|
PR PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH
|
Professional
|
Both
|
$2,550.00
|
|
|
Service Code
|
HCPCS 92924
|
| Min. Negotiated Rate |
$599.85 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: Aetna Commercial |
$803.80
|
| Rate for Payer: Aetna Medicare |
$623.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$863.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.80
|
| Rate for Payer: BCBS Complete |
$1,020.00
|
| Rate for Payer: BCBS MAPPO |
$599.85
|
| Rate for Payer: BCN Medicare Advantage |
$599.85
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cofinity Commercial |
$863.78
|
| Rate for Payer: Cofinity Commercial |
$803.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.84
|
| Rate for Payer: Nomi Health Commercial |
$719.82
|
| Rate for Payer: PACE SWMI |
$599.85
|
| Rate for Payer: PHP Commercial |
$839.79
|
| Rate for Payer: PHP Medicare Advantage |
$599.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.50
|
| Rate for Payer: Priority Health Medicare |
$599.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.85
|
| Rate for Payer: UHC Medicare Advantage |
$599.85
|
| Rate for Payer: UMR Bronson Commercial |
$1,173.00
|
|
|
PR PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH
|
Professional
|
Both
|
$1,078.00
|
|
|
Service Code
|
HCPCS 92921
|
| Min. Negotiated Rate |
$431.20 |
| Max. Negotiated Rate |
$700.70 |
| Rate for Payer: Aetna Medicare |
$539.00
|
| Rate for Payer: BCBS Complete |
$431.20
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.70
|
| Rate for Payer: UMR Bronson Commercial |
$495.88
|
|
|
PR PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH
|
Professional
|
Both
|
$1,119.00
|
|
|
Service Code
|
HCPCS 92920
|
| Min. Negotiated Rate |
$447.60 |
| Max. Negotiated Rate |
$727.35 |
| Rate for Payer: Aetna Commercial |
$674.85
|
| Rate for Payer: Aetna Medicare |
$523.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$725.21
|
| Rate for Payer: BCBS Complete |
$447.60
|
| Rate for Payer: BCBS MAPPO |
$503.62
|
| Rate for Payer: BCN Medicare Advantage |
$503.62
|
| Rate for Payer: Cash Price |
$895.20
|
| Rate for Payer: Cash Price |
$895.20
|
| Rate for Payer: Cofinity Commercial |
$674.85
|
| Rate for Payer: Cofinity Commercial |
$725.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$503.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$528.80
|
| Rate for Payer: Nomi Health Commercial |
$604.34
|
| Rate for Payer: PACE SWMI |
$503.62
|
| Rate for Payer: PHP Commercial |
$705.07
|
| Rate for Payer: PHP Medicare Advantage |
$503.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$727.35
|
| Rate for Payer: Priority Health Medicare |
$503.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$503.62
|
| Rate for Payer: UHC Medicare Advantage |
$503.62
|
| Rate for Payer: UMR Bronson Commercial |
$514.74
|
|
|
PR PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 92938
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: UMR Bronson Commercial |
$129.26
|
|
|
PR PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL
|
Professional
|
Both
|
$1,243.00
|
|
|
Service Code
|
HCPCS 92937
|
| Min. Negotiated Rate |
$497.20 |
| Max. Negotiated Rate |
$807.95 |
| Rate for Payer: Aetna Commercial |
$749.23
|
| Rate for Payer: Aetna Medicare |
$581.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$749.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.15
|
| Rate for Payer: BCBS Complete |
$497.20
|
| Rate for Payer: BCBS MAPPO |
$559.13
|
| Rate for Payer: BCN Medicare Advantage |
$559.13
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cofinity Commercial |
$749.23
|
| Rate for Payer: Cofinity Commercial |
$805.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$559.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$587.09
|
| Rate for Payer: Nomi Health Commercial |
$670.96
|
| Rate for Payer: PACE SWMI |
$559.13
|
| Rate for Payer: PHP Commercial |
$782.78
|
| Rate for Payer: PHP Medicare Advantage |
