|
PR RPR/ADVMNT FLXR TDN ZONE 2 W/FR GRAFT EA TENDON
|
Professional
|
Both
|
$2,709.00
|
|
|
Service Code
|
HCPCS 26358
|
| Min. Negotiated Rate |
$945.32 |
| Max. Negotiated Rate |
$1,760.85 |
| Rate for Payer: Aetna Commercial |
$1,266.73
|
| Rate for Payer: Aetna Medicare |
$983.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,361.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,266.73
|
| Rate for Payer: BCBS Complete |
$1,083.60
|
| Rate for Payer: BCBS MAPPO |
$945.32
|
| Rate for Payer: BCN Medicare Advantage |
$945.32
|
| Rate for Payer: Cash Price |
$2,167.20
|
| Rate for Payer: Cash Price |
$2,167.20
|
| Rate for Payer: Cofinity Commercial |
$1,361.26
|
| Rate for Payer: Cofinity Commercial |
$1,266.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$945.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$992.59
|
| Rate for Payer: Nomi Health Commercial |
$1,134.38
|
| Rate for Payer: PACE SWMI |
$945.32
|
| Rate for Payer: PHP Commercial |
$1,323.45
|
| Rate for Payer: PHP Medicare Advantage |
$945.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,760.85
|
| Rate for Payer: Priority Health Medicare |
$945.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$945.32
|
| Rate for Payer: UHC Medicare Advantage |
$945.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,246.14
|
|
|
PR RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON
|
Professional
|
Both
|
$2,775.00
|
|
|
Service Code
|
HCPCS 26357
|
| Min. Negotiated Rate |
$856.00 |
| Max. Negotiated Rate |
$1,803.75 |
| Rate for Payer: Aetna Commercial |
$1,147.04
|
| Rate for Payer: Aetna Medicare |
$890.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,232.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,147.04
|
| Rate for Payer: BCBS Complete |
$1,110.00
|
| Rate for Payer: BCBS MAPPO |
$856.00
|
| Rate for Payer: BCN Medicare Advantage |
$856.00
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cofinity Commercial |
$1,232.64
|
| Rate for Payer: Cofinity Commercial |
$1,147.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$856.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$898.80
|
| Rate for Payer: Nomi Health Commercial |
$1,027.20
|
| Rate for Payer: PACE SWMI |
$856.00
|
| Rate for Payer: PHP Commercial |
$1,198.40
|
| Rate for Payer: PHP Medicare Advantage |
$856.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.75
|
| Rate for Payer: Priority Health Medicare |
$856.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$856.00
|
| Rate for Payer: UHC Medicare Advantage |
$856.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,276.50
|
|
|
PR RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON
|
Professional
|
Both
|
$2,657.00
|
|
|
Service Code
|
HCPCS 26356
|
| Min. Negotiated Rate |
$763.85 |
| Max. Negotiated Rate |
$1,727.05 |
| Rate for Payer: Aetna Commercial |
$1,023.56
|
| Rate for Payer: Aetna Medicare |
$794.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,099.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,023.56
|
| Rate for Payer: BCBS Complete |
$1,062.80
|
| Rate for Payer: BCBS MAPPO |
$763.85
|
| Rate for Payer: BCN Medicare Advantage |
$763.85
|
| Rate for Payer: Cash Price |
$2,125.60
|
| Rate for Payer: Cash Price |
$2,125.60
|
| Rate for Payer: Cofinity Commercial |
$1,099.94
|
| Rate for Payer: Cofinity Commercial |
$1,023.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$763.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$802.04
|
| Rate for Payer: Nomi Health Commercial |
$916.62
|
| Rate for Payer: PACE SWMI |
$763.85
|
| Rate for Payer: PHP Commercial |
$1,069.39
|
| Rate for Payer: PHP Medicare Advantage |
$763.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,727.05
|
| Rate for Payer: Priority Health Medicare |
$763.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$763.85
|
| Rate for Payer: UHC Medicare Advantage |
$763.85
|
| Rate for Payer: UMR Bronson Commercial |
$1,222.22
|
|
|
PR RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN
|
Professional
|
Both
|
$2,340.00
|
|
|
Service Code
