|
PR TC99M SESTAMIBI
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS A9500
|
| Min. Negotiated Rate |
$102.48 |
| Max. Negotiated Rate |
$450.58 |
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna Medicare |
$165.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.48
|
| Rate for Payer: BCN Commercial |
$128.10
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$247.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$450.58
|
| Rate for Payer: UHC Core |
$450.58
|
| Rate for Payer: UHC Exchange |
$450.58
|
| Rate for Payer: UMR Bronson Commercial |
$151.80
|
|
|
PR TCATH STENT PLACEMT ANTEGRADE CAROTID/INNOMINATE
|
Professional
|
Both
|
$1,868.00
|
|
|
Service Code
|
HCPCS 37218
|
| Min. Negotiated Rate |
$473.07 |
| Max. Negotiated Rate |
$1,460.92 |
| Rate for Payer: Aetna Commercial |
$998.18
|
| Rate for Payer: Aetna Medicare |
$774.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,072.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$998.18
|
| Rate for Payer: BCBS Complete |
$496.72
|
| Rate for Payer: BCBS MAPPO |
$744.91
|
| Rate for Payer: BCN Commercial |
$1,216.57
|
| Rate for Payer: BCN Medicare Advantage |
$744.91
|
| Rate for Payer: Cash Price |
$1,494.40
|
| Rate for Payer: Cash Price |
$1,494.40
|
| Rate for Payer: Cofinity Commercial |
$998.18
|
| Rate for Payer: Cofinity Commercial |
$1,072.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$744.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$782.16
|
| Rate for Payer: Meridian Medicaid |
$496.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$819.40
|
| Rate for Payer: Nomi Health Commercial |
$893.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,401.00
|
| Rate for Payer: PACE SWMI |
$744.91
|
| Rate for Payer: PHP Commercial |
$1,042.87
|
| Rate for Payer: PHP Medicare Advantage |
$744.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,308.26
|
| Rate for Payer: Priority Health Medicare |
$744.91
|
| Rate for Payer: Priority Health SBD |
$1,308.26
|
| Rate for Payer: Priority Health Tiered Network |
$1,308.26
|
| Rate for Payer: Railroad Medicare Medicare |
$744.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,460.92
|
| Rate for Payer: UHC Core |
$1,460.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$744.91
|
| Rate for Payer: UHC Exchange |
$1,460.92
|
| Rate for Payer: UHC Medicaid |
$473.07
|
| Rate for Payer: UHCCP Medicaid |
$473.07
|
| Rate for Payer: UMR Bronson Commercial |
$859.28
|
|
|
PR TCATH STENT PLACEMT RETROGRAD CAROTID/INNOMINATE
|
Professional
|
Both
|
$1,808.00
|
|
|
Service Code
|
HCPCS 37217
|
| Min. Negotiated Rate |
$624.52 |
| Max. Negotiated Rate |
$1,935.99 |
| Rate for Payer: Aetna Commercial |
$1,324.01
|
| Rate for Payer: Aetna Medicare |
$1,027.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,324.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,422.82
|
| Rate for Payer: BCBS Complete |
$655.75
|
| Rate for Payer: BCBS MAPPO |
$988.07
|
| Rate for Payer: BCN Commercial |
$1,583.58
|
| Rate for Payer: BCN Medicare Advantage |
$988.07
|
| Rate for Payer: Cash Price |
$1,446.40
|
| Rate for Payer: Cash Price |
$1,446.40
|
| Rate for Payer: Cofinity Commercial |
$1,324.01
|
| Rate for Payer: Cofinity Commercial |
$1,422.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$988.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,037.47
|
| Rate for Payer: Meridian Medicaid |
$655.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,086.88
|
| Rate for Payer: Nomi Health Commercial |
$1,185.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,356.00
|
| Rate for Payer: PACE SWMI |
$988.07
|
| Rate for Payer: PHP Commercial |
$1,383.30
|
| Rate for Payer: PHP Medicare Advantage |
$988.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$624.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,702.94
|
| Rate for Payer: Priority Health Medicare |
$988.07
|
| Rate for Payer: Priority Health SBD |
$1,702.94
|
| Rate for Payer: Priority Health Tiered Network |
$1,702.94
|
| Rate for Payer: Railroad Medicare Medicare |
$988.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,935.99
|
| Rate for Payer: UHC Core |
$1,935.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$988.07
|
| Rate for Payer: UHC Exchange |
$1,935.99
|
| Rate for Payer: UHC Medicaid |
$624.52
|
| Rate for Payer: UHCCP Medicaid |
$624.52
|
| Rate for Payer: UMR Bronson Commercial |
$831.68
|
|
|
PR TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR
|
Professional
|
Both
|
$708.00
|
|
|
Service Code
|
HCPCS 33289
|
| Min. Negotiated Rate |
$181.26 |
| Max. Negotiated Rate |
$587.35 |
| Rate for Payer: Aetna Commercial |
$382.03
|
| Rate for Payer: Aetna Medicare |
$296.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.54
|
| Rate for Payer: BCBS Complete |
$190.32
|
| Rate for Payer: BCBS MAPPO |
$285.10
|
| Rate for Payer: BCN Commercial |
$489.52
|
| Rate for Payer: BCN Medicare Advantage |
$285.10
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cofinity Commercial |