$559.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.95
|
| Rate for Payer: Priority Health Medicare |
$559.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$559.13
|
| Rate for Payer: UHC Medicare Advantage |
$559.13
|
| Rate for Payer: UMR Bronson Commercial |
$571.78
|
|
|
PR PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 92934
|
| Min. Negotiated Rate |
$498.00 |
| Max. Negotiated Rate |
$809.25 |
| Rate for Payer: Aetna Medicare |
$622.50
|
| Rate for Payer: BCBS Complete |
$498.00
|
| Rate for Payer: Cash Price |
$996.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$809.25
|
| Rate for Payer: UMR Bronson Commercial |
$572.70
|
|
|
PR PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH
|
Professional
|
Both
|
$1,213.00
|
|
|
Service Code
|
HCPCS 92929
|
| Min. Negotiated Rate |
$485.20 |
| Max. Negotiated Rate |
$788.45 |
| Rate for Payer: Aetna Medicare |
$606.50
|
| Rate for Payer: BCBS Complete |
$485.20
|
| Rate for Payer: Cash Price |
$970.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.45
|
| Rate for Payer: UMR Bronson Commercial |
$557.98
|
|
|
PR PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
HCPCS 92928
|
| Min. Negotiated Rate |
$497.60 |
| Max. Negotiated Rate |
$808.60 |
| Rate for Payer: Aetna Commercial |
$749.66
|
| Rate for Payer: Aetna Medicare |
$581.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$749.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.61
|
| Rate for Payer: BCBS Complete |
$497.60
|
| Rate for Payer: BCBS MAPPO |
$559.45
|
| Rate for Payer: BCN Medicare Advantage |
$559.45
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cofinity Commercial |
$749.66
|
| Rate for Payer: Cofinity Commercial |
$805.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$559.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$587.42
|
| Rate for Payer: Nomi Health Commercial |
$671.34
|
| Rate for Payer: PACE SWMI |
$559.45
|
| Rate for Payer: PHP Commercial |
$783.23
|
| Rate for Payer: PHP Medicare Advantage |
$559.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$808.60
|
| Rate for Payer: Priority Health Medicare |
$559.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$559.45
|
| Rate for Payer: UHC Medicare Advantage |
$559.45
|
| Rate for Payer: UMR Bronson Commercial |
$572.24
|
|
|
PR PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL
|
Professional
|
Both
|
$1,392.00
|
|
|
Service Code
|
HCPCS 92943
|
| Min. Negotiated Rate |
$556.80 |
| Max. Negotiated Rate |
$905.50 |
| Rate for Payer: Aetna Commercial |
$842.62
|
| Rate for Payer: Aetna Medicare |
$653.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$905.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$842.62
|
| Rate for Payer: BCBS Complete |
$556.80
|
| Rate for Payer: BCBS MAPPO |
$628.82
|
| Rate for Payer: BCN Medicare Advantage |
$628.82
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Cofinity Commercial |
$905.50
|
| Rate for Payer: Cofinity Commercial |
$842.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$628.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$660.26
|
| Rate for Payer: Nomi Health Commercial |
$754.58
|
| Rate for Payer: PACE SWMI |
$628.82
|
| Rate for Payer: PHP Commercial |
$880.35
|
| Rate for Payer: PHP Medicare Advantage |
$628.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$904.80
|
| Rate for Payer: Priority Health Medicare |
$628.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$628.82
|
| Rate for Payer: UHC Medicare Advantage |
$628.82
|
| Rate for Payer: UMR Bronson Commercial |
$640.32
|
|
|
PR PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH
|
Professional
|
Both
|
$1,437.00
|
|
|
Service Code
|
HCPCS 92933
|
| Min. Negotiated Rate |
$574.80 |
| Max. Negotiated Rate |
$934.05 |
| Rate for Payer: Aetna Commercial |
$841.75
|
| Rate for Payer: Aetna Medicare |
$653.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$904.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$841.75
|
