|
PR PROSTECT RETROPUBIC RAD W/WO NRV SPAR W/LYMPH BX
|
Professional
|
Both
|
$4,213.00
|
|
|
Service Code
|
HCPCS 55842
|
| Min. Negotiated Rate |
$1,114.05 |
| Max. Negotiated Rate |
$2,738.45 |
| Rate for Payer: Aetna Commercial |
$1,492.83
|
| Rate for Payer: Aetna Medicare |
$1,158.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,604.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,492.83
|
| Rate for Payer: BCBS Complete |
$1,685.20
|
| Rate for Payer: BCBS MAPPO |
$1,114.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,114.05
|
| Rate for Payer: Cash Price |
$3,370.40
|
| Rate for Payer: Cash Price |
$3,370.40
|
| Rate for Payer: Cofinity Commercial |
$1,604.23
|
| Rate for Payer: Cofinity Commercial |
$1,492.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,114.05
|
| Rate for Payer: Healthscope Commercial |
$1,782.48
|
| Rate for Payer: Healthscope Commercial |
$2,060.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,169.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,738.45
|
| Rate for Payer: Nomi Health Commercial |
$1,336.86
|
| Rate for Payer: PACE SWMI |
$1,114.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,114.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,738.45
|
| Rate for Payer: Priority Health Medicare |
$1,114.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,114.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,114.05
|
|
|
PR PROSTECT RETROPUB RAD W/WO NRV SPAR & BI PLV LYM
|
Professional
|
Both
|
$2,838.00
|
|
|
Service Code
|
HCPCS 55845
|
| Min. Negotiated Rate |
$1,135.20 |
| Max. Negotiated Rate |
$2,401.86 |
| Rate for Payer: Aetna Commercial |
$1,739.72
|
| Rate for Payer: Aetna Medicare |
$1,350.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,869.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,739.72
|
| Rate for Payer: BCBS Complete |
$1,135.20
|
| Rate for Payer: BCBS MAPPO |
$1,298.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,298.30
|
| Rate for Payer: Cash Price |
$2,270.40
|
| Rate for Payer: Cash Price |
$2,270.40
|
| Rate for Payer: Cofinity Commercial |
$1,869.55
|
| Rate for Payer: Cofinity Commercial |
$1,739.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,298.30
|
| Rate for Payer: Healthscope Commercial |
$2,401.86
|
| Rate for Payer: Healthscope Commercial |
$2,077.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,363.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,844.70
|
| Rate for Payer: Nomi Health Commercial |
$1,557.96
|
| Rate for Payer: PACE SWMI |
$1,298.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,298.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,844.70
|
| Rate for Payer: Priority Health Medicare |
$1,298.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,298.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,298.30
|
|
|
PR PROSTHESIS REMOVAL HUMERAL AND GLENOID COMPONENT
|
Professional
|
Both
|
$1,967.00
|
|
|
Service Code
|
HCPCS 23335
|
| Min. Negotiated Rate |
$786.80 |
| Max. Negotiated Rate |
$2,253.98 |
| Rate for Payer: Aetna Commercial |
$1,632.62
|
| Rate for Payer: Aetna Medicare |
$1,267.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,754.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,632.62
|
| Rate for Payer: BCBS Complete |
$786.80
|
| Rate for Payer: BCBS MAPPO |
$1,218.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,218.37
|
| Rate for Payer: Cash Price |
$1,573.60
|
| Rate for Payer: Cash Price |
$1,573.60
|
| Rate for Payer: Cofinity Commercial |
$1,754.45
|
| Rate for Payer: Cofinity Commercial |
$1,632.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,218.37
|
| Rate for Payer: Healthscope Commercial |
$1,949.39
|
| Rate for Payer: Healthscope Commercial |
$2,253.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,279.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,278.55
|
| Rate for Payer: Nomi Health Commercial |
$1,462.04
|
| Rate for Payer: PACE SWMI |
$1,218.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,218.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,278.55
|
| Rate for Payer: Priority Health Medicare |
$1,218.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,218.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,218.37
|
|
|
PR PROSTHESIS REMOVAL HUMERAL AND ULNAR COMPONENTS
|
Professional
|
Both
|
$2,052.00
|
|
|
Service Code
|
HCPCS 24160