|
HCPCS 26370
|
| Min. Negotiated Rate |
$731.54 |
| Max. Negotiated Rate |
$1,521.00 |
| Rate for Payer: Aetna Commercial |
$980.26
|
| Rate for Payer: Aetna Medicare |
$760.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$980.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,053.42
|
| Rate for Payer: BCBS Complete |
$936.00
|
| Rate for Payer: BCBS MAPPO |
$731.54
|
| Rate for Payer: BCN Medicare Advantage |
$731.54
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Cofinity Commercial |
$980.26
|
| Rate for Payer: Cofinity Commercial |
$1,053.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$731.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$768.12
|
| Rate for Payer: Nomi Health Commercial |
$877.85
|
| Rate for Payer: PACE SWMI |
$731.54
|
| Rate for Payer: PHP Commercial |
$1,024.16
|
| Rate for Payer: PHP Medicare Advantage |
$731.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,521.00
|
| Rate for Payer: Priority Health Medicare |
$731.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$731.54
|
| Rate for Payer: UHC Medicare Advantage |
$731.54
|
| Rate for Payer: UMR Bronson Commercial |
$1,076.40
|
|
|
PR RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/FREE GRAFT EA
|
Professional
|
Both
|
$3,106.00
|
|
|
Service Code
|
HCPCS 26372
|
| Min. Negotiated Rate |
$856.02 |
| Max. Negotiated Rate |
$2,018.90 |
| Rate for Payer: Aetna Commercial |
$1,147.07
|
| Rate for Payer: Aetna Medicare |
$890.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,232.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,147.07
|
| Rate for Payer: BCBS Complete |
$1,242.40
|
| Rate for Payer: BCBS MAPPO |
$856.02
|
| Rate for Payer: BCN Medicare Advantage |
$856.02
|
| Rate for Payer: Cash Price |
$2,484.80
|
| Rate for Payer: Cash Price |
$2,484.80
|
| Rate for Payer: Cofinity Commercial |
$1,232.67
|
| Rate for Payer: Cofinity Commercial |
$1,147.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$856.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$898.82
|
| Rate for Payer: Nomi Health Commercial |
$1,027.22
|
| Rate for Payer: PACE SWMI |
$856.02
|
| Rate for Payer: PHP Commercial |
$1,198.43
|
| Rate for Payer: PHP Medicare Advantage |
$856.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,018.90
|
| Rate for Payer: Priority Health Medicare |
$856.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$856.02
|
| Rate for Payer: UHC Medicare Advantage |
$856.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,428.76
|
|
|
PR RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/O FREE GRF EA
|
Professional
|
Both
|
$2,854.00
|
|
|
Service Code
|
HCPCS 26373
|
| Min. Negotiated Rate |
$822.63 |
| Max. Negotiated Rate |
$1,855.10 |
| Rate for Payer: Aetna Commercial |
$1,102.32
|
| Rate for Payer: Aetna Medicare |
$855.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,184.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,102.32
|
| Rate for Payer: BCBS Complete |
$1,141.60
|
| Rate for Payer: BCBS MAPPO |
$822.63
|
| Rate for Payer: BCN Medicare Advantage |
$822.63
|
| Rate for Payer: Cash Price |
$2,283.20
|
| Rate for Payer: Cash Price |
$2,283.20
|
| Rate for Payer: Cofinity Commercial |
$1,184.59
|
| Rate for Payer: Cofinity Commercial |
$1,102.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$822.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$863.76
|
| Rate for Payer: Nomi Health Commercial |
$987.16
|
| Rate for Payer: PACE SWMI |
$822.63
|
| Rate for Payer: PHP Commercial |
$1,151.68
|
| Rate for Payer: PHP Medicare Advantage |
$822.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,855.10
|
| Rate for Payer: Priority Health Medicare |
$822.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$822.63
|
| Rate for Payer: UHC Medicare Advantage |
$822.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,312.84
|
|
|
PR RPR ANOM AORTIC ORIGIN CORONARY ART UNROOF/TLCJ
|
Professional
|
Both
|
$3,602.00
|
|
|
Service Code
|
HCPCS 33507
|
| Min. Negotiated Rate |
$1,440.80 |
| Max. Negotiated Rate |
$2,380.06 |
