|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT NECK
|
Professional
|
Both
|
$1,953.00
|
|
|
Service Code
|
HCPCS 35231
|
| Min. Negotiated Rate |
$692.04 |
| Max. Negotiated Rate |
$2,224.85 |
| Rate for Payer: Aetna Commercial |
$1,444.61
|
| Rate for Payer: Aetna Medicare |
$1,121.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,444.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,552.42
|
| Rate for Payer: BCBS Complete |
$726.64
|
| Rate for Payer: BCBS MAPPO |
$1,078.07
|
| Rate for Payer: BCN Commercial |
$1,858.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,078.07
|
| Rate for Payer: Cash Price |
$1,562.40
|
| Rate for Payer: Cash Price |
$1,562.40
|
| Rate for Payer: Cofinity Commercial |
$1,552.42
|
| Rate for Payer: Cofinity Commercial |
$1,444.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,078.07
|
| Rate for Payer: Healthscope Commercial |
$1,994.43
|
| Rate for Payer: Healthscope Commercial |
$1,724.91
|
| Rate for Payer: Mclaren Medicaid |
$692.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,131.97
|
| Rate for Payer: Meridian Medicaid |
$726.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,185.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,212.16
|
| Rate for Payer: Nomi Health Commercial |
$1,293.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,464.75
|
| Rate for Payer: PACE SWMI |
$1,078.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,078.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$692.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,998.54
|
| Rate for Payer: Priority Health Medicare |
$1,078.07
|
| Rate for Payer: Priority Health SBD |
$1,998.54
|
| Rate for Payer: Priority Health Tiered Network |
$1,998.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,078.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,224.85
|
| Rate for Payer: UHC Core |
$2,224.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,078.07
|
| Rate for Payer: UHC Exchange |
$2,224.85
|
| Rate for Payer: UHC Medicaid |
$692.04
|
| Rate for Payer: UHCCP Medicaid |
$692.04
|
|
|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY
|
Professional
|
Both
|
$3,809.00
|
|
|
Service Code
|
HCPCS 35236
|
| Min. Negotiated Rate |
$584.90 |
| Max. Negotiated Rate |
$2,856.75 |
| Rate for Payer: Aetna Commercial |
$1,231.42
|
| Rate for Payer: Aetna Medicare |
$955.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,231.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,323.32
|
| Rate for Payer: BCBS Complete |
$614.14
|
| Rate for Payer: BCBS MAPPO |
$918.97
|
| Rate for Payer: BCN Commercial |
$1,486.97
|
| Rate for Payer: BCN Medicare Advantage |
$918.97
|
| Rate for Payer: Cash Price |
$3,047.20
|
| Rate for Payer: Cash Price |
$3,047.20
|
| Rate for Payer: Cofinity Commercial |
$1,323.32
|
| Rate for Payer: Cofinity Commercial |
$1,231.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.97
|
| Rate for Payer: Healthscope Commercial |
$1,700.09
|
| Rate for Payer: Healthscope Commercial |
$1,470.35
|
| Rate for Payer: Mclaren Medicaid |
$584.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.92
|
| Rate for Payer: Meridian Medicaid |
$614.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,010.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,763.69
|
| Rate for Payer: Nomi Health Commercial |
$1,102.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,856.75
|
| Rate for Payer: PACE SWMI |
$918.97
|
| Rate for Payer: PHP Medicare Advantage |
$918.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,599.06
|
| Rate for Payer: Priority Health Medicare |
$918.97
|
| Rate for Payer: Priority Health SBD |
$1,599.06
|
| Rate for Payer: Priority Health Tiered Network |
$1,599.06
|
| Rate for Payer: Railroad Medicare Medicare |
$918.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,794.18
|
| Rate for Payer: UHC Core |
