rate for Payer: Aetna Commercial |
$140.77
|
| Rate for Payer: Aetna Medicare |
$109.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.77
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS MAPPO |
$105.05
|
| Rate for Payer: BCN Medicare Advantage |
$105.05
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$151.27
|
| Rate for Payer: Cofinity Commercial |
$140.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.30
|
| Rate for Payer: Nomi Health Commercial |
$126.06
|
| Rate for Payer: PACE SWMI |
$105.05
|
| Rate for Payer: PHP Commercial |
$147.07
|
| Rate for Payer: PHP Medicare Advantage |
$105.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health Medicare |
$105.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.05
|
| Rate for Payer: UHC Medicare Advantage |
$105.05
|
| Rate for Payer: UMR Bronson Commercial |
$78.66
|
|
|
PR EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART 1ST
|
Professional
|
Both
|
$1,105.00
|
|
|
Service Code
|
HCPCS 61650
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$828.37 |
| Rate for Payer: Aetna Commercial |
$770.85
|
| Rate for Payer: Aetna Medicare |
$598.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$828.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$770.85
|
| Rate for Payer: BCBS Complete |
$442.00
|
| Rate for Payer: BCBS MAPPO |
$575.26
|
| Rate for Payer: BCN Medicare Advantage |
$575.26
|
| Rate for Payer: Cash Price |
$884.00
|
| Rate for Payer: Cash Price |
$884.00
|
| Rate for Payer: Cofinity Commercial |
$828.37
|
| Rate for Payer: Cofinity Commercial |
$770.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$575.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$604.02
|
| Rate for Payer: Nomi Health Commercial |
$690.31
|
| Rate for Payer: PACE SWMI |
$575.26
|
| Rate for Payer: PHP Commercial |
$805.36
|
| Rate for Payer: PHP Medicare Advantage |
$575.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$718.25
|
| Rate for Payer: Priority Health Medicare |
$575.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$575.26
|
| Rate for Payer: UHC Medicare Advantage |
$575.26
|
| Rate for Payer: UMR Bronson Commercial |
$508.30
|
|
|
PR EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART ADDL
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 61651
|
| Min. Negotiated Rate |
$188.00 |
| Max. Negotiated Rate |
$353.68 |
| Rate for Payer: Aetna Commercial |
$329.12
|
| Rate for Payer: Aetna Medicare |
$255.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.12
|
| Rate for Payer: BCBS Complete |
$188.00
|
| Rate for Payer: BCBS MAPPO |
$245.61
|
| Rate for Payer: BCN Medicare Advantage |
$245.61
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$353.68
|
| Rate for Payer: Cofinity Commercial |
$329.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$257.89
|
| Rate for Payer: Nomi Health Commercial |
$294.73
|
| Rate for Payer: PACE SWMI |
$245.61
|
| Rate for Payer: PHP Commercial |
$343.85
|
| Rate for Payer: PHP Medicare Advantage |
$245.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health Medicare |
$245.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$245.61
|
| Rate for Payer: UHC Medicare Advantage |
$245.61
|
| Rate for Payer: UMR Bronson Commercial |
$216.20
|
|
|
PR EVASC PLACEMENT ILIAC ARTERY OCCLUSION DEVICE
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 34808
|
| Min. Negotiated Rate |
$178.00 |
| Max. Negotiated Rate |
$289.25 |
| Rate for Payer: Aetna Commercial |
$260.72
|
| Rate for Payer: Aetna Medicare |
$202.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.72
|
| Rate for Payer: BCBS Complete |
$178.00
|
| Rate for Payer: BCBS MAPPO |
$194.57
|
| Rate for Payer: BCN Medicare Advantage |
$194.57
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$280.18
|
| Rate for Payer: Cofinity Commercial |
$260.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.30
|
| Rate for Payer: Nomi Health Commercial |
$233.48
|
| Rate for Payer: PACE SWMI |
$194.57
|
| Rate for Payer: PHP Commercial |
$272.40
|
| Rate for Payer: PHP Medicare Advantage |
$194.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health Medicare |
$194.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.57
|
| Rate for Payer: UHC Medicare Advantage |
$194.57
|
| Rate for Payer: UMR Bronson Commercial |
$204.70
|
|
|
PR EVASC RPR DPLMNT AORTO-AORTIC NDGFT
|
Professional
|
Both
|
$2,588.00
|
|
|
Service Code
|
HCPCS 34701
|
| Min. Negotiated Rate |
$1,035.20 |
| Max. Negotiated Rate |
$1,706.31 |
| Rate for Payer: Aetna Commercial |
$1,587.82
|