| Rate for Payer: Aetna Commercial |
$2,214.78
|
| Rate for Payer: Aetna Medicare |
$1,718.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,380.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,214.78
|
| Rate for Payer: BCBS Complete |
$1,440.80
|
| Rate for Payer: BCBS MAPPO |
$1,652.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,652.82
|
| Rate for Payer: Cash Price |
$2,881.60
|
| Rate for Payer: Cash Price |
$2,881.60
|
| Rate for Payer: Cofinity Commercial |
$2,380.06
|
| Rate for Payer: Cofinity Commercial |
$2,214.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,652.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,735.46
|
| Rate for Payer: Nomi Health Commercial |
$1,983.38
|
| Rate for Payer: PACE SWMI |
$1,652.82
|
| Rate for Payer: PHP Commercial |
$2,313.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,652.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,341.30
|
| Rate for Payer: Priority Health Medicare |
$1,652.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,652.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,652.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,656.92
|
|
|
PR RPR ANOM CORONARY ART PULM ART ORIGIN GRF W/BYP
|
Professional
|
Both
|
$5,041.00
|
|
|
Service Code
|
HCPCS 33504
|
| Min. Negotiated Rate |
$1,411.26 |
| Max. Negotiated Rate |
$3,276.65 |
| Rate for Payer: Aetna Commercial |
$1,891.09
|
| Rate for Payer: Aetna Medicare |
$1,467.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,032.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,891.09
|
| Rate for Payer: BCBS Complete |
$2,016.40
|
| Rate for Payer: BCBS MAPPO |
$1,411.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,411.26
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Cofinity Commercial |
$2,032.21
|
| Rate for Payer: Cofinity Commercial |
$1,891.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,411.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,481.82
|
| Rate for Payer: Nomi Health Commercial |
$1,693.51
|
| Rate for Payer: PACE SWMI |
$1,411.26
|
| Rate for Payer: PHP Commercial |
$1,975.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,411.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,276.65
|
| Rate for Payer: Priority Health Medicare |
$1,411.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,411.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,411.26
|
| Rate for Payer: UMR Bronson Commercial |
$2,318.86
|
|
|
PR RPR ATRIAL SEPTAL DFCT SECUNDUM W/BYP W/WO PATCH
|
Professional
|
Both
|
$5,071.00
|
|
|
Service Code
|
HCPCS 33641
|
| Min. Negotiated Rate |
$1,574.01 |
| Max. Negotiated Rate |
$3,296.15 |
| Rate for Payer: Aetna Commercial |
$2,109.17
|
| Rate for Payer: Aetna Medicare |
$1,636.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,266.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,109.17
|
| Rate for Payer: BCBS Complete |
$2,028.40
|
| Rate for Payer: BCBS MAPPO |
$1,574.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,574.01
|
| Rate for Payer: Cash Price |
$4,056.80
|
| Rate for Payer: Cash Price |
$4,056.80
|
| Rate for Payer: Cofinity Commercial |
$2,266.57
|
| Rate for Payer: Cofinity Commercial |
$2,109.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,574.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,652.71
|
| Rate for Payer: Nomi Health Commercial |
$1,888.81
|
| Rate for Payer: PACE SWMI |
$1,574.01
|
| Rate for Payer: PHP Commercial |
$2,203.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,574.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,296.15
|
| Rate for Payer: Priority Health Medicare |
$1,574.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,574.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,574.01
|
| Rate for Payer: UMR Bronson Commercial |
$2,332.66
|
|
|
PR RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL
|
Professional
|
Both
|
$1,139.00
|
|
|
Service Code
|
HCPCS 67903
|
| Min. Negotiated Rate |
$444.24 |
| Max. Negotiated Rate |
$740.35 |
| Rate for Payer: Aetna Commercial |
$595.28