|
| Min. Negotiated Rate |
$820.80 |
| Max. Negotiated Rate |
$2,240.74 |
| Rate for Payer: Aetna Commercial |
$1,623.02
|
| Rate for Payer: Aetna Medicare |
$1,259.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,744.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,623.02
|
| Rate for Payer: BCBS Complete |
$820.80
|
| Rate for Payer: BCBS MAPPO |
$1,211.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,211.21
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Cofinity Commercial |
$1,744.14
|
| Rate for Payer: Cofinity Commercial |
$1,623.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,211.21
|
| Rate for Payer: Healthscope Commercial |
$2,240.74
|
| Rate for Payer: Healthscope Commercial |
$1,937.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,271.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.80
|
| Rate for Payer: Nomi Health Commercial |
$1,453.45
|
| Rate for Payer: PACE SWMI |
$1,211.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,211.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,333.80
|
| Rate for Payer: Priority Health Medicare |
$1,211.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,211.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,211.21
|
|
|
PR PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT
|
Professional
|
Both
|
$2,533.00
|
|
|
Service Code
|
HCPCS 23334
|
| Min. Negotiated Rate |
$1,013.20 |
| Max. Negotiated Rate |
$1,894.16 |
| Rate for Payer: Aetna Commercial |
$1,371.99
|
| Rate for Payer: Aetna Medicare |
$1,064.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,474.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,371.99
|
| Rate for Payer: BCBS Complete |
$1,013.20
|
| Rate for Payer: BCBS MAPPO |
$1,023.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,023.87
|
| Rate for Payer: Cash Price |
$2,026.40
|
| Rate for Payer: Cash Price |
$2,026.40
|
| Rate for Payer: Cofinity Commercial |
$1,474.37
|
| Rate for Payer: Cofinity Commercial |
$1,371.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,023.87
|
| Rate for Payer: Healthscope Commercial |
$1,638.19
|
| Rate for Payer: Healthscope Commercial |
$1,894.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,075.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,646.45
|
| Rate for Payer: Nomi Health Commercial |
$1,228.64
|
| Rate for Payer: PACE SWMI |
$1,023.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,023.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,646.45
|
| Rate for Payer: Priority Health Medicare |
$1,023.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,023.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,023.87
|
|
|
PR PROSTHESIS REMOVAL RADIAL HEAD
|
Professional
|
Both
|
$2,287.00
|
|
|
Service Code
|
HCPCS 24164
|
| Min. Negotiated Rate |
$702.11 |
| Max. Negotiated Rate |
$1,486.55 |
| Rate for Payer: Aetna Commercial |
$940.83
|
| Rate for Payer: Aetna Medicare |
$730.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,011.04
|
| Rate for Payer: BCBS Complete |
$914.80
|
| Rate for Payer: BCBS MAPPO |
$702.11
|
| Rate for Payer: BCN Medicare Advantage |
$702.11
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cofinity Commercial |
$940.83
|
| Rate for Payer: Cofinity Commercial |
$1,011.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$702.11
|
| Rate for Payer: Healthscope Commercial |
$1,123.38
|
| Rate for Payer: Healthscope Commercial |
$1,298.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$737.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,486.55
|
| Rate for Payer: Nomi Health Commercial |
$842.53
|
| Rate for Payer: PACE SWMI |
$702.11
|
| Rate for Payer: PHP Medicare Advantage |
$702.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,486.55
|
| Rate for Payer: Priority Health Medicare |
$702.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$702.11
|
| Rate for Payer: UHC Medicare Advantage |
$702.11
|
|
|
PR PROSTHESIS SERVICE APHAKIA TEMPORARY
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 92358
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Aetna Medicare |
$11.00
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
|
|
PR PROTECTOR HEEL OR ELBOW
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS E0191
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
|
|
PR PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS
|