$382.03
|
| Rate for Payer: Cofinity Commercial |
$410.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$299.36
|
| Rate for Payer: Meridian Medicaid |
$190.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$313.61
|
| Rate for Payer: Nomi Health Commercial |
$342.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$531.00
|
| Rate for Payer: PACE SWMI |
$285.10
|
| Rate for Payer: PHP Commercial |
$399.14
|
| Rate for Payer: PHP Medicare Advantage |
$285.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$526.42
|
| Rate for Payer: Priority Health Medicare |
$285.10
|
| Rate for Payer: Priority Health SBD |
$526.42
|
| Rate for Payer: Priority Health Tiered Network |
$526.42
|
| Rate for Payer: Railroad Medicare Medicare |
$285.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$587.35
|
| Rate for Payer: UHC Core |
$587.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$285.10
|
| Rate for Payer: UHC Exchange |
$587.35
|
| Rate for Payer: UHC Medicaid |
$181.26
|
| Rate for Payer: UHCCP Medicaid |
$181.26
|
| Rate for Payer: UMR Bronson Commercial |
$325.68
|
|
|
PR TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL
|
Professional
|
Both
|
$787.00
|
|
|
Service Code
|
HCPCS 0823T
|
| Min. Negotiated Rate |
$314.80 |
| Max. Negotiated Rate |
$17,831.53 |
| Rate for Payer: Aetna Medicare |
$393.50
|
| Rate for Payer: BCBS Complete |
$314.80
|
| Rate for Payer: BCN Commercial |
$17,831.53
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$590.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$645.32
|
| Rate for Payer: Priority Health SBD |
$645.32
|
| Rate for Payer: Priority Health Tiered Network |
$645.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$868.36
|
| Rate for Payer: UHC Core |
$868.36
|
| Rate for Payer: UHC Exchange |
$868.36
|
| Rate for Payer: UMR Bronson Commercial |
$362.02
|
|
|
PR TCAT INSJ PERM DUAL CHAMBER LDLS PM COMPL SYS
|
Professional
|
Both
|
$25,536.00
|
|
|
Service Code
|
HCPCS 0795T
|
| Min. Negotiated Rate |
$868.36 |
| Max. Negotiated Rate |
$19,152.00 |
| Rate for Payer: Aetna Medicare |
$12,768.00
|
| Rate for Payer: BCBS Complete |
$10,214.40
|
| Rate for Payer: BCN Commercial |
$17,831.53
|
| Rate for Payer: Cash Price |
$20,428.80
|
| Rate for Payer: Cash Price |
$20,428.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19,152.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$868.36
|
| Rate for Payer: UHC Core |
$868.36
|
| Rate for Payer: UHC Exchange |
$868.36
|
| Rate for Payer: UMR Bronson Commercial |
$11,746.56
|
|
|
PR TCAT INSJ/RPL PERM LEADLESS PACEMAKER RV W/IMG
|
Professional
|
Both
|
$1,051.00
|
|
|
Service Code
|
HCPCS 33274
|
| Min. Negotiated Rate |
$267.53 |
| Max. Negotiated Rate |
$862.01 |
| Rate for Payer: Aetna Commercial |
$559.99
|
| Rate for Payer: Aetna Medicare |
$434.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.78
|
| Rate for Payer: BCBS Complete |
$280.91
|
| Rate for Payer: BCBS MAPPO |
$417.90
|
| Rate for Payer: BCN Commercial |
$702.65
|
| Rate for Payer: BCN Medicare Advantage |
$417.90
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Cofinity Commercial |
$601.78
|
| Rate for Payer: Cofinity Commercial |
$559.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$417.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$438.80
|
| Rate for Payer: Meridian Medicaid |
$280.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$459.69
|
| Rate for Payer: Nomi Health Commercial |
$501.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$788.25
|
| Rate for Payer: PACE SWMI |
$417.90
|
| Rate for Payer: PHP Commercial |
$585.06
|
| Rate for Payer: PHP Medicare Advantage |
$417.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$755.61
|
| Rate for Payer: Priority Health Medicare |
$417.90
|
| Rate for Payer: Priority Health SBD |
$755.61
|
| Rate for Payer: Priority Health Tiered Network |
$755.61
|
| Rate for Payer: Railroad Medicare Medicare |
$417.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$862.01
|
| Rate for Payer: UHC Core |
$862.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$417.90
|
| Rate for Payer: UHC Exchange |
$862.01
|
| Rate for Payer: UHC Medicaid |
$267.53
|
| Rate for Payer: UHCCP Medicaid |
$267.53
|
| Rate for Payer: UMR Bronson Commercial |
$483.46
|
|
|
PR TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ
|
Professional
|
Both
|
$2,173.00
|
|
|
Service Code
|
HCPCS 37215
|
| Min. Negotiated Rate |
$567.22 |
| Max. Negotiated Rate |
$1,785.27 |
| Rate for Payer: Aetna Commercial |
$1,200.25
|
| Rate for Payer: Aetna Medicare |
$931.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,200.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,289.82
|
| Rate for Payer: BCBS Complete |
$595.58
|
| Rate for Payer: BCBS MAPPO |
$895.71
|
| Rate for Payer: BCN Commercial |
$1,444.64
|
| Rate for Payer: BCN Medicare Advantage |
$895.71
|
| Rate for Payer: Cash Price |
$1,738.40
|
| Rate for Payer: Cash Price |
$1,738.40
|
| Rate for Payer: Cofinity Commercial |