|
| Rate for Payer: Aetna Medicare |
$462.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.28
|
| Rate for Payer: BCBS Complete |
$455.60
|
| Rate for Payer: BCBS MAPPO |
$444.24
|
| Rate for Payer: BCN Medicare Advantage |
$444.24
|
| Rate for Payer: Cash Price |
$911.20
|
| Rate for Payer: Cash Price |
$911.20
|
| Rate for Payer: Cofinity Commercial |
$639.71
|
| Rate for Payer: Cofinity Commercial |
$595.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$466.45
|
| Rate for Payer: Nomi Health Commercial |
$533.09
|
| Rate for Payer: PACE SWMI |
$444.24
|
| Rate for Payer: PHP Commercial |
$621.94
|
| Rate for Payer: PHP Medicare Advantage |
$444.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$740.35
|
| Rate for Payer: Priority Health Medicare |
$444.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$444.24
|
| Rate for Payer: UHC Medicare Advantage |
$444.24
|
| Rate for Payer: UMR Bronson Commercial |
$523.94
|
|
|
PR RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 67904
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$792.17 |
| Rate for Payer: Aetna Commercial |
$737.16
|
| Rate for Payer: Aetna Medicare |
$572.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$792.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$737.16
|
| Rate for Payer: BCBS Complete |
$387.60
|
| Rate for Payer: BCBS MAPPO |
$550.12
|
| Rate for Payer: BCN Medicare Advantage |
$550.12
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$792.17
|
| Rate for Payer: Cofinity Commercial |
$737.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$577.63
|
| Rate for Payer: Nomi Health Commercial |
$660.14
|
| Rate for Payer: PACE SWMI |
$550.12
|
| Rate for Payer: PHP Commercial |
$770.17
|
| Rate for Payer: PHP Medicare Advantage |
$550.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health Medicare |
$550.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$550.12
|
| Rate for Payer: UHC Medicare Advantage |
$550.12
|
| Rate for Payer: UMR Bronson Commercial |
$445.74
|
|
|
PR RPR BLOOD VESSEL DIRECT INTRATHORACIC W/BYPASS
|
Professional
|
Both
|
$2,893.00
|
|
|
Service Code
|
HCPCS 35211
|
| Min. Negotiated Rate |
$1,157.20 |
| Max. Negotiated Rate |
$1,920.14 |
| Rate for Payer: Aetna Commercial |
$1,786.80
|
| Rate for Payer: Aetna Medicare |
$1,386.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,920.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,786.80
|
| Rate for Payer: BCBS Complete |
$1,157.20
|
| Rate for Payer: BCBS MAPPO |
$1,333.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,333.43
|
| Rate for Payer: Cash Price |
$2,314.40
|
| Rate for Payer: Cash Price |
$2,314.40
|
| Rate for Payer: Cofinity Commercial |
$1,920.14
|
| Rate for Payer: Cofinity Commercial |
$1,786.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,333.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,400.10
|
| Rate for Payer: Nomi Health Commercial |
$1,600.12
|
| Rate for Payer: PACE SWMI |
$1,333.43
|
| Rate for Payer: PHP Commercial |
$1,866.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,333.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,880.45
|
| Rate for Payer: Priority Health Medicare |
$1,333.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,333.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,333.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,330.78
|
|
|
PR RPR BLOOD VESSEL DIRECT INTRATHORACIC W/O BYPASS
|
Professional
|
Both
|
$5,326.00
|
|
|
Service Code
|
HCPCS 35216
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$3,461.90 |
| Rate for Payer: Aetna Commercial |
$2,673.30
|
| Rate for Payer: Aetna Medicare |
$2,074.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,872.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,673.30
|
| Rate for Payer: BCBS Complete |
$2,130.40
|
| Rate for Payer: BCBS MAPPO |
$1,995.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,995.00
|
| Rate for Payer: Cash Price |
$4,260.80
|
| Rate for Payer: Cash Price |
$4,260.80
|
| Rate for Payer: Cofinity Commercial |