| Rate for Payer: BCBS Complete |
$574.80
|
| Rate for Payer: BCBS MAPPO |
$628.17
|
| Rate for Payer: BCN Medicare Advantage |
$628.17
|
| Rate for Payer: Cash Price |
$1,149.60
|
| Rate for Payer: Cash Price |
$1,149.60
|
| Rate for Payer: Cofinity Commercial |
$904.56
|
| Rate for Payer: Cofinity Commercial |
$841.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$628.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$659.58
|
| Rate for Payer: Nomi Health Commercial |
$753.80
|
| Rate for Payer: PACE SWMI |
$628.17
|
| Rate for Payer: PHP Commercial |
$879.44
|
| Rate for Payer: PHP Medicare Advantage |
$628.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$934.05
|
| Rate for Payer: Priority Health Medicare |
$628.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$628.17
|
| Rate for Payer: UHC Medicare Advantage |
$628.17
|
| Rate for Payer: UMR Bronson Commercial |
$661.02
|
|
|
PR PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL
|
Professional
|
Both
|
$1,398.00
|
|
|
Service Code
|
HCPCS 92941
|
| Min. Negotiated Rate |
$559.20 |
| Max. Negotiated Rate |
$908.70 |
| Rate for Payer: Aetna Commercial |
$842.50
|
| Rate for Payer: Aetna Medicare |
$653.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$905.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$842.50
|
| Rate for Payer: BCBS Complete |
$559.20
|
| Rate for Payer: BCBS MAPPO |
$628.73
|
| Rate for Payer: BCN Medicare Advantage |
$628.73
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cofinity Commercial |
$905.37
|
| Rate for Payer: Cofinity Commercial |
$842.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$628.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$660.17
|
| Rate for Payer: Nomi Health Commercial |
$754.48
|
| Rate for Payer: PACE SWMI |
$628.73
|
| Rate for Payer: PHP Commercial |
$880.22
|
| Rate for Payer: PHP Medicare Advantage |
$628.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$908.70
|
| Rate for Payer: Priority Health Medicare |
$628.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$628.73
|
| Rate for Payer: UHC Medicare Advantage |
$628.73
|
| Rate for Payer: UMR Bronson Commercial |
$643.08
|
|
|
PR PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX
|
Professional
|
Both
|
$542.00
|
|
|
Service Code
|
HCPCS 37188
|
| Min. Negotiated Rate |
$216.80 |
| Max. Negotiated Rate |
$385.95 |
| Rate for Payer: Aetna Commercial |
$359.15
|
| Rate for Payer: Aetna Medicare |
$278.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.15
|
| Rate for Payer: BCBS Complete |
$216.80
|
| Rate for Payer: BCBS MAPPO |
$268.02
|
| Rate for Payer: BCN Medicare Advantage |
$268.02
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cofinity Commercial |
$385.95
|
| Rate for Payer: Cofinity Commercial |
$359.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$268.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$281.42
|
| Rate for Payer: Nomi Health Commercial |
$321.62
|
| Rate for Payer: PACE SWMI |
$268.02
|
| Rate for Payer: PHP Commercial |
$375.23
|
| Rate for Payer: PHP Medicare Advantage |
$268.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.30
|
| Rate for Payer: Priority Health Medicare |
$268.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$268.02
|
| Rate for Payer: UHC Medicare Advantage |
$268.02
|
| Rate for Payer: UMR Bronson Commercial |
$249.32
|
|
|
PR PRTL ESOPHAGECTOMY CERVICAL W/FREE INTSTINAL GRF
|
Professional
|
Both
|
$9,458.00
|
|
|
Service Code
|
HCPCS 43116
|
| Min. Negotiated Rate |
$3,783.20 |
| Max. Negotiated Rate |
$6,875.14 |
| Rate for Payer: Aetna Commercial |
$6,397.70
|
| Rate for Payer: Aetna Medicare |
$4,965.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,875.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,397.70
|
| Rate for Payer: BCBS Complete |
$3,783.20
|
| Rate for Payer: BCBS MAPPO |
$4,774.40
|
| Rate for Payer: BCN Medicare Advantage |
$4,774.40
|
| Rate for Payer: Cash Price |
$7,566.40
|
| Rate for Payer: Cash Price |