$1,200.25
|
| Rate for Payer: Cofinity Commercial |
$1,289.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$895.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$940.50
|
| Rate for Payer: Meridian Medicaid |
$595.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$985.28
|
| Rate for Payer: Nomi Health Commercial |
$1,074.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,629.75
|
| Rate for Payer: PACE SWMI |
$895.71
|
| Rate for Payer: PHP Commercial |
$1,253.99
|
| Rate for Payer: PHP Medicare Advantage |
$895.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$567.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,553.53
|
| Rate for Payer: Priority Health Medicare |
$895.71
|
| Rate for Payer: Priority Health SBD |
$1,553.53
|
| Rate for Payer: Priority Health Tiered Network |
$1,553.53
|
| Rate for Payer: Railroad Medicare Medicare |
$895.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,785.27
|
| Rate for Payer: UHC Core |
$1,785.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$895.71
|
| Rate for Payer: UHC Exchange |
$1,785.27
|
| Rate for Payer: UHC Medicaid |
$567.22
|
| Rate for Payer: UHCCP Medicaid |
$567.22
|
| Rate for Payer: UMR Bronson Commercial |
$999.58
|
|
|
PR TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ
|
Professional
|
Both
|
$4,310.00
|
|
|
Service Code
|
HCPCS 37216
|
| Min. Negotiated Rate |
$1,302.62 |
| Max. Negotiated Rate |
$3,232.50 |
| Rate for Payer: Aetna Commercial |
$1,302.62
|
| Rate for Payer: Aetna Medicare |
$2,155.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,302.62
|
| Rate for Payer: BCBS Complete |
$1,724.00
|
| Rate for Payer: BCN Commercial |
$1,458.09
|
| Rate for Payer: Cash Price |
$3,448.00
|
| Rate for Payer: Cash Price |
$3,448.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,232.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,568.00
|
| Rate for Payer: Priority Health SBD |
$1,568.00
|
| Rate for Payer: Priority Health Tiered Network |
$1,568.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,727.80
|
| Rate for Payer: UHC Core |
$1,727.80
|
| Rate for Payer: UHC Exchange |
$1,727.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,982.60
|
|
|
PR TCAT MITRAL VALVE REPAIR INITIAL PROSTHESIS
|
Professional
|
Both
|
$3,872.00
|
|
|
Service Code
|
HCPCS 33418
|
| Min. Negotiated Rate |
$1,008.13 |
| Max. Negotiated Rate |
$3,206.25 |
| Rate for Payer: Aetna Commercial |
$2,128.31
|
| Rate for Payer: Aetna Medicare |
$1,651.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,128.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,287.14
|
| Rate for Payer: BCBS Complete |
$1,058.54
|
| Rate for Payer: BCBS MAPPO |
$1,588.29
|
| Rate for Payer: BCN Commercial |
$2,635.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,588.29
|
| Rate for Payer: Cash Price |
$3,097.60
|
| Rate for Payer: Cash Price |
$3,097.60
|
| Rate for Payer: Cofinity Commercial |
$2,128.31
|
| Rate for Payer: Cofinity Commercial |
$2,287.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,588.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,667.70
|
| Rate for Payer: Meridian Medicaid |
$1,058.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,747.12
|
| Rate for Payer: Nomi Health Commercial |
$1,905.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,904.00
|
| Rate for Payer: PACE SWMI |
$1,588.29
|
| Rate for Payer: PHP Commercial |
$2,223.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,588.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,008.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,834.48
|
| Rate for Payer: Priority Health Medicare |
$1,588.29
|
| Rate for Payer: Priority Health SBD |
$2,834.48
|
| Rate for Payer: Priority Health Tiered Network |
$2,834.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,588.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,206.25
|
| Rate for Payer: UHC Core |
$3,206.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,588.29
|
| Rate for Payer: UHC Exchange |
$3,206.25
|
| Rate for Payer: UHC Medicaid |
$1,008.13
|
| Rate for Payer: UHCCP Medicaid |
$1,008.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,781.12
|
|
|
PR TCAT PERM OCCLS/EMBOLIZATION PERQ CNS
|
Professional
|
Both
|
$4,763.00
|
|
|
Service Code
|
HCPCS 61624
|
| Min. Negotiated Rate |
$666.26 |
| Max. Negotiated Rate |
$3,572.25 |
| Rate for Payer: Aetna Commercial |
$1,415.72
|
| Rate for Payer: Aetna Medicare |
$1,098.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,415.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,521.37
|
| Rate for Payer: BCBS Complete |
$699.57
|
| Rate for Payer: BCBS MAPPO |
$1,056.51
|
| Rate for Payer: BCN Commercial |
$2,407.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,056.51
|
| Rate for Payer: Cash Price |
$3,810.40
|
| Rate for Payer: Cash Price |
$3,810.40
|
| Rate for Payer: Cofinity Commercial |
$1,415.72
|
| Rate for Payer: Cofinity Commercial |
$1,521.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,056.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,109.34