$1,794.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$918.97
|
| Rate for Payer: UHC Exchange |
$1,794.18
|
| Rate for Payer: UHC Medicaid |
$584.90
|
| Rate for Payer: UHCCP Medicaid |
$584.90
|
|
|
PR REPAIR BROW PTOSIS
|
Professional
|
Both
|
$1,366.00
|
|
|
Service Code
|
HCPCS 67900
|
| Min. Negotiated Rate |
$276.05 |
| Max. Negotiated Rate |
$1,024.50 |
| Rate for Payer: Aetna Commercial |
$561.29
|
| Rate for Payer: Aetna Medicare |
$435.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$561.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.17
|
| Rate for Payer: BCBS Complete |
$289.85
|
| Rate for Payer: BCBS MAPPO |
$418.87
|
| Rate for Payer: BCN Commercial |
$749.46
|
| Rate for Payer: BCN Medicare Advantage |
$418.87
|
| Rate for Payer: Cash Price |
$1,092.80
|
| Rate for Payer: Cash Price |
$1,092.80
|
| Rate for Payer: Cofinity Commercial |
$603.17
|
| Rate for Payer: Cofinity Commercial |
$561.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$418.87
|
| Rate for Payer: Healthscope Commercial |
$774.91
|
| Rate for Payer: Healthscope Commercial |
$670.19
|
| Rate for Payer: Mclaren Medicaid |
$276.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$439.81
|
| Rate for Payer: Meridian Medicaid |
$289.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$460.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$869.36
|
| Rate for Payer: Nomi Health Commercial |
$502.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,024.50
|
| Rate for Payer: PACE SWMI |
$418.87
|
| Rate for Payer: PHP Medicare Advantage |
$418.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$276.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$877.87
|
| Rate for Payer: Priority Health Medicare |
$418.87
|
| Rate for Payer: Priority Health SBD |
$877.87
|
| Rate for Payer: Priority Health Tiered Network |
$877.87
|
| Rate for Payer: Railroad Medicare Medicare |
$418.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$865.82
|
| Rate for Payer: UHC Core |
$865.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$418.87
|
| Rate for Payer: UHC Exchange |
$865.82
|
| Rate for Payer: UHC Medicaid |
$276.05
|
| Rate for Payer: UHCCP Medicaid |
$276.05
|
|
|
PR REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS
|
Professional
|
Both
|
$7,917.00
|
|
|
Service Code
|
HCPCS 33305
|
| Min. Negotiated Rate |
$2,402.64 |
| Max. Negotiated Rate |
$7,339.55 |
| Rate for Payer: Aetna Commercial |
$5,081.86
|
| Rate for Payer: Aetna Medicare |
$3,944.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,081.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,461.10
|
| Rate for Payer: BCBS Complete |
$2,522.77
|
| Rate for Payer: BCBS MAPPO |
$3,792.43
|
| Rate for Payer: BCN Commercial |
$5,987.23
|
| Rate for Payer: BCN Medicare Advantage |
$3,792.43
|
| Rate for Payer: Cash Price |
$6,333.60
|
| Rate for Payer: Cash Price |
$6,333.60
|
| Rate for Payer: Cofinity Commercial |
$5,461.10
|
| Rate for Payer: Cofinity Commercial |
$5,081.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,792.43
|
| Rate for Payer: Healthscope Commercial |
$7,016.00
|
| Rate for Payer: Healthscope Commercial |
$6,067.89
|
| Rate for Payer: Mclaren Medicaid |
$2,402.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,982.05
|
| Rate for Payer: Meridian Medicaid |
$2,522.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,171.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,236.32
|
| Rate for Payer: Nomi Health Commercial |
$4,550.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,937.75
|
| Rate for Payer: PACE SWMI |
$3,792.43
|
| Rate for Payer: PHP Medicare Advantage |
$3,792.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,402.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,438.50
|
| Rate for Payer: Priority Health Medicare |
$3,792.43
|
| Rate for Payer: Priority Health SBD |
$6,438.50
|