$2,872.80
|
| Rate for Payer: Cofinity Commercial |
$2,673.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,995.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,094.75
|
| Rate for Payer: Nomi Health Commercial |
$2,394.00
|
| Rate for Payer: PACE SWMI |
$1,995.00
|
| Rate for Payer: PHP Commercial |
$2,793.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,995.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,461.90
|
| Rate for Payer: Priority Health Medicare |
$1,995.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,995.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,995.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,449.96
|
|
|
PR RPR BLOOD VESSEL VEIN GRAFT INTRATHORACIC W/BYP
|
Professional
|
Both
|
$6,519.00
|
|
|
Service Code
|
HCPCS 35241
|
| Min. Negotiated Rate |
$1,371.97 |
| Max. Negotiated Rate |
$4,237.35 |
| Rate for Payer: Aetna Commercial |
$1,838.44
|
| Rate for Payer: Aetna Medicare |
$1,426.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,975.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,838.44
|
| Rate for Payer: BCBS Complete |
$2,607.60
|
| Rate for Payer: BCBS MAPPO |
$1,371.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,371.97
|
| Rate for Payer: Cash Price |
$5,215.20
|
| Rate for Payer: Cash Price |
$5,215.20
|
| Rate for Payer: Cofinity Commercial |
$1,975.64
|
| Rate for Payer: Cofinity Commercial |
$1,838.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,371.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,440.57
|
| Rate for Payer: Nomi Health Commercial |
$1,646.36
|
| Rate for Payer: PACE SWMI |
$1,371.97
|
| Rate for Payer: PHP Commercial |
$1,920.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,371.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,237.35
|
| Rate for Payer: Priority Health Medicare |
$1,371.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,371.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,371.97
|
| Rate for Payer: UMR Bronson Commercial |
$2,998.74
|
|
|
PR RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/BYP
|
Professional
|
Both
|
$6,744.00
|
|
|
Service Code
|
HCPCS 35271
|
| Min. Negotiated Rate |
$1,323.88 |
| Max. Negotiated Rate |
$4,383.60 |
| Rate for Payer: Aetna Commercial |
$1,774.00
|
| Rate for Payer: Aetna Medicare |
$1,376.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,906.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,774.00
|
| Rate for Payer: BCBS Complete |
$2,697.60
|
| Rate for Payer: BCBS MAPPO |
$1,323.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,323.88
|
| Rate for Payer: Cash Price |
$5,395.20
|
| Rate for Payer: Cash Price |
$5,395.20
|
| Rate for Payer: Cofinity Commercial |
$1,906.39
|
| Rate for Payer: Cofinity Commercial |
$1,774.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,323.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,390.07
|
| Rate for Payer: Nomi Health Commercial |
$1,588.66
|
| Rate for Payer: PACE SWMI |
$1,323.88
|
| Rate for Payer: PHP Commercial |
$1,853.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,323.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,383.60
|
| Rate for Payer: Priority Health Medicare |
$1,323.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,323.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,323.88
|
| Rate for Payer: UMR Bronson Commercial |
$3,102.24
|
|
|
PR RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY
|
Professional
|
Both
|
$1,793.00
|
|
|
Service Code
|
HCPCS 35266
|
| Min. Negotiated Rate |
$717.20 |
| Max. Negotiated Rate |
$1,195.50 |
| Rate for Payer: Aetna Commercial |
$1,112.48
|
| Rate for Payer: Aetna Medicare |
$863.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,195.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,112.48
|
| Rate for Payer: BCBS Complete |
$717.20
|
| Rate for Payer: BCBS MAPPO |
$830.21
|
| Rate for Payer: BCN Medicare Advantage |
$830.21
|
| Rate for Payer: Cash Price |
$1,434.40
|
| Rate for Payer: Cash Price |
$1,434.40
|
| Rate for Payer: Cofinity Commercial |