Professional
|
Both
|
$1,398.00
|
|
|
Service Code
|
HCPCS 62267
|
| Min. Negotiated Rate |
$146.06 |
| Max. Negotiated Rate |
$908.70 |
| Rate for Payer: Aetna Commercial |
$195.72
|
| Rate for Payer: Aetna Medicare |
$151.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.72
|
| Rate for Payer: BCBS Complete |
$559.20
|
| Rate for Payer: BCBS MAPPO |
$146.06
|
| Rate for Payer: BCN Medicare Advantage |
$146.06
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cofinity Commercial |
$210.33
|
| Rate for Payer: Cofinity Commercial |
$195.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.06
|
| Rate for Payer: Healthscope Commercial |
$270.21
|
| Rate for Payer: Healthscope Commercial |
$233.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$908.70
|
| Rate for Payer: Nomi Health Commercial |
$175.27
|
| Rate for Payer: PACE SWMI |
$146.06
|
| Rate for Payer: PHP Medicare Advantage |
$146.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$908.70
|
| Rate for Payer: Priority Health Medicare |
$146.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.06
|
| Rate for Payer: UHC Medicare Advantage |
$146.06
|
|
|
PR PRQ BALLOON VALVULOPLASTY AORTIC VALVE
|
Professional
|
Both
|
$2,680.00
|
|
|
Service Code
|
HCPCS 92986
|
| Min. Negotiated Rate |
$1,072.00 |
| Max. Negotiated Rate |
$2,331.31 |
| Rate for Payer: Aetna Commercial |
$1,688.63
|
| Rate for Payer: Aetna Medicare |
$1,310.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,814.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,688.63
|
| Rate for Payer: BCBS Complete |
$1,072.00
|
| Rate for Payer: BCBS MAPPO |
$1,260.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,260.17
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Cofinity Commercial |
$1,814.64
|
| Rate for Payer: Cofinity Commercial |
$1,688.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,260.17
|
| Rate for Payer: Healthscope Commercial |
$2,016.27
|
| Rate for Payer: Healthscope Commercial |
$2,331.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,323.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,742.00
|
| Rate for Payer: Nomi Health Commercial |
$1,512.20
|
| Rate for Payer: PACE SWMI |
$1,260.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,260.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,742.00
|
| Rate for Payer: Priority Health Medicare |
$1,260.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,260.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,260.17
|
|
|
PR PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING
|
Professional
|
Both
|
$1,989.00
|
|
|
Service Code
|
HCPCS 64561
|
| Min. Negotiated Rate |
$289.62 |
| Max. Negotiated Rate |
$1,292.85 |
| Rate for Payer: Aetna Commercial |
$388.09
|
| Rate for Payer: Aetna Medicare |
$301.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.09
|
| Rate for Payer: BCBS Complete |
$795.60
|
| Rate for Payer: BCBS MAPPO |
$289.62
|
| Rate for Payer: BCN Medicare Advantage |
$289.62
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cofinity Commercial |
$417.05
|
| Rate for Payer: Cofinity Commercial |
$388.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.62
|
| Rate for Payer: Healthscope Commercial |
$535.80
|
| Rate for Payer: Healthscope Commercial |
$463.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$304.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,292.85
|
| Rate for Payer: Nomi Health Commercial |
$347.54
|
| Rate for Payer: PACE SWMI |
$289.62
|
| Rate for Payer: PHP Medicare Advantage |
$289.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,292.85
|
| Rate for Payer: Priority Health Medicare |
$289.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.62
|
| Rate for Payer: UHC Medicare Advantage |
$289.62
|
|
|
PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD CRANIAL NERVE
|
Professional
|
Both
|
$454.00
|
|
|
Service Code
|
HCPCS 64553
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$823.77 |
| Rate for Payer: Aetna Commercial |
$596.68
|
| Rate for Payer: Aetna Medicare |
$463.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$596.68
|
| Rate for Payer: BCBS Complete |
$181.60
|
| Rate for Payer: BCBS MAPPO |
$445.28
|
| Rate for Payer: BCN Medicare Advantage |
$445.28
|
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Cofinity Commercial |
$641.20
|
| Rate for Payer: Cofinity Commercial |