$7,566.40
|
| Rate for Payer: Cofinity Commercial |
$6,875.14
|
| Rate for Payer: Cofinity Commercial |
$6,397.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,774.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,013.12
|
| Rate for Payer: Nomi Health Commercial |
$5,729.28
|
| Rate for Payer: PACE SWMI |
$4,774.40
|
| Rate for Payer: PHP Commercial |
$6,684.16
|
| Rate for Payer: PHP Medicare Advantage |
$4,774.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,147.70
|
| Rate for Payer: Priority Health Medicare |
$4,774.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,774.40
|
| Rate for Payer: UHC Medicare Advantage |
$4,774.40
|
| Rate for Payer: UMR Bronson Commercial |
$4,350.68
|
|
|
PR PRTL ESOPHAGEC W/WO PROX GASTREC/PYLOROPLASTY
|
Professional
|
Both
|
$6,010.00
|
|
|
Service Code
|
HCPCS 43121
|
| Min. Negotiated Rate |
$2,404.00 |
| Max. Negotiated Rate |
$3,956.47 |
| Rate for Payer: Aetna Commercial |
$3,681.72
|
| Rate for Payer: Aetna Medicare |
$2,857.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,956.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,681.72
|
| Rate for Payer: BCBS Complete |
$2,404.00
|
| Rate for Payer: BCBS MAPPO |
$2,747.55
|
| Rate for Payer: BCN Medicare Advantage |
$2,747.55
|
| Rate for Payer: Cash Price |
$4,808.00
|
| Rate for Payer: Cash Price |
$4,808.00
|
| Rate for Payer: Cofinity Commercial |
$3,956.47
|
| Rate for Payer: Cofinity Commercial |
$3,681.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,747.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,884.93
|
| Rate for Payer: Nomi Health Commercial |
$3,297.06
|
| Rate for Payer: PACE SWMI |
$2,747.55
|
| Rate for Payer: PHP Commercial |
$3,846.57
|
| Rate for Payer: PHP Medicare Advantage |
$2,747.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,906.50
|
| Rate for Payer: Priority Health Medicare |
$2,747.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,747.55
|
| Rate for Payer: UHC Medicare Advantage |
$2,747.55
|
| Rate for Payer: UMR Bronson Commercial |
$2,764.60
|
|
|
PR PRTL ESOPHECT DSTL W/WO PROX GASTRECT/PYLORPLSTY
|
Professional
|
Both
|
$6,334.00
|
|
|
Service Code
|
HCPCS 43117
|
| Min. Negotiated Rate |
$2,533.60 |
| Max. Negotiated Rate |
$4,510.90 |
| Rate for Payer: Aetna Commercial |
$4,197.64
|
| Rate for Payer: Aetna Medicare |
$3,257.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,510.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,197.64
|
| Rate for Payer: BCBS Complete |
$2,533.60
|
| Rate for Payer: BCBS MAPPO |
$3,132.57
|
| Rate for Payer: BCN Medicare Advantage |
$3,132.57
|
| Rate for Payer: Cash Price |
$5,067.20
|
| Rate for Payer: Cash Price |
$5,067.20
|
| Rate for Payer: Cofinity Commercial |
$4,510.90
|
| Rate for Payer: Cofinity Commercial |
$4,197.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,289.20
|
| Rate for Payer: Nomi Health Commercial |
$3,759.08
|
| Rate for Payer: PACE SWMI |
$3,132.57
|
| Rate for Payer: PHP Commercial |
$4,385.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,132.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,117.10
|
| Rate for Payer: Priority Health Medicare |
$3,132.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,132.57
|
| Rate for Payer: UHC Medicare Advantage |
$3,132.57
|
| Rate for Payer: UMR Bronson Commercial |
$2,913.64
|
|
|
PR PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 28122
|
| Min. Negotiated Rate |
$420.64 |
| Max. Negotiated Rate |
$809.25 |
| Rate for Payer: Aetna Commercial |
$563.66
|
| Rate for Payer: Aetna Medicare |
$437.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$605.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.66
|
| Rate for Payer: BCBS Complete |
$498.00
|
| Rate for Payer: BCBS MAPPO |
$420.64
|
| Rate for Payer: BCN Medicare Advantage |
$420.64
|
| Rate for Payer: Cash Price |
$996.00
|
| Rate for Payer: Cash Price |
$996.00
|
| Rate for Payer: Cofinity Commercial |
$605.72
|
| Rate for Payer: Cofinity Commercial |