$1,195.50
|
| Rate for Payer: Cofinity Commercial |
$1,112.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$830.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$871.72
|
| Rate for Payer: Nomi Health Commercial |
$996.25
|
| Rate for Payer: PACE SWMI |
$830.21
|
| Rate for Payer: PHP Commercial |
$1,162.29
|
| Rate for Payer: PHP Medicare Advantage |
$830.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.45
|
| Rate for Payer: Priority Health Medicare |
$830.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$830.21
|
| Rate for Payer: UHC Medicare Advantage |
$830.21
|
| Rate for Payer: UMR Bronson Commercial |
$824.78
|
|
|
PR RPR BLVSL W/GRF OTHER/THAN VEIN LOWER EXTREMITY
|
Professional
|
Both
|
$3,792.00
|
|
|
Service Code
|
HCPCS 35286
|
| Min. Negotiated Rate |
$888.62 |
| Max. Negotiated Rate |
$2,464.80 |
| Rate for Payer: Aetna Commercial |
$1,190.75
|
| Rate for Payer: Aetna Medicare |
$924.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,279.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,190.75
|
| Rate for Payer: BCBS Complete |
$1,516.80
|
| Rate for Payer: BCBS MAPPO |
$888.62
|
| Rate for Payer: BCN Medicare Advantage |
$888.62
|
| Rate for Payer: Cash Price |
$3,033.60
|
| Rate for Payer: Cash Price |
$3,033.60
|
| Rate for Payer: Cofinity Commercial |
$1,279.61
|
| Rate for Payer: Cofinity Commercial |
$1,190.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$888.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$933.05
|
| Rate for Payer: Nomi Health Commercial |
$1,066.34
|
| Rate for Payer: PACE SWMI |
$888.62
|
| Rate for Payer: PHP Commercial |
$1,244.07
|
| Rate for Payer: PHP Medicare Advantage |
$888.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,464.80
|
| Rate for Payer: Priority Health Medicare |
$888.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$888.62
|
| Rate for Payer: UHC Medicare Advantage |
$888.62
|
| Rate for Payer: UMR Bronson Commercial |
$1,744.32
|
|
|
PR RPR CLOACAL ANOMALY SACROPERINEAL
|
Professional
|
Both
|
$6,583.00
|
|
|
Service Code
|
HCPCS 46744
|
| Min. Negotiated Rate |
$2,633.20 |
| Max. Negotiated Rate |
$4,946.50 |
| Rate for Payer: Aetna Commercial |
$4,602.99
|
| Rate for Payer: Aetna Medicare |
$3,572.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,946.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,602.99
|
| Rate for Payer: BCBS Complete |
$2,633.20
|
| Rate for Payer: BCBS MAPPO |
$3,435.07
|
| Rate for Payer: BCN Medicare Advantage |
$3,435.07
|
| Rate for Payer: Cash Price |
$5,266.40
|
| Rate for Payer: Cash Price |
$5,266.40
|
| Rate for Payer: Cofinity Commercial |
$4,946.50
|
| Rate for Payer: Cofinity Commercial |
$4,602.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,435.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,606.82
|
| Rate for Payer: Nomi Health Commercial |
$4,122.08
|
| Rate for Payer: PACE SWMI |
$3,435.07
|
| Rate for Payer: PHP Commercial |
$4,809.10
|
| Rate for Payer: PHP Medicare Advantage |
$3,435.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,278.95
|
| Rate for Payer: Priority Health Medicare |
$3,435.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,435.07
|
| Rate for Payer: UHC Medicare Advantage |
$3,435.07
|
| Rate for Payer: UMR Bronson Commercial |
$3,028.18
|
|
|
PR RPR COLTRL LIGM MTCARPHLNGL/IPHAL JT
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 26540
|
| Min. Negotiated Rate |
$655.19 |
| Max. Negotiated Rate |
$1,288.95 |
| Rate for Payer: Aetna Commercial |
$877.95
|
| Rate for Payer: Aetna Medicare |
$681.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$943.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$877.95
|
| Rate for Payer: BCBS Complete |
$793.20
|
| Rate for Payer: BCBS MAPPO |
$655.19
|
| Rate for Payer: BCN Medicare Advantage |
$655.19
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Commercial |
$943.47
|
| Rate for Payer: Cofinity Commercial |
$877.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$655.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$687.95