|
| Rate for Payer: Meridian Medicaid |
$699.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,162.16
|
| Rate for Payer: Nomi Health Commercial |
$1,267.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,572.25
|
| Rate for Payer: PACE SWMI |
$1,056.51
|
| Rate for Payer: PHP Commercial |
$1,479.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,056.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$666.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,023.80
|
| Rate for Payer: Priority Health Medicare |
$1,056.51
|
| Rate for Payer: Priority Health SBD |
$2,023.80
|
| Rate for Payer: Priority Health Tiered Network |
$2,023.80
|
| Rate for Payer: Railroad Medicare Medicare |
$1,056.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,050.28
|
| Rate for Payer: UHC Core |
$2,050.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,056.51
|
| Rate for Payer: UHC Exchange |
$2,050.28
|
| Rate for Payer: UHC Medicaid |
$666.26
|
| Rate for Payer: UHCCP Medicaid |
$666.26
|
| Rate for Payer: UMR Bronson Commercial |
$2,190.98
|
|
|
PR TCAT PERM OCCLS/EMBOLJ PERQ NON-CNS HEAD/NECK
|
Professional
|
Both
|
$1,904.00
|
|
|
Service Code
|
HCPCS 61626
|
| Min. Negotiated Rate |
$480.95 |
| Max. Negotiated Rate |
$1,575.83 |
| Rate for Payer: Aetna Commercial |
$1,019.98
|
| Rate for Payer: Aetna Medicare |
$791.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,019.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,096.10
|
| Rate for Payer: BCBS Complete |
$505.00
|
| Rate for Payer: BCBS MAPPO |
$761.18
|
| Rate for Payer: BCN Commercial |
$1,351.52
|
| Rate for Payer: BCN Medicare Advantage |
$761.18
|
| Rate for Payer: Cash Price |
$1,523.20
|
| Rate for Payer: Cash Price |
$1,523.20
|
| Rate for Payer: Cofinity Commercial |
$1,019.98
|
| Rate for Payer: Cofinity Commercial |
$1,096.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$761.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$799.24
|
| Rate for Payer: Meridian Medicaid |
$505.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$837.30
|
| Rate for Payer: Nomi Health Commercial |
$913.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,428.00
|
| Rate for Payer: PACE SWMI |
$761.18
|
| Rate for Payer: PHP Commercial |
$1,065.65
|
| Rate for Payer: PHP Medicare Advantage |
$761.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$480.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,569.76
|
| Rate for Payer: Priority Health Medicare |
$761.18
|
| Rate for Payer: Priority Health SBD |
$1,569.76
|
| Rate for Payer: Priority Health Tiered Network |
$1,569.76
|
| Rate for Payer: Railroad Medicare Medicare |
$761.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,575.83
|
| Rate for Payer: UHC Core |
$1,575.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$761.18
|
| Rate for Payer: UHC Exchange |
$1,575.83
|
| Rate for Payer: UHC Medicaid |
$480.95
|
| Rate for Payer: UHCCP Medicaid |
$480.95
|
| Rate for Payer: UMR Bronson Commercial |
$875.84
|
|
|
PR TCAT PLMT IV STENT ICRA W/BALO ANGIOP IF PFRMD
|
Professional
|
Both
|
$6,997.00
|
|
|
Service Code
|
HCPCS 61635
|
| Min. Negotiated Rate |
$1,359.71 |
| Max. Negotiated Rate |
$5,247.75 |
| Rate for Payer: Aetna Commercial |
$1,822.01
|
| Rate for Payer: Aetna Medicare |
$1,414.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,822.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,957.98
|
| Rate for Payer: BCBS Complete |
$2,798.80
|
| Rate for Payer: BCBS MAPPO |
$1,359.71
|
| Rate for Payer: BCN Commercial |
$2,241.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,359.71
|
| Rate for Payer: Cash Price |
$5,597.60
|
| Rate for Payer: Cash Price |
$5,597.60
|
| Rate for Payer: Cofinity Commercial |
$1,957.98
|
| Rate for Payer: Cofinity Commercial |
$1,822.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,359.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,427.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,495.68
|
| Rate for Payer: Nomi Health Commercial |
$1,631.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,247.75
|
| Rate for Payer: PACE SWMI |
$1,359.71
|
| Rate for Payer: PHP Commercial |
$1,903.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,359.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,603.37
|
| Rate for Payer: Priority Health Medicare |
$1,359.71
|
| Rate for Payer: Priority Health SBD |
$2,603.37
|
| Rate for Payer: Priority Health Tiered Network |
$2,603.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,359.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,573.86
|
| Rate for Payer: UHC Core |
$2,573.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,359.71
|
| Rate for Payer: UHC Exchange |
$2,573.86
|
| Rate for Payer: UMR Bronson Commercial |
$3,218.62
|
|
|
PR TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL
|
Professional
|
Both
|
$10,169.00
|
|
|
Service Code
|
HCPCS 0075T
|
| Min. Negotiated Rate |
$1,381.29 |