$563.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$441.67
|
| Rate for Payer: Nomi Health Commercial |
$504.77
|
| Rate for Payer: PACE SWMI |
$420.64
|
| Rate for Payer: PHP Commercial |
$588.90
|
| Rate for Payer: PHP Medicare Advantage |
$420.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$809.25
|
| Rate for Payer: Priority Health Medicare |
$420.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$420.64
|
| Rate for Payer: UHC Medicare Advantage |
$420.64
|
| Rate for Payer: UMR Bronson Commercial |
$572.70
|
|
|
PR PRTL EXC BONE FEMUR PROX TIBIA&/FIBULA
|
Professional
|
Both
|
$3,303.00
|
|
|
Service Code
|
HCPCS 27360
|
| Min. Negotiated Rate |
$862.21 |
| Max. Negotiated Rate |
$2,146.95 |
| Rate for Payer: Aetna Commercial |
$1,155.36
|
| Rate for Payer: Aetna Medicare |
$896.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,241.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,155.36
|
| Rate for Payer: BCBS Complete |
$1,321.20
|
| Rate for Payer: BCBS MAPPO |
$862.21
|
| Rate for Payer: BCN Medicare Advantage |
$862.21
|
| Rate for Payer: Cash Price |
$2,642.40
|
| Rate for Payer: Cash Price |
$2,642.40
|
| Rate for Payer: Cofinity Commercial |
$1,241.58
|
| Rate for Payer: Cofinity Commercial |
$1,155.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$862.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$905.32
|
| Rate for Payer: Nomi Health Commercial |
$1,034.65
|
| Rate for Payer: PACE SWMI |
$862.21
|
| Rate for Payer: PHP Commercial |
$1,207.09
|
| Rate for Payer: PHP Medicare Advantage |
$862.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,146.95
|
| Rate for Payer: Priority Health Medicare |
$862.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$862.21
|
| Rate for Payer: UHC Medicare Advantage |
$862.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,519.38
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM CRV
|
Professional
|
Both
|
$1,770.00
|
|
|
Service Code
|
HCPCS 22100
|
| Min. Negotiated Rate |
$708.00 |
| Max. Negotiated Rate |
$1,339.82 |
| Rate for Payer: Aetna Commercial |
$1,246.78
|
| Rate for Payer: Aetna Medicare |
$967.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,339.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,246.78
|
| Rate for Payer: BCBS Complete |
$708.00
|
| Rate for Payer: BCBS MAPPO |
$930.43
|
| Rate for Payer: BCN Medicare Advantage |
$930.43
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cofinity Commercial |
$1,339.82
|
| Rate for Payer: Cofinity Commercial |
$1,246.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$930.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$976.95
|
| Rate for Payer: Nomi Health Commercial |
$1,116.52
|
| Rate for Payer: PACE SWMI |
$930.43
|
| Rate for Payer: PHP Commercial |
$1,302.60
|
| Rate for Payer: PHP Medicare Advantage |
$930.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,150.50
|
| Rate for Payer: Priority Health Medicare |
$930.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$930.43
|
| Rate for Payer: UHC Medicare Advantage |
$930.43
|
| Rate for Payer: UMR Bronson Commercial |
$814.20
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM EA
|
Professional
|
Both
|
$656.00
|
|
|
Service Code
|
HCPCS 22103
|
| Min. Negotiated Rate |
$129.06 |
| Max. Negotiated Rate |
$426.40 |
| Rate for Payer: Aetna Commercial |
$172.94
|
| Rate for Payer: Aetna Medicare |
$134.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.94
|
| Rate for Payer: BCBS Complete |
$262.40
|
| Rate for Payer: BCBS MAPPO |
$129.06
|
| Rate for Payer: BCN Medicare Advantage |
$129.06
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Cofinity Commercial |
$185.85
|
| Rate for Payer: Cofinity Commercial |
$172.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.51
|
| Rate for Payer: Nomi Health Commercial |
$154.87
|
| Rate for Payer: PACE SWMI |
$129.06
|
| Rate for Payer: PHP Commercial |
$180.68
|
| Rate for Payer: PHP Medicare Advantage |