| Rate for Payer: Aetna Medicare |
$1,232.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,706.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,587.82
|
| Rate for Payer: BCBS Complete |
$1,035.20
|
| Rate for Payer: BCBS MAPPO |
$1,184.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,184.94
|
| Rate for Payer: Cash Price |
$2,070.40
|
| Rate for Payer: Cash Price |
$2,070.40
|
| Rate for Payer: Cofinity Commercial |
$1,706.31
|
| Rate for Payer: Cofinity Commercial |
$1,587.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,184.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,244.19
|
| Rate for Payer: Nomi Health Commercial |
$1,421.93
|
| Rate for Payer: PACE SWMI |
$1,184.94
|
| Rate for Payer: PHP Commercial |
$1,658.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,184.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,682.20
|
| Rate for Payer: Priority Health Medicare |
$1,184.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,184.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,184.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,190.48
|
|
|
PR EVASC RPR DPLMNT AORTO-AORTIC NDGFT RPT
|
Professional
|
Both
|
$3,913.00
|
|
|
Service Code
|
HCPCS 34702
|
| Min. Negotiated Rate |
$1,565.20 |
| Max. Negotiated Rate |
$2,543.45 |
| Rate for Payer: Aetna Commercial |
$2,315.02
|
| Rate for Payer: Aetna Medicare |
$1,796.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,487.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,315.02
|
| Rate for Payer: BCBS Complete |
$1,565.20
|
| Rate for Payer: BCBS MAPPO |
$1,727.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,727.63
|
| Rate for Payer: Cash Price |
$3,130.40
|
| Rate for Payer: Cash Price |
$3,130.40
|
| Rate for Payer: Cofinity Commercial |
$2,487.79
|
| Rate for Payer: Cofinity Commercial |
$2,315.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,727.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,814.01
|
| Rate for Payer: Nomi Health Commercial |
$2,073.16
|
| Rate for Payer: PACE SWMI |
$1,727.63
|
| Rate for Payer: PHP Commercial |
$2,418.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,727.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,543.45
|
| Rate for Payer: Priority Health Medicare |
$1,727.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,727.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,727.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,799.98
|
|
|
PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT
|
Professional
|
Both
|
$3,166.00
|
|
|
Service Code
|
HCPCS 34705
|
| Min. Negotiated Rate |
$1,266.40 |
| Max. Negotiated Rate |
$2,103.49 |
| Rate for Payer: Aetna Commercial |
$1,957.42
|
| Rate for Payer: Aetna Medicare |
$1,519.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,103.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,957.42
|
| Rate for Payer: BCBS Complete |
$1,266.40
|
| Rate for Payer: BCBS MAPPO |
$1,460.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,460.76
|
| Rate for Payer: Cash Price |
$2,532.80
|
| Rate for Payer: Cash Price |
$2,532.80
|
| Rate for Payer: Cofinity Commercial |
$2,103.49
|
| Rate for Payer: Cofinity Commercial |
$1,957.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,460.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,533.80
|
| Rate for Payer: Nomi Health Commercial |
$1,752.91
|
| Rate for Payer: PACE SWMI |
$1,460.76
|
| Rate for Payer: PHP Commercial |
$2,045.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,460.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,057.90
|
| Rate for Payer: Priority Health Medicare |
$1,460.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,460.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,460.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,456.36
|
|
|
PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT
|
Professional
|
Both
|
$4,840.00
|
|
|
Service Code
|
HCPCS 34706
|
| Min. Negotiated Rate |
$1,936.00 |
| Max. Negotiated Rate |
$3,147.51 |
| Rate for Payer: Aetna Commercial |
$2,928.93
|
| Rate for Payer: Aetna Medicare |
$2,273.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,147.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,928.93
|
| Rate for Payer: BCBS Complete |
$1,936.00
|
| Rate for Payer: BCBS MAPPO |
$2,185.77
|
| Rate for Payer: BCN Medicare Advantage |
$2,185.77
|
| Rate for Payer: Cash Price |
$3,872.00
|
| Rate for Payer: Cash Price |
$3,872.00
|
| Rate for Payer: Cofinity Commercial |
$3,147.51
|
| Rate for Payer: Cofinity Commercial |