| Max. Negotiated Rate |
$10,427.07 |
| Rate for Payer: Aetna Commercial |
$1,381.29
|
| Rate for Payer: Aetna Medicare |
$5,084.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,381.29
|
| Rate for Payer: BCBS Complete |
$4,067.60
|
| Rate for Payer: BCN Commercial |
$6,509.92
|
| Rate for Payer: Cash Price |
$8,135.20
|
| Rate for Payer: Cash Price |
$8,135.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,626.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,900.00
|
| Rate for Payer: Priority Health SBD |
$5,900.00
|
| Rate for Payer: Priority Health Tiered Network |
$5,900.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,427.07
|
| Rate for Payer: UHC Core |
$10,427.07
|
| Rate for Payer: UHC Exchange |
$10,427.07
|
| Rate for Payer: UMR Bronson Commercial |
$4,677.74
|
|
|
PR TCAT REMOVAL PERM LEADLESS PM RIGHT VENTR W/IMG
|
Professional
|
Both
|
$1,781.00
|
|
|
Service Code
|
HCPCS 33275
|
| Min. Negotiated Rate |
$285.21 |
| Max. Negotiated Rate |
$1,335.75 |
| Rate for Payer: Aetna Commercial |
$599.13
|
| Rate for Payer: Aetna Medicare |
$464.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$643.84
|
| Rate for Payer: BCBS Complete |
$299.47
|
| Rate for Payer: BCBS MAPPO |
$447.11
|
| Rate for Payer: BCN Commercial |
$742.99
|
| Rate for Payer: BCN Medicare Advantage |
$447.11
|
| Rate for Payer: Cash Price |
$1,424.80
|
| Rate for Payer: Cash Price |
$1,424.80
|
| Rate for Payer: Cofinity Commercial |
$599.13
|
| Rate for Payer: Cofinity Commercial |
$643.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.47
|
| Rate for Payer: Meridian Medicaid |
$299.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$491.82
|
| Rate for Payer: Nomi Health Commercial |
$536.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,335.75
|
| Rate for Payer: PACE SWMI |
$447.11
|
| Rate for Payer: PHP Commercial |
$625.95
|
| Rate for Payer: PHP Medicare Advantage |
$447.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$285.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$798.99
|
| Rate for Payer: Priority Health Medicare |
$447.11
|
| Rate for Payer: Priority Health SBD |
$798.99
|
| Rate for Payer: Priority Health Tiered Network |
$798.99
|
| Rate for Payer: Railroad Medicare Medicare |
$447.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$943.76
|
| Rate for Payer: UHC Core |
$943.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$447.11
|
| Rate for Payer: UHC Exchange |
$943.76
|
| Rate for Payer: UHC Medicaid |
$285.21
|
| Rate for Payer: UHCCP Medicaid |
$285.21
|
| Rate for Payer: UMR Bronson Commercial |
$819.26
|
|
|
PR TCD STD ICR ART VEN-ARTL SHNT DETCJ IV MBUBB NJX
|
Professional
|
Both
|
$695.00
|
|
|
Service Code
|
HCPCS 93893
|
| Min. Negotiated Rate |
$319.70 |
| Max. Negotiated Rate |
$543.09 |
| Rate for Payer: Aetna Commercial |
$452.79
|
| Rate for Payer: Aetna Medicare |
$351.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.79
|
| Rate for Payer: BCBS MAPPO |
$337.90
|
| Rate for Payer: BCN Commercial |
$498.48
|
| Rate for Payer: BCN Medicare Advantage |
$337.90
|
| Rate for Payer: Cash Price |
$556.00
|
| Rate for Payer: Cash Price |
$556.00
|
| Rate for Payer: Cofinity Commercial |
$486.58
|
| Rate for Payer: Cofinity Commercial |
$452.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$354.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$371.69
|
| Rate for Payer: Nomi Health Commercial |
$405.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$521.25
|
| Rate for Payer: PACE SWMI |
$337.90
|
| Rate for Payer: PHP Commercial |
$473.06
|
| Rate for Payer: PHP Medicare Advantage |
$337.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$459.71
|
| Rate for Payer: Priority Health Medicare |
$337.90
|
| Rate for Payer: Priority Health SBD |
$459.71
|
| Rate for Payer: Priority Health Tiered Network |
$459.71
|
| Rate for Payer: Railroad Medicare Medicare |
$337.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.09
|
| Rate for Payer: UHC Core |
$543.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$337.90
|
| Rate for Payer: UHC Exchange |
$543.09
|
| Rate for Payer: UMR Bronson Commercial |
$319.70
|
|
|
PR TDAP VACCINE 7 YRS/> IM
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 90715
|
| Min. Negotiated Rate |
$26.68 |
| Max. Negotiated Rate |
$56.85 |
| Rate for Payer: Aetna Commercial |
$52.90
|
| Rate for Payer: Aetna Medicare |
$41.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.85
|
| Rate for Payer: BCBS MAPPO |
$39.48
|
| Rate for Payer: BCBS Trust/PPO |
$48.75
|
| Rate for Payer: BCN Commercial |
$48.04
|
| Rate for Payer: BCN Medicare Advantage |
$39.48
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$52.90
|
| Rate for Payer: Cofinity Commercial |
$56.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.43
|
| Rate for Payer: Nomi Health Commercial |
$47.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.50
|
| Rate for Payer: PACE SWMI |
$39.48
|
| Rate for Payer: PHP Commercial |
$55.27
|