$129.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.40
|
| Rate for Payer: Priority Health Medicare |
$129.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.06
|
| Rate for Payer: UHC Medicare Advantage |
$129.06
|
| Rate for Payer: UMR Bronson Commercial |
$301.76
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM LMBR
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 22102
|
| Min. Negotiated Rate |
$733.51 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna Commercial |
$982.90
|
| Rate for Payer: Aetna Medicare |
$762.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$982.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,056.25
|
| Rate for Payer: BCBS Complete |
$880.00
|
| Rate for Payer: BCBS MAPPO |
$733.51
|
| Rate for Payer: BCN Medicare Advantage |
$733.51
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cofinity Commercial |
$982.90
|
| Rate for Payer: Cofinity Commercial |
$1,056.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$733.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$770.19
|
| Rate for Payer: Nomi Health Commercial |
$880.21
|
| Rate for Payer: PACE SWMI |
$733.51
|
| Rate for Payer: PHP Commercial |
$1,026.91
|
| Rate for Payer: PHP Medicare Advantage |
$733.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.00
|
| Rate for Payer: Priority Health Medicare |
$733.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$733.51
|
| Rate for Payer: UHC Medicare Advantage |
$733.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,012.00
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM THRC
|
Professional
|
Both
|
$2,270.00
|
|
|
Service Code
|
HCPCS 22101
|
| Min. Negotiated Rate |
$868.48 |
| Max. Negotiated Rate |
$1,475.50 |
| Rate for Payer: Aetna Commercial |
$1,163.76
|
| Rate for Payer: Aetna Medicare |
$903.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,250.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,163.76
|
| Rate for Payer: BCBS Complete |
$908.00
|
| Rate for Payer: BCBS MAPPO |
$868.48
|
| Rate for Payer: BCN Medicare Advantage |
$868.48
|
| Rate for Payer: Cash Price |
$1,816.00
|
| Rate for Payer: Cash Price |
$1,816.00
|
| Rate for Payer: Cofinity Commercial |
$1,250.61
|
| Rate for Payer: Cofinity Commercial |
$1,163.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.90
|
| Rate for Payer: Nomi Health Commercial |
$1,042.18
|
| Rate for Payer: PACE SWMI |
$868.48
|
| Rate for Payer: PHP Commercial |
$1,215.87
|
| Rate for Payer: PHP Medicare Advantage |
$868.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,475.50
|
| Rate for Payer: Priority Health Medicare |
$868.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.48
|
| Rate for Payer: UHC Medicare Advantage |
$868.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,044.20
|
|
|
PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM CRV
|
Professional
|
Both
|
$3,264.00
|
|
|
Service Code
|
HCPCS 22110
|
| Min. Negotiated Rate |
$1,033.24 |
| Max. Negotiated Rate |
$2,121.60 |
| Rate for Payer: Aetna Commercial |
$1,384.54
|
| Rate for Payer: Aetna Medicare |
$1,074.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,487.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,384.54
|
| Rate for Payer: BCBS Complete |
$1,305.60
|
| Rate for Payer: BCBS MAPPO |
$1,033.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,033.24
|
| Rate for Payer: Cash Price |
$2,611.20
|
| Rate for Payer: Cash Price |
$2,611.20
|
| Rate for Payer: Cofinity Commercial |
$1,487.87
|
| Rate for Payer: Cofinity Commercial |
$1,384.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,033.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,084.90
|
| Rate for Payer: Nomi Health Commercial |
$1,239.89
|
| Rate for Payer: PACE SWMI |
$1,033.24
|
| Rate for Payer: PHP Commercial |
$1,446.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,033.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,121.60
|
| Rate for Payer: Priority Health Medicare |