$596.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.28
|
| Rate for Payer: Healthscope Commercial |
$712.45
|
| Rate for Payer: Healthscope Commercial |
$823.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.10
|
| Rate for Payer: Nomi Health Commercial |
$534.34
|
| Rate for Payer: PACE SWMI |
$445.28
|
| Rate for Payer: PHP Medicare Advantage |
$445.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.10
|
| Rate for Payer: Priority Health Medicare |
$445.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$445.28
|
| Rate for Payer: UHC Medicare Advantage |
$445.28
|
|
|
PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV
|
Professional
|
Both
|
$498.00
|
|
|
Service Code
|
HCPCS 64555
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$575.35 |
| Rate for Payer: Aetna Commercial |
$416.74
|
| Rate for Payer: Aetna Medicare |
$323.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.74
|
| Rate for Payer: BCBS Complete |
$199.20
|
| Rate for Payer: BCBS MAPPO |
$311.00
|
| Rate for Payer: BCN Medicare Advantage |
$311.00
|
| Rate for Payer: Cash Price |
$398.40
|
| Rate for Payer: Cash Price |
$398.40
|
| Rate for Payer: Cofinity Commercial |
$447.84
|
| Rate for Payer: Cofinity Commercial |
$416.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.00
|
| Rate for Payer: Healthscope Commercial |
$575.35
|
| Rate for Payer: Healthscope Commercial |
$497.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$326.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.70
|
| Rate for Payer: Nomi Health Commercial |
$373.20
|
| Rate for Payer: PACE SWMI |
$311.00
|
| Rate for Payer: PHP Medicare Advantage |
$311.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.70
|
| Rate for Payer: Priority Health Medicare |
$311.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$311.00
|
| Rate for Payer: UHC Medicare Advantage |
$311.00
|
|
|
PR PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL
|
Professional
|
Both
|
$5,346.00
|
|
|
Service Code
|
HCPCS 63650
|
| Min. Negotiated Rate |
$395.29 |
| Max. Negotiated Rate |
$3,474.90 |
| Rate for Payer: Aetna Commercial |
$529.69
|
| Rate for Payer: Aetna Medicare |
$411.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$529.69
|
| Rate for Payer: BCBS Complete |
$2,138.40
|
| Rate for Payer: BCBS MAPPO |
$395.29
|
| Rate for Payer: BCN Medicare Advantage |
$395.29
|
| Rate for Payer: Cash Price |
$4,276.80
|
| Rate for Payer: Cash Price |
$4,276.80
|
| Rate for Payer: Cofinity Commercial |
$569.22
|
| Rate for Payer: Cofinity Commercial |
$529.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$395.29
|
| Rate for Payer: Healthscope Commercial |
$632.46
|
| Rate for Payer: Healthscope Commercial |
$731.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$415.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,474.90
|
| Rate for Payer: Nomi Health Commercial |
$474.35
|
| Rate for Payer: PACE SWMI |
$395.29
|
| Rate for Payer: PHP Medicare Advantage |
$395.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,474.90
|
| Rate for Payer: Priority Health Medicare |
$395.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$395.29
|
| Rate for Payer: UHC Medicare Advantage |
$395.29
|
|
|
PR PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL
|
Professional
|
Both
|
$2,470.00
|
|
|
Service Code
|
HCPCS 47533
|
| Min. Negotiated Rate |
$247.34 |
| Max. Negotiated Rate |
$1,605.50 |
| Rate for Payer: Aetna Commercial |
$331.44
|
| Rate for Payer: Aetna Medicare |
$257.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.44
|
| Rate for Payer: BCBS Complete |
$988.00
|
| Rate for Payer: BCBS MAPPO |
$247.34
|
| Rate for Payer: BCN Medicare Advantage |
$247.34
|
| Rate for Payer: Cash Price |
$1,976.00
|
| Rate for Payer: Cash Price |
$1,976.00
|
| Rate for Payer: Cofinity Commercial |
$356.17
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$247.34
|
| Rate for Payer: Healthscope Commercial |
$457.58
|
| Rate for Payer: Healthscope Commercial |
$395.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$259.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,605.50
|
| Rate for Payer: Nomi Health Commercial |
$296.81
|
| Rate for Payer: PACE SWMI |
$247.34
|
| Rate for Payer: PHP Medicare Advantage |
$247.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,605.50
|
| Rate for Payer: Priority Health Medicare |