| Rate for Payer: PHP Medicare Advantage |
$39.48
|
| Rate for Payer: Priority Health Medicare |
$39.48
|
| Rate for Payer: Railroad Medicare Medicare |
$39.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.86
|
| Rate for Payer: UHC Core |
$49.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$39.48
|
| Rate for Payer: UHC Exchange |
$49.86
|
| Rate for Payer: UMR Bronson Commercial |
$26.68
|
|
|
PR TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN
|
Professional
|
Both
|
$2,712.00
|
|
|
Service Code
|
HCPCS 25310
|
| Min. Negotiated Rate |
$426.21 |
| Max. Negotiated Rate |
$2,034.00 |
| Rate for Payer: Aetna Commercial |
$868.01
|
| Rate for Payer: Aetna Medicare |
$673.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$868.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$932.79
|
| Rate for Payer: BCBS Complete |
$447.52
|
| Rate for Payer: BCBS MAPPO |
$647.77
|
| Rate for Payer: BCN Commercial |
$1,093.07
|
| Rate for Payer: BCN Medicare Advantage |
$647.77
|
| Rate for Payer: Cash Price |
$2,169.60
|
| Rate for Payer: Cash Price |
$2,169.60
|
| Rate for Payer: Cofinity Commercial |
$868.01
|
| Rate for Payer: Cofinity Commercial |
$932.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$680.16
|
| Rate for Payer: Meridian Medicaid |
$447.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$712.55
|
| Rate for Payer: Nomi Health Commercial |
$777.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,034.00
|
| Rate for Payer: PACE SWMI |
$647.77
|
| Rate for Payer: PHP Commercial |
$906.88
|
| Rate for Payer: PHP Medicare Advantage |
$647.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$426.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,168.47
|
| Rate for Payer: Priority Health Medicare |
$647.77
|
| Rate for Payer: Priority Health SBD |
$1,168.47
|
| Rate for Payer: Priority Health Tiered Network |
$1,168.47
|
| Rate for Payer: Railroad Medicare Medicare |
$647.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,076.29
|
| Rate for Payer: UHC Core |
$1,076.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$647.77
|
| Rate for Payer: UHC Exchange |
$1,076.29
|
| Rate for Payer: UHC Medicaid |
$426.21
|
| Rate for Payer: UHCCP Medicaid |
$426.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,247.52
|
|
|
PR TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1/TDN GR
|
Professional
|
Both
|
$1,630.00
|
|
|
Service Code
|
HCPCS 25312
|
| Min. Negotiated Rate |
$423.44 |
| Max. Negotiated Rate |
$1,251.65 |
| Rate for Payer: Aetna Commercial |
$867.80
|
| Rate for Payer: Aetna Medicare |
$673.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$867.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$932.56
|
| Rate for Payer: BCBS Complete |
$444.61
|
| Rate for Payer: BCBS MAPPO |
$647.61
|
| Rate for Payer: BCN Commercial |
$1,099.54
|
| Rate for Payer: BCN Medicare Advantage |
$647.61
|
| Rate for Payer: Cash Price |
$1,304.00
|
| Rate for Payer: Cash Price |
$1,304.00
|
| Rate for Payer: Cofinity Commercial |
$867.80
|
| Rate for Payer: Cofinity Commercial |
$932.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.99
|
| Rate for Payer: Meridian Medicaid |
$444.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$712.37
|
| Rate for Payer: Nomi Health Commercial |
$777.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,222.50
|
| Rate for Payer: PACE SWMI |
$647.61
|
| Rate for Payer: PHP Commercial |
$906.65
|
| Rate for Payer: PHP Medicare Advantage |
$647.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$423.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,175.38
|
| Rate for Payer: Priority Health Medicare |
$647.61
|
| Rate for Payer: Priority Health SBD |
$1,175.38
|
| Rate for Payer: Priority Health Tiered Network |
$1,175.38
|
| Rate for Payer: Railroad Medicare Medicare |
$647.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,251.65
|
| Rate for Payer: UHC Core |
$1,251.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$647.61
|
| Rate for Payer: UHC Exchange |
$1,251.65
|
| Rate for Payer: UHC Medicaid |
$423.44
|
| Rate for Payer: UHCCP Medicaid |
$423.44
|
| Rate for Payer: UMR Bronson Commercial |
$749.80
|
|
|
PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 90714
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna Commercial |
$51.92
|
| Rate for Payer: Aetna Medicare |
$40.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.92
|
| Rate for Payer: BCBS MAPPO |
$38.75
|
| Rate for Payer: BCBS Trust/PPO |
$45.91
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: BCN Medicare Advantage |
$38.75
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$51.92
|
| Rate for Payer: Cofinity Commercial |
$55.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.62
|
| Rate for Payer: Nomi Health Commercial |
$46.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.00
|
| Rate for Payer: PACE SWMI |
$38.75
|
| Rate for Payer: PHP Commercial |
$54.25
|
| Rate for Payer: PHP Medicare Advantage |
$38.75
|
| Rate for Payer: Priority Health Medicare |