| Rate for Payer: Priority Health Tiered Network |
$6,438.50
|
| Rate for Payer: Railroad Medicare Medicare |
$3,792.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,339.55
|
| Rate for Payer: UHC Core |
$7,339.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,792.43
|
| Rate for Payer: UHC Exchange |
$7,339.55
|
| Rate for Payer: UHC Medicaid |
$2,402.64
|
| Rate for Payer: UHCCP Medicaid |
$2,402.64
|
|
|
PR REPAIR CARDIAC WOUND W/O BYPASS
|
Professional
|
Both
|
$4,735.00
|
|
|
Service Code
|
HCPCS 33300
|
| Min. Negotiated Rate |
$1,446.91 |
| Max. Negotiated Rate |
$4,377.20 |
| Rate for Payer: Aetna Commercial |
$3,051.49
|
| Rate for Payer: Aetna Medicare |
$2,368.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,051.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,279.21
|
| Rate for Payer: BCBS Complete |
$1,519.26
|
| Rate for Payer: BCBS MAPPO |
$2,277.23
|
| Rate for Payer: BCN Commercial |
$3,593.92
|
| Rate for Payer: BCN Medicare Advantage |
$2,277.23
|
| Rate for Payer: Cash Price |
$3,788.00
|
| Rate for Payer: Cash Price |
$3,788.00
|
| Rate for Payer: Cofinity Commercial |
$3,279.21
|
| Rate for Payer: Cofinity Commercial |
$3,051.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,277.23
|
| Rate for Payer: Healthscope Commercial |
$4,212.88
|
| Rate for Payer: Healthscope Commercial |
$3,643.57
|
| Rate for Payer: Mclaren Medicaid |
$1,446.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,391.09
|
| Rate for Payer: Meridian Medicaid |
$1,519.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,504.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,313.20
|
| Rate for Payer: Nomi Health Commercial |
$2,732.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,551.25
|
| Rate for Payer: PACE SWMI |
$2,277.23
|
| Rate for Payer: PHP Medicare Advantage |
$2,277.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,864.82
|
| Rate for Payer: Priority Health Medicare |
$2,277.23
|
| Rate for Payer: Priority Health SBD |
$3,864.82
|
| Rate for Payer: Priority Health Tiered Network |
$3,864.82
|
| Rate for Payer: Railroad Medicare Medicare |
$2,277.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,377.20
|
| Rate for Payer: UHC Core |
$4,377.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,277.23
|
| Rate for Payer: UHC Exchange |
$4,377.20
|
| Rate for Payer: UHC Medicaid |
$1,446.91
|
| Rate for Payer: UHCCP Medicaid |
$1,446.91
|
|
|
PR REPAIR CHOANAL ATRESIA INTRANASAL
|
Professional
|
Both
|
$1,264.00
|
|
|
Service Code
|
HCPCS 30540
|
| Min. Negotiated Rate |
$428.98 |
| Max. Negotiated Rate |
$1,301.33 |
| Rate for Payer: Aetna Commercial |
$863.98
|
| Rate for Payer: Aetna Medicare |
$670.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$863.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$928.45
|
| Rate for Payer: BCBS Complete |
$450.43
|
| Rate for Payer: BCBS MAPPO |
$644.76
|
| Rate for Payer: BCN Commercial |
$1,104.52
|
| Rate for Payer: BCN Medicare Advantage |
$644.76
|
| Rate for Payer: Cash Price |
$1,011.20
|
| Rate for Payer: Cash Price |
$1,011.20
|
| Rate for Payer: Cofinity Commercial |
$928.45
|
| Rate for Payer: Cofinity Commercial |
$863.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.76
|
| Rate for Payer: Healthscope Commercial |
$1,192.81
|
| Rate for Payer: Healthscope Commercial |
$1,031.62
|
| Rate for Payer: Mclaren Medicaid |
$428.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$677.00
|
| Rate for Payer: Meridian Medicaid |
$450.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$709.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,301.33
|
| Rate for Payer: Nomi Health Commercial |
$773.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$948.00
|
| Rate for Payer: PACE SWMI |
$644.76
|
| Rate for Payer: PHP Medicare Advantage |
$644.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$428.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,040.14