$247.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$247.34
|
| Rate for Payer: UHC Medicare Advantage |
$247.34
|
|
|
PR PRQ SKELETAL FIXATION TALUS FRACTURE W/MANJ
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
HCPCS 28436
|
| Min. Negotiated Rate |
$456.80 |
| Max. Negotiated Rate |
$876.01 |
| Rate for Payer: Aetna Commercial |
$634.52
|
| Rate for Payer: Aetna Medicare |
$492.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.52
|
| Rate for Payer: BCBS Complete |
$456.80
|
| Rate for Payer: BCBS MAPPO |
$473.52
|
| Rate for Payer: BCN Medicare Advantage |
$473.52
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cofinity Commercial |
$681.87
|
| Rate for Payer: Cofinity Commercial |
$634.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$473.52
|
| Rate for Payer: Healthscope Commercial |
$757.63
|
| Rate for Payer: Healthscope Commercial |
$876.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$497.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$742.30
|
| Rate for Payer: Nomi Health Commercial |
$568.22
|
| Rate for Payer: PACE SWMI |
$473.52
|
| Rate for Payer: PHP Medicare Advantage |
$473.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$742.30
|
| Rate for Payer: Priority Health Medicare |
$473.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$473.52
|
| Rate for Payer: UHC Medicare Advantage |
$473.52
|
|
|
PR PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE
|
Professional
|
Both
|
$1,659.00
|
|
|
Service Code
|
HCPCS 27756
|
| Min. Negotiated Rate |
$569.25 |
| Max. Negotiated Rate |
$1,078.35 |
| Rate for Payer: Aetna Commercial |
$762.79
|
| Rate for Payer: Aetna Medicare |
$592.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$819.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$762.79
|
| Rate for Payer: BCBS Complete |
$663.60
|
| Rate for Payer: BCBS MAPPO |
$569.25
|
| Rate for Payer: BCN Medicare Advantage |
$569.25
|
| Rate for Payer: Cash Price |
$1,327.20
|
| Rate for Payer: Cash Price |
$1,327.20
|
| Rate for Payer: Cofinity Commercial |
$819.72
|
| Rate for Payer: Cofinity Commercial |
$762.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$569.25
|
| Rate for Payer: Healthscope Commercial |
$910.80
|
| Rate for Payer: Healthscope Commercial |
$1,053.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$597.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,078.35
|
| Rate for Payer: Nomi Health Commercial |
$683.10
|
| Rate for Payer: PACE SWMI |
$569.25
|
| Rate for Payer: PHP Medicare Advantage |
$569.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,078.35
|
| Rate for Payer: Priority Health Medicare |
$569.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$569.25
|
| Rate for Payer: UHC Medicare Advantage |
$569.25
|
|
|
PR PRQ SKELETAL FIX CARPO/METACARPAL FX DISLC THUMB
|
Professional
|
Both
|
$1,540.00
|
|
|
Service Code
|
HCPCS 26650
|
| Min. Negotiated Rate |
$466.36 |
| Max. Negotiated Rate |
$1,001.00 |
| Rate for Payer: Aetna Commercial |
$624.92
|
| Rate for Payer: Aetna Medicare |
$485.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.92
|
| Rate for Payer: BCBS Complete |
$616.00
|
| Rate for Payer: BCBS MAPPO |
$466.36
|
| Rate for Payer: BCN Medicare Advantage |
$466.36
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cofinity Commercial |
$671.56
|
| Rate for Payer: Cofinity Commercial |
$624.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$466.36
|
| Rate for Payer: Healthscope Commercial |
$746.18
|
| Rate for Payer: Healthscope Commercial |
$862.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$489.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,001.00
|
| Rate for Payer: Nomi Health Commercial |
$559.63
|
| Rate for Payer: PACE SWMI |
$466.36
|
| Rate for Payer: PHP Medicare Advantage |
$466.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.00
|
| Rate for Payer: Priority Health Medicare |
$466.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$466.36
|
| Rate for Payer: UHC Medicare Advantage |
$466.36
|
|
|
PR PRQ SKELETAL FIXJ CALCANEAL FRACTURE W/MANJ
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
HCPCS 28406
|
| Min. Negotiated Rate |
$565.75 |
| Max. Negotiated Rate |
$1,046.64 |
| Rate for Payer: Aetna Commercial |
$758.11
|
| Rate for Payer: Aetna Medicare |
$588.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$814.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$758.11