|
| Rate for Payer: Nomi Health Commercial |
$786.23
|
| Rate for Payer: PACE SWMI |
$655.19
|
| Rate for Payer: PHP Commercial |
$917.27
|
| Rate for Payer: PHP Medicare Advantage |
$655.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.95
|
| Rate for Payer: Priority Health Medicare |
$655.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$655.19
|
| Rate for Payer: UHC Medicare Advantage |
$655.19
|
| Rate for Payer: UMR Bronson Commercial |
$912.18
|
|
|
PR RPR COMPONENT INFLATABLE PENILE PROSTHESIS
|
Professional
|
Both
|
$1,505.00
|
|
|
Service Code
|
HCPCS 54408
|
| Min. Negotiated Rate |
$602.00 |
| Max. Negotiated Rate |
$1,089.48 |
| Rate for Payer: Aetna Commercial |
$1,013.82
|
| Rate for Payer: Aetna Medicare |
$786.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,089.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,013.82
|
| Rate for Payer: BCBS Complete |
$602.00
|
| Rate for Payer: BCBS MAPPO |
$756.58
|
| Rate for Payer: BCN Medicare Advantage |
$756.58
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cofinity Commercial |
$1,089.48
|
| Rate for Payer: Cofinity Commercial |
$1,013.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$756.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$794.41
|
| Rate for Payer: Nomi Health Commercial |
$907.90
|
| Rate for Payer: PACE SWMI |
$756.58
|
| Rate for Payer: PHP Commercial |
$1,059.21
|
| Rate for Payer: PHP Medicare Advantage |
$756.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$978.25
|
| Rate for Payer: Priority Health Medicare |
$756.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$756.58
|
| Rate for Payer: UHC Medicare Advantage |
$756.58
|
| Rate for Payer: UMR Bronson Commercial |
$692.30
|
|
|
PR RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/BYPASS
|
Professional
|
Both
|
$5,809.00
|
|
|
Service Code
|
HCPCS 33500
|
| Min. Negotiated Rate |
$1,492.25 |
| Max. Negotiated Rate |
$3,775.85 |
| Rate for Payer: Aetna Commercial |
$1,999.62
|
| Rate for Payer: Aetna Medicare |
$1,551.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,148.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,999.62
|
| Rate for Payer: BCBS Complete |
$2,323.60
|
| Rate for Payer: BCBS MAPPO |
$1,492.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,492.25
|
| Rate for Payer: Cash Price |
$4,647.20
|
| Rate for Payer: Cash Price |
$4,647.20
|
| Rate for Payer: Cofinity Commercial |
$2,148.84
|
| Rate for Payer: Cofinity Commercial |
$1,999.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,492.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,566.86
|
| Rate for Payer: Nomi Health Commercial |
$1,790.70
|
| Rate for Payer: PACE SWMI |
$1,492.25
|
| Rate for Payer: PHP Commercial |
$2,089.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,492.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,775.85
|
| Rate for Payer: Priority Health Medicare |
$1,492.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,492.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,492.25
|
| Rate for Payer: UMR Bronson Commercial |
$2,672.14
|
|
|
PR RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT
|
Professional
|
Both
|
$852.00
|
|
|
Service Code
|
HCPCS 36576
|
| Min. Negotiated Rate |
$173.57 |
| Max. Negotiated Rate |
$553.80 |
| Rate for Payer: Aetna Commercial |
$232.58
|
| Rate for Payer: Aetna Medicare |
$180.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.58
|
| Rate for Payer: BCBS Complete |
$340.80
|
| Rate for Payer: BCBS MAPPO |
$173.57
|
| Rate for Payer: BCN Medicare Advantage |
$173.57
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cofinity Commercial |
$249.94
|
| Rate for Payer: Cofinity Commercial |
$232.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.25
|
| Rate for Payer: Nomi Health Commercial |
$208.28
|
| Rate for Payer: PACE SWMI |
$173.57
|
| Rate for Payer: PHP Commercial |
$243.00
|
| Rate for Payer: PHP Medicare Advantage |
$173.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.80
|
| Rate for Payer: Priority Health Medicare |