$1,033.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,033.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,033.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,501.44
|
|
|
PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM EA
|
Professional
|
Both
|
$803.00
|
|
|
Service Code
|
HCPCS 22116
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$521.95 |
| Rate for Payer: Aetna Commercial |
$186.93
|
| Rate for Payer: Aetna Medicare |
$145.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.93
|
| Rate for Payer: BCBS Complete |
$321.20
|
| Rate for Payer: BCBS MAPPO |
$139.50
|
| Rate for Payer: BCN Medicare Advantage |
$139.50
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cofinity Commercial |
$200.88
|
| Rate for Payer: Cofinity Commercial |
$186.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.47
|
| Rate for Payer: Nomi Health Commercial |
$167.40
|
| Rate for Payer: PACE SWMI |
$139.50
|
| Rate for Payer: PHP Commercial |
$195.30
|
| Rate for Payer: PHP Medicare Advantage |
$139.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.95
|
| Rate for Payer: Priority Health Medicare |
$139.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.50
|
| Rate for Payer: UHC Medicare Advantage |
$139.50
|
| Rate for Payer: UMR Bronson Commercial |
$369.38
|
|
|
PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM LMBR
|
Professional
|
Both
|
$2,432.00
|
|
|
Service Code
|
HCPCS 22114
|
| Min. Negotiated Rate |
$972.80 |
| Max. Negotiated Rate |
$1,615.74 |
| Rate for Payer: Aetna Commercial |
$1,503.53
|
| Rate for Payer: Aetna Medicare |
$1,166.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,615.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,503.53
|
| Rate for Payer: BCBS Complete |
$972.80
|
| Rate for Payer: BCBS MAPPO |
$1,122.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,122.04
|
| Rate for Payer: Cash Price |
$1,945.60
|
| Rate for Payer: Cash Price |
$1,945.60
|
| Rate for Payer: Cofinity Commercial |
$1,615.74
|
| Rate for Payer: Cofinity Commercial |
$1,503.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,122.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,178.14
|
| Rate for Payer: Nomi Health Commercial |
$1,346.45
|
| Rate for Payer: PACE SWMI |
$1,122.04
|
| Rate for Payer: PHP Commercial |
$1,570.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,122.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,580.80
|
| Rate for Payer: Priority Health Medicare |
$1,122.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,122.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,122.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,118.72
|
|
|
PR PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY
|
Professional
|
Both
|
$3,968.00
|
|
|
Service Code
|
HCPCS 60210
|
| Min. Negotiated Rate |
$684.32 |
| Max. Negotiated Rate |
$2,579.20 |
| Rate for Payer: Aetna Commercial |
$916.99
|
| Rate for Payer: Aetna Medicare |
$711.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$985.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$916.99
|
| Rate for Payer: BCBS Complete |
$1,587.20
|
| Rate for Payer: BCBS MAPPO |
$684.32
|
| Rate for Payer: BCN Medicare Advantage |
$684.32
|
| Rate for Payer: Cash Price |
$3,174.40
|
| Rate for Payer: Cash Price |
$3,174.40
|
| Rate for Payer: Cofinity Commercial |
$985.42
|
| Rate for Payer: Cofinity Commercial |
$916.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$684.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$718.54
|
| Rate for Payer: Nomi Health Commercial |
$821.18
|
| Rate for Payer: PACE SWMI |
$684.32
|
| Rate for Payer: PHP Commercial |
$958.05
|
| Rate for Payer: PHP Medicare Advantage |
$684.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,579.20
|
| Rate for Payer: Priority Health Medicare |
$684.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$684.32
|
| Rate for Payer: UHC Medicare Advantage |
$684.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,825.28
|
|