|
| Rate for Payer: BCBS Complete |
$628.40
|
| Rate for Payer: BCBS MAPPO |
$565.75
|
| Rate for Payer: BCN Medicare Advantage |
$565.75
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cofinity Commercial |
$814.68
|
| Rate for Payer: Cofinity Commercial |
$758.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$565.75
|
| Rate for Payer: Healthscope Commercial |
$905.20
|
| Rate for Payer: Healthscope Commercial |
$1,046.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$594.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.15
|
| Rate for Payer: Nomi Health Commercial |
$678.90
|
| Rate for Payer: PACE SWMI |
$565.75
|
| Rate for Payer: PHP Medicare Advantage |
$565.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.15
|
| Rate for Payer: Priority Health Medicare |
$565.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$565.75
|
| Rate for Payer: UHC Medicare Advantage |
$565.75
|
|
|
PR PRQ SKELETAL FIXJ FEMORAL FX DISTAL END
|
Professional
|
Both
|
$2,236.00
|
|
|
Service Code
|
HCPCS 27509
|
| Min. Negotiated Rate |
$647.52 |
| Max. Negotiated Rate |
$1,453.40 |
| Rate for Payer: Aetna Commercial |
$867.68
|
| Rate for Payer: Aetna Medicare |
$673.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$932.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$867.68
|
| Rate for Payer: BCBS Complete |
$894.40
|
| Rate for Payer: BCBS MAPPO |
$647.52
|
| Rate for Payer: BCN Medicare Advantage |
$647.52
|
| Rate for Payer: Cash Price |
$1,788.80
|
| Rate for Payer: Cash Price |
$1,788.80
|
| Rate for Payer: Cofinity Commercial |
$932.43
|
| Rate for Payer: Cofinity Commercial |
$867.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.52
|
| Rate for Payer: Healthscope Commercial |
$1,036.03
|
| Rate for Payer: Healthscope Commercial |
$1,197.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,453.40
|
| Rate for Payer: Nomi Health Commercial |
$777.02
|
| Rate for Payer: PACE SWMI |
$647.52
|
| Rate for Payer: PHP Medicare Advantage |
$647.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,453.40
|
| Rate for Payer: Priority Health Medicare |
$647.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.52
|
| Rate for Payer: UHC Medicare Advantage |
$647.52
|
|
|
PR PRQ SKELETAL FIXJ METACARPAL FX EACH BONE
|
Professional
|
Both
|
$1,540.00
|
|
|
Service Code
|
HCPCS 26608
|
| Min. Negotiated Rate |
$465.04 |
| Max. Negotiated Rate |
$1,001.00 |
| Rate for Payer: Aetna Commercial |
$623.15
|
| Rate for Payer: Aetna Medicare |
$483.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$669.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$623.15
|
| Rate for Payer: BCBS Complete |
$616.00
|
| Rate for Payer: BCBS MAPPO |
$465.04
|
| Rate for Payer: BCN Medicare Advantage |
$465.04
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cofinity Commercial |
$669.66
|
| Rate for Payer: Cofinity Commercial |
$623.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.04
|
| Rate for Payer: Healthscope Commercial |
$860.32
|
| Rate for Payer: Healthscope Commercial |
$744.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$488.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,001.00
|
| Rate for Payer: Nomi Health Commercial |
$558.05
|
| Rate for Payer: PACE SWMI |
$465.04
|
| Rate for Payer: PHP Medicare Advantage |
$465.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.00
|
| Rate for Payer: Priority Health Medicare |
$465.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$465.04
|
| Rate for Payer: UHC Medicare Advantage |
$465.04
|
|
|
PR PRQ SKEL FIXJ CARPO/MTCRPL DISLC THMB MANJ EA JT
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 26676
|
| Min. Negotiated Rate |
$493.20 |
| Max. Negotiated Rate |
$1,072.50 |
| Rate for Payer: Aetna Commercial |
$660.89
|
| Rate for Payer: Aetna Medicare |
$512.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.89
|
| Rate for Payer: BCBS Complete |
$660.00
|
| Rate for Payer: BCBS MAPPO |
$493.20
|
| Rate for Payer: BCN Medicare Advantage |
$493.20
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cofinity Commercial |
$710.21
|
| Rate for Payer: Cofinity Commercial |
$660.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$493.20
|
| Rate for Payer: Healthscope Commercial |
$789.12
|
| Rate for Payer: Healthscope Commercial |