$173.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.57
|
| Rate for Payer: UHC Medicare Advantage |
$173.57
|
| Rate for Payer: UMR Bronson Commercial |
$391.92
|
|
|
PR RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC AQT
|
Professional
|
Both
|
$5,993.00
|
|
|
Service Code
|
HCPCS 39540
|
| Min. Negotiated Rate |
$835.58 |
| Max. Negotiated Rate |
$3,895.45 |
| Rate for Payer: Aetna Commercial |
$1,119.68
|
| Rate for Payer: Aetna Medicare |
$869.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,203.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,119.68
|
| Rate for Payer: BCBS Complete |
$2,397.20
|
| Rate for Payer: BCBS MAPPO |
$835.58
|
| Rate for Payer: BCN Medicare Advantage |
$835.58
|
| Rate for Payer: Cash Price |
$4,794.40
|
| Rate for Payer: Cash Price |
$4,794.40
|
| Rate for Payer: Cofinity Commercial |
$1,203.24
|
| Rate for Payer: Cofinity Commercial |
$1,119.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$835.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$877.36
|
| Rate for Payer: Nomi Health Commercial |
$1,002.70
|
| Rate for Payer: PACE SWMI |
$835.58
|
| Rate for Payer: PHP Commercial |
$1,169.81
|
| Rate for Payer: PHP Medicare Advantage |
$835.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,895.45
|
| Rate for Payer: Priority Health Medicare |
$835.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$835.58
|
| Rate for Payer: UHC Medicare Advantage |
$835.58
|
| Rate for Payer: UMR Bronson Commercial |
$2,756.78
|
|
|
PR RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC CHRNC
|
Professional
|
Both
|
$1,712.00
|
|
|
Service Code
|
HCPCS 39541
|
| Min. Negotiated Rate |
$684.80 |
| Max. Negotiated Rate |
$1,306.90 |
| Rate for Payer: Aetna Commercial |
$1,216.14
|
| Rate for Payer: Aetna Medicare |
$943.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,306.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,216.14
|
| Rate for Payer: BCBS Complete |
$684.80
|
| Rate for Payer: BCBS MAPPO |
$907.57
|
| Rate for Payer: BCN Medicare Advantage |
$907.57
|
| Rate for Payer: Cash Price |
$1,369.60
|
| Rate for Payer: Cash Price |
$1,369.60
|
| Rate for Payer: Cofinity Commercial |
$1,306.90
|
| Rate for Payer: Cofinity Commercial |
$1,216.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$907.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$952.95
|
| Rate for Payer: Nomi Health Commercial |
$1,089.08
|
| Rate for Payer: PACE SWMI |
$907.57
|
| Rate for Payer: PHP Commercial |
$1,270.60
|
| Rate for Payer: PHP Medicare Advantage |
$907.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,112.80
|
| Rate for Payer: Priority Health Medicare |
$907.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$907.57
|
| Rate for Payer: UHC Medicare Advantage |
$907.57
|
| Rate for Payer: UMR Bronson Commercial |
$787.52
|
|
|
PR RPR DISLOC PERONEAL TENDON W/O FIBULAR OSTEOTOMY
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 27675
|
| Min. Negotiated Rate |
$477.80 |
| Max. Negotiated Rate |
$845.65 |
| Rate for Payer: Aetna Commercial |
$640.25
|
| Rate for Payer: Aetna Medicare |
$496.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$688.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$640.25
|
| Rate for Payer: BCBS Complete |
$520.40
|
| Rate for Payer: BCBS MAPPO |
$477.80
|
| Rate for Payer: BCN Medicare Advantage |
$477.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$688.03
|
| Rate for Payer: Cofinity Commercial |
$640.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$477.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$501.69
|
| Rate for Payer: Nomi Health Commercial |
$573.36
|
| Rate for Payer: PACE SWMI |
$477.80
|
| Rate for Payer: PHP Commercial |
$668.92
|
| Rate for Payer: PHP Medicare Advantage |
$477.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health Medicare |
$477.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$477.80
|
| Rate for Payer: UHC Medicare Advantage |
$477.80
|
| Rate for Payer: UMR Bronson Commercial |
$598.46
|
|