$38.75
|
| Rate for Payer: Railroad Medicare Medicare |
$38.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.91
|
| Rate for Payer: UHC Core |
$45.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.75
|
| Rate for Payer: UHC Exchange |
$45.91
|
| Rate for Payer: UMR Bronson Commercial |
$18.40
|
|
|
PR TEAEC W/GRAFT EA ADDL TIBIAL/PERONEAL ART
|
Professional
|
Both
|
$970.00
|
|
|
Service Code
|
HCPCS 35306
|
| Min. Negotiated Rate |
$256.67 |
| Max. Negotiated Rate |
$805.69 |
| Rate for Payer: Aetna Commercial |
$549.86
|
| Rate for Payer: Aetna Medicare |
$426.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.86
|
| Rate for Payer: BCBS Complete |
$269.50
|
| Rate for Payer: BCBS MAPPO |
$410.34
|
| Rate for Payer: BCN Commercial |
$647.87
|
| Rate for Payer: BCN Medicare Advantage |
$410.34
|
| Rate for Payer: Cash Price |
$776.00
|
| Rate for Payer: Cash Price |
$776.00
|
| Rate for Payer: Cofinity Commercial |
$590.89
|
| Rate for Payer: Cofinity Commercial |
$549.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$410.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$430.86
|
| Rate for Payer: Meridian Medicaid |
$269.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$451.37
|
| Rate for Payer: Nomi Health Commercial |
$492.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$727.50
|
| Rate for Payer: PACE SWMI |
$410.34
|
| Rate for Payer: PHP Commercial |
$574.48
|
| Rate for Payer: PHP Medicare Advantage |
$410.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$256.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$696.71
|
| Rate for Payer: Priority Health Medicare |
$410.34
|
| Rate for Payer: Priority Health SBD |
$696.71
|
| Rate for Payer: Priority Health Tiered Network |
$696.71
|
| Rate for Payer: Railroad Medicare Medicare |
$410.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$805.69
|
| Rate for Payer: UHC Core |
$805.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$410.34
|
| Rate for Payer: UHC Exchange |
$805.69
|
| Rate for Payer: UHC Medicaid |
$256.67
|
| Rate for Payer: UHCCP Medicaid |
$256.67
|
| Rate for Payer: UMR Bronson Commercial |
$446.20
|
|
|
PR TEAEC W/GRAFT POPLITEAL ARTERY
|
Professional
|
Both
|
$2,459.00
|
|
|
Service Code
|
HCPCS 35303
|
| Min. Negotiated Rate |
$710.14 |
| Max. Negotiated Rate |
$2,223.89 |
| Rate for Payer: Aetna Commercial |
$1,508.53
|
| Rate for Payer: Aetna Medicare |
$1,170.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,508.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,621.11
|
| Rate for Payer: BCBS Complete |
$745.65
|
| Rate for Payer: BCBS MAPPO |
$1,125.77
|
| Rate for Payer: BCN Commercial |
$1,789.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,125.77
|
| Rate for Payer: Cash Price |
$1,967.20
|
| Rate for Payer: Cash Price |
$1,967.20
|
| Rate for Payer: Cofinity Commercial |
$1,508.53
|
| Rate for Payer: Cofinity Commercial |
$1,621.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,125.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,182.06
|
| Rate for Payer: Meridian Medicaid |
$745.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,238.35
|
| Rate for Payer: Nomi Health Commercial |
$1,350.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,844.25
|
| Rate for Payer: PACE SWMI |
$1,125.77
|
| Rate for Payer: PHP Commercial |
$1,576.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,125.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$710.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,924.64
|
| Rate for Payer: Priority Health Medicare |
$1,125.77
|
| Rate for Payer: Priority Health SBD |
$1,924.64
|
| Rate for Payer: Priority Health Tiered Network |
$1,924.64
|
| Rate for Payer: Railroad Medicare Medicare |
$1,125.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,223.89
|
| Rate for Payer: UHC Core |
$2,223.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,125.77
|
| Rate for Payer: UHC Exchange |
$2,223.89
|
| Rate for Payer: UHC Medicaid |
$710.14
|
| Rate for Payer: UHCCP Medicaid |
$710.14
|
| Rate for Payer: UMR Bronson Commercial |
$1,131.14
|
|
|
PR TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY
|
Professional
|
Both
|
$2,258.00
|
|
|
Service Code
|
HCPCS 35302
|
| Min. Negotiated Rate |
$645.60 |
| Max. Negotiated Rate |
$2,013.84 |
| Rate for Payer: Aetna Commercial |
$1,370.87
|
| Rate for Payer: Aetna Medicare |
$1,063.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,370.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,473.18
|
| Rate for Payer: BCBS Complete |
$677.88
|
| Rate for Payer: BCBS MAPPO |
$1,023.04
|
| Rate for Payer: BCN Commercial |
$1,628.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,023.04
|
| Rate for Payer: Cash Price |
$1,806.40
|
| Rate for Payer: Cash Price |
$1,806.40
|
| Rate for Payer: Cofinity Commercial |
$1,370.87
|
| Rate for Payer: Cofinity Commercial |
$1,473.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,023.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,074.19