$912.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$517.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,072.50
|
| Rate for Payer: Nomi Health Commercial |
$591.84
|
| Rate for Payer: PACE SWMI |
$493.20
|
| Rate for Payer: PHP Medicare Advantage |
$493.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,072.50
|
| Rate for Payer: Priority Health Medicare |
$493.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$493.20
|
| Rate for Payer: UHC Medicare Advantage |
$493.20
|
|
|
PR PRQ SKEL FIXJ DSTL PHLNGL FX FNGR/THMB EA
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26756
|
| Min. Negotiated Rate |
$409.15 |
| Max. Negotiated Rate |
$756.93 |
| Rate for Payer: Aetna Commercial |
$548.26
|
| Rate for Payer: Aetna Medicare |
$425.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$589.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$548.26
|
| Rate for Payer: BCBS Complete |
$440.00
|
| Rate for Payer: BCBS MAPPO |
$409.15
|
| Rate for Payer: BCN Medicare Advantage |
$409.15
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cofinity Commercial |
$589.18
|
| Rate for Payer: Cofinity Commercial |
$548.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$409.15
|
| Rate for Payer: Healthscope Commercial |
$756.93
|
| Rate for Payer: Healthscope Commercial |
$654.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$429.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.00
|
| Rate for Payer: Nomi Health Commercial |
$490.98
|
| Rate for Payer: PACE SWMI |
$409.15
|
| Rate for Payer: PHP Medicare Advantage |
$409.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$715.00
|
| Rate for Payer: Priority Health Medicare |
$409.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$409.15
|
| Rate for Payer: UHC Medicare Advantage |
$409.15
|
|
|
PR PRQ SKEL FIXJ FEMORAL FX PROX END NECK
|
Professional
|
Both
|
$3,359.00
|
|
|
Service Code
|
HCPCS 27235
|
| Min. Negotiated Rate |
$874.41 |
| Max. Negotiated Rate |
$2,183.35 |
| Rate for Payer: Aetna Commercial |
$1,171.71
|
| Rate for Payer: Aetna Medicare |
$909.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,259.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,171.71
|
| Rate for Payer: BCBS Complete |
$1,343.60
|
| Rate for Payer: BCBS MAPPO |
$874.41
|
| Rate for Payer: BCN Medicare Advantage |
$874.41
|
| Rate for Payer: Cash Price |
$2,687.20
|
| Rate for Payer: Cash Price |
$2,687.20
|
| Rate for Payer: Cofinity Commercial |
$1,259.15
|
| Rate for Payer: Cofinity Commercial |
$1,171.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$874.41
|
| Rate for Payer: Healthscope Commercial |
$1,399.06
|
| Rate for Payer: Healthscope Commercial |
$1,617.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$918.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,183.35
|
| Rate for Payer: Nomi Health Commercial |
$1,049.29
|
| Rate for Payer: PACE SWMI |
$874.41
|
| Rate for Payer: PHP Medicare Advantage |
$874.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,183.35
|
| Rate for Payer: Priority Health Medicare |
$874.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$874.41
|
| Rate for Payer: UHC Medicare Advantage |
$874.41
|
|
|
PR PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MANJ
|
Professional
|
Both
|
$1,122.00
|
|
|
Service Code
|
HCPCS 28496
|
| Min. Negotiated Rate |
$263.12 |
| Max. Negotiated Rate |
$729.30 |
| Rate for Payer: Aetna Commercial |
$352.58
|
| Rate for Payer: Aetna Medicare |
$273.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.58
|
| Rate for Payer: BCBS Complete |
$448.80
|
| Rate for Payer: BCBS MAPPO |
$263.12
|
| Rate for Payer: BCN Medicare Advantage |
$263.12
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cofinity Commercial |
$378.89
|
| Rate for Payer: Cofinity Commercial |
$352.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.12
|
| Rate for Payer: Healthscope Commercial |
$486.77
|
| Rate for Payer: Healthscope Commercial |
$420.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$729.30
|
| Rate for Payer: Nomi Health Commercial |
$315.74
|
| Rate for Payer: PACE SWMI |
$263.12
|
| Rate for Payer: PHP Medicare Advantage |
$263.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.30
|
| Rate for Payer: Priority Health Medicare |
$263.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.12
|
| Rate for Payer: UHC Medicare Advantage |
$263.12
|
|