$2,928.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,185.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,295.06
|
| Rate for Payer: Nomi Health Commercial |
$2,622.92
|
| Rate for Payer: PACE SWMI |
$2,185.77
|
| Rate for Payer: PHP Commercial |
$3,060.08
|
| Rate for Payer: PHP Medicare Advantage |
$2,185.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,146.00
|
| Rate for Payer: Priority Health Medicare |
$2,185.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,185.77
|
| Rate for Payer: UHC Medicare Advantage |
$2,185.77
|
| Rate for Payer: UMR Bronson Commercial |
$2,226.40
|
|
|
PR EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT
|
Professional
|
Both
|
$2,917.00
|
|
|
Service Code
|
HCPCS 34703
|
| Min. Negotiated Rate |
$1,166.80 |
| Max. Negotiated Rate |
$1,896.05 |
| Rate for Payer: Aetna Commercial |
$1,761.51
|
| Rate for Payer: Aetna Medicare |
$1,367.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,892.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,761.51
|
| Rate for Payer: BCBS Complete |
$1,166.80
|
| Rate for Payer: BCBS MAPPO |
$1,314.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,314.56
|
| Rate for Payer: Cash Price |
$2,333.60
|
| Rate for Payer: Cash Price |
$2,333.60
|
| Rate for Payer: Cofinity Commercial |
$1,892.97
|
| Rate for Payer: Cofinity Commercial |
$1,761.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,314.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,380.29
|
| Rate for Payer: Nomi Health Commercial |
$1,577.47
|
| Rate for Payer: PACE SWMI |
$1,314.56
|
| Rate for Payer: PHP Commercial |
$1,840.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,314.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,896.05
|
| Rate for Payer: Priority Health Medicare |
$1,314.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,314.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,314.56
|
| Rate for Payer: UMR Bronson Commercial |
$1,341.82
|
|
|
PR EVASC RPR DPLMNT ILIO-ILIAC NDGFT
|
Professional
|
Both
|
$2,414.00
|
|
|
Service Code
|
HCPCS 34707
|
| Min. Negotiated Rate |
$965.60 |
| Max. Negotiated Rate |
$1,602.56 |
| Rate for Payer: Aetna Commercial |
$1,491.27
|
| Rate for Payer: Aetna Medicare |
$1,157.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,602.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,491.27
|
| Rate for Payer: BCBS Complete |
$965.60
|
| Rate for Payer: BCBS MAPPO |
$1,112.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,112.89
|
| Rate for Payer: Cash Price |
$1,931.20
|
| Rate for Payer: Cash Price |
$1,931.20
|
| Rate for Payer: Cofinity Commercial |
$1,602.56
|
| Rate for Payer: Cofinity Commercial |
$1,491.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,112.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,168.53
|
| Rate for Payer: Nomi Health Commercial |
$1,335.47
|
| Rate for Payer: PACE SWMI |
$1,112.89
|
| Rate for Payer: PHP Commercial |
$1,558.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,112.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,569.10
|
| Rate for Payer: Priority Health Medicare |
$1,112.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,112.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,112.89
|
| Rate for Payer: UMR Bronson Commercial |
$1,110.44
|
|
|
PR EVASC RPR DPLMNT ILIO-ILIAC NDGFT RPT
|
Professional
|
Both
|
$3,899.00
|
|
|
Service Code
|
HCPCS 34708
|
| Min. Negotiated Rate |
$1,559.60 |
| Max. Negotiated Rate |
$2,534.35 |
| Rate for Payer: Aetna Commercial |
$2,345.95
|
| Rate for Payer: Aetna Medicare |
$1,820.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,521.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,345.95
|
| Rate for Payer: BCBS Complete |
$1,559.60
|
| Rate for Payer: BCBS MAPPO |
$1,750.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,750.71
|
| Rate for Payer: Cash Price |
$3,119.20
|
| Rate for Payer: Cash Price |
$3,119.20
|
| Rate for Payer: Cofinity Commercial |
$2,521.02
|
| Rate for Payer: Cofinity Commercial |
$2,345.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,750.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,838.25
|
| Rate for Payer: Nomi Health Commercial |
$2,100.85
|
| Rate for Payer: PACE SWMI |
$1,750.71
|
| Rate for Payer: PHP Commercial |
$2,450.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,750.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,534.35
|
| Rate for Payer: Priority Health Medicare |
$1,750.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,750.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,750.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,793.54