|
| Rate for Payer: Meridian Medicaid |
$677.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,125.34
|
| Rate for Payer: Nomi Health Commercial |
$1,227.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,693.50
|
| Rate for Payer: PACE SWMI |
$1,023.04
|
| Rate for Payer: PHP Commercial |
$1,432.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,023.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$645.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,751.66
|
| Rate for Payer: Priority Health Medicare |
$1,023.04
|
| Rate for Payer: Priority Health SBD |
$1,751.66
|
| Rate for Payer: Priority Health Tiered Network |
$1,751.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1,023.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,013.84
|
| Rate for Payer: UHC Core |
$2,013.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,023.04
|
| Rate for Payer: UHC Exchange |
$2,013.84
|
| Rate for Payer: UHC Medicaid |
$645.60
|
| Rate for Payer: UHCCP Medicaid |
$645.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,038.68
|
|
|
PR TEAEC W/GRAFT TIBIAL/PERONEAL ART 1ST VESSEL
|
Professional
|
Both
|
$2,483.00
|
|
|
Service Code
|
HCPCS 35305
|
| Min. Negotiated Rate |
$702.05 |
| Max. Negotiated Rate |
$2,201.48 |
| Rate for Payer: Aetna Commercial |
$1,493.11
|
| Rate for Payer: Aetna Medicare |
$1,158.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,493.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,604.53
|
| Rate for Payer: BCBS Complete |
$737.15
|
| Rate for Payer: BCBS MAPPO |
$1,114.26
|
| Rate for Payer: BCN Commercial |
$1,784.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,114.26
|
| Rate for Payer: Cash Price |
$1,986.40
|
| Rate for Payer: Cash Price |
$1,986.40
|
| Rate for Payer: Cofinity Commercial |
$1,493.11
|
| Rate for Payer: Cofinity Commercial |
$1,604.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,114.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,169.97
|
| Rate for Payer: Meridian Medicaid |
$737.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,225.69
|
| Rate for Payer: Nomi Health Commercial |
$1,337.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,862.25
|
| Rate for Payer: PACE SWMI |
$1,114.26
|
| Rate for Payer: PHP Commercial |
$1,559.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,114.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$702.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,919.29
|
| Rate for Payer: Priority Health Medicare |
$1,114.26
|
| Rate for Payer: Priority Health SBD |
$1,919.29
|
| Rate for Payer: Priority Health Tiered Network |
$1,919.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,114.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,201.48
|
| Rate for Payer: UHC Core |
$2,201.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,114.26
|
| Rate for Payer: UHC Exchange |
$2,201.48
|
| Rate for Payer: UHC Medicaid |
$702.05
|
| Rate for Payer: UHCCP Medicaid |
$702.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,142.18
|
|
|
PR TEAEC W/GRAFT TIBIOPERONEAL TRUNK ARTERY
|
Professional
|
Both
|
$2,584.00
|
|
|
Service Code
|
HCPCS 35304
|
| Min. Negotiated Rate |
$736.98 |
| Max. Negotiated Rate |
$2,292.14 |
| Rate for Payer: Aetna Commercial |
$1,566.84
|
| Rate for Payer: Aetna Medicare |
$1,216.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,566.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,683.76
|
| Rate for Payer: BCBS Complete |
$773.83
|
| Rate for Payer: BCBS MAPPO |
$1,169.28
|
| Rate for Payer: BCN Commercial |
$1,859.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,169.28
|
| Rate for Payer: Cash Price |
$2,067.20
|
| Rate for Payer: Cash Price |
$2,067.20
|
| Rate for Payer: Cofinity Commercial |
$1,566.84
|
| Rate for Payer: Cofinity Commercial |
$1,683.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,169.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,227.74
|
| Rate for Payer: Meridian Medicaid |
$773.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,286.21
|
| Rate for Payer: Nomi Health Commercial |
$1,403.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,938.00
|
| Rate for Payer: PACE SWMI |
$1,169.28
|
| Rate for Payer: PHP Commercial |
$1,636.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,169.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$736.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,000.15
|
| Rate for Payer: Priority Health Medicare |
$1,169.28
|
| Rate for Payer: Priority Health SBD |
$2,000.15
|
| Rate for Payer: Priority Health Tiered Network |
$2,000.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1,169.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,292.14
|
| Rate for Payer: UHC Core |
$2,292.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,169.28
|
| Rate for Payer: UHC Exchange |
$2,292.14
|
| Rate for Payer: UHC Medicaid |
$736.98
|
| Rate for Payer: UHCCP Medicaid |
$736.98
|
| Rate for Payer: UMR Bronson Commercial |
$1,188.64
|
|