|
|
|
PR EVASC RPR DTA COVERAGE ART ORIGIN 1ST ENDOPROSTH
|
Professional
|
Both
|
$8,245.00
|
|
|
Service Code
|
HCPCS 33880
|
| Min. Negotiated Rate |
$1,710.21 |
| Max. Negotiated Rate |
$5,359.25 |
| Rate for Payer: Aetna Commercial |
$2,291.68
|
| Rate for Payer: Aetna Medicare |
$1,778.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,462.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,291.68
|
| Rate for Payer: BCBS Complete |
$3,298.00
|
| Rate for Payer: BCBS MAPPO |
$1,710.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,710.21
|
| Rate for Payer: Cash Price |
$6,596.00
|
| Rate for Payer: Cash Price |
$6,596.00
|
| Rate for Payer: Cofinity Commercial |
$2,462.70
|
| Rate for Payer: Cofinity Commercial |
$2,291.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,710.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,795.72
|
| Rate for Payer: Nomi Health Commercial |
$2,052.25
|
| Rate for Payer: PACE SWMI |
$1,710.21
|
| Rate for Payer: PHP Commercial |
$2,394.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,710.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,359.25
|
| Rate for Payer: Priority Health Medicare |
$1,710.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,710.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,710.21
|
| Rate for Payer: UMR Bronson Commercial |
$3,792.70
|
|
|
PR EVASC RPR DTA EXP COVERAGE W/O ART ORIGIN
|
Professional
|
Both
|
$5,504.00
|
|
|
Service Code
|
HCPCS 33881
|
| Min. Negotiated Rate |
$1,468.63 |
| Max. Negotiated Rate |
$3,577.60 |
| Rate for Payer: Aetna Commercial |
$1,967.96
|
| Rate for Payer: Aetna Medicare |
$1,527.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,114.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,967.96
|
| Rate for Payer: BCBS Complete |
$2,201.60
|
| Rate for Payer: BCBS MAPPO |
$1,468.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,468.63
|
| Rate for Payer: Cash Price |
$4,403.20
|
| Rate for Payer: Cash Price |
$4,403.20
|
| Rate for Payer: Cofinity Commercial |
$2,114.83
|
| Rate for Payer: Cofinity Commercial |
$1,967.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,468.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,542.06
|
| Rate for Payer: Nomi Health Commercial |
$1,762.36
|
| Rate for Payer: PACE SWMI |
$1,468.63
|
| Rate for Payer: PHP Commercial |
$2,056.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,468.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,577.60
|
| Rate for Payer: Priority Health Medicare |
$1,468.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,468.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,468.63
|
| Rate for Payer: UMR Bronson Commercial |
$2,531.84
|
|
|
PR EVASC RPR ILAC ART BIFUR ENDGRFT CATHJ RS&I UNI
|
Professional
|
Both
|
$959.00
|
|
|
Service Code
|
HCPCS 0254T
|
| Min. Negotiated Rate |
$383.60 |
| Max. Negotiated Rate |
$623.35 |
| Rate for Payer: Aetna Medicare |
$479.50
|
| Rate for Payer: BCBS Complete |
$383.60
|
| Rate for Payer: Cash Price |
$767.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.35
|
| Rate for Payer: UMR Bronson Commercial |
$441.14
|
|
|
PR EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNI
|
Professional
|
Both
|
$2,162.00
|
|
|
Service Code
|
HCPCS 34718
|
| Min. Negotiated Rate |
$864.80 |
| Max. Negotiated Rate |
$1,706.00 |
| Rate for Payer: Aetna Commercial |
$1,587.52
|
| Rate for Payer: Aetna Medicare |
$1,232.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,587.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,706.00
|
| Rate for Payer: BCBS Complete |
$864.80
|
| Rate for Payer: BCBS MAPPO |
$1,184.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,184.72
|
| Rate for Payer: Cash Price |
$1,729.60
|
| Rate for Payer: Cash Price |
$1,729.60
|
| Rate for Payer: Cofinity Commercial |
$1,587.52
|
| Rate for Payer: Cofinity Commercial |
$1,706.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,184.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,243.96
|
| Rate for Payer: Nomi Health Commercial |
$1,421.66
|
| Rate for Payer: PACE SWMI |
$1,184.72
|
| Rate for Payer: PHP Commercial |
$1,658.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,184.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,405.30
|
| Rate for Payer: Priority Health Medicare |
$1,184.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,184.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,184.72
|
| Rate for Payer: UMR Bronson Commercial |
$994.52
|
|