|
| Rate for Payer: Priority Health Medicare |
$644.76
|
| Rate for Payer: Priority Health SBD |
$1,040.14
|
| Rate for Payer: Priority Health Tiered Network |
$1,040.14
|
| Rate for Payer: Railroad Medicare Medicare |
$644.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,210.92
|
| Rate for Payer: UHC Core |
$1,210.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$644.76
|
| Rate for Payer: UHC Exchange |
$1,210.92
|
| Rate for Payer: UHC Medicaid |
$428.98
|
| Rate for Payer: UHCCP Medicaid |
$428.98
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 13151
|
| Min. Negotiated Rate |
$148.67 |
| Max. Negotiated Rate |
$717.00 |
| Rate for Payer: Aetna Commercial |
$306.52
|
| Rate for Payer: Aetna Medicare |
$237.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.40
|
| Rate for Payer: BCBS Complete |
$156.10
|
| Rate for Payer: BCBS MAPPO |
$228.75
|
| Rate for Payer: BCN Commercial |
$415.81
|
| Rate for Payer: BCN Medicare Advantage |
$228.75
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cofinity Commercial |
$329.40
|
| Rate for Payer: Cofinity Commercial |
$306.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$228.75
|
| Rate for Payer: Healthscope Commercial |
$423.19
|
| Rate for Payer: Healthscope Commercial |
$366.00
|
| Rate for Payer: Mclaren Medicaid |
$148.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.19
|
| Rate for Payer: Meridian Medicaid |
$156.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$251.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.44
|
| Rate for Payer: Nomi Health Commercial |
$274.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$717.00
|
| Rate for Payer: PACE SWMI |
$228.75
|
| Rate for Payer: PHP Medicare Advantage |
$228.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$380.57
|
| Rate for Payer: Priority Health Medicare |
$228.75
|
| Rate for Payer: Priority Health SBD |
$380.57
|
| Rate for Payer: Priority Health Tiered Network |
$380.57
|
| Rate for Payer: Railroad Medicare Medicare |
$228.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$490.70
|
| Rate for Payer: UHC Core |
$490.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$228.75
|
| Rate for Payer: UHC Exchange |
$490.70
|
| Rate for Payer: UHC Medicaid |
$148.67
|
| Rate for Payer: UHCCP Medicaid |
$148.67
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Professional
|
Both
|
$1,269.00
|
|
|
Service Code
|
HCPCS 13152
|
| Min. Negotiated Rate |
$177.64 |
| Max. Negotiated Rate |
$951.75 |
| Rate for Payer: Aetna Commercial |
$366.99
|
| Rate for Payer: Aetna Medicare |
$284.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$394.37
|
| Rate for Payer: BCBS Complete |
$186.52
|
| Rate for Payer: BCBS MAPPO |
$273.87
|
| Rate for Payer: BCN Commercial |
$499.48
|
| Rate for Payer: BCN Medicare Advantage |
$273.87
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cofinity Commercial |
$394.37
|
| Rate for Payer: Cofinity Commercial |
$366.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.87
|
| Rate for Payer: Healthscope Commercial |
$506.66
|
| Rate for Payer: Healthscope Commercial |
$438.19
|
| Rate for Payer: Mclaren Medicaid |
$177.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$287.56
|
| Rate for Payer: Meridian Medicaid |
$186.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$301.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.88
|
| Rate for Payer: Nomi Health Commercial |
$328.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$951.75
|
| Rate for Payer: PACE SWMI |
$273.87
|
| Rate for Payer: PHP Medicare Advantage |
$273.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$177.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$457.16
|
| Rate for Payer: Priority Health Medicare |
$273.87
|
| Rate for Payer: Priority Health SBD |
$457.16
|
| Rate for Payer: Priority Health Tiered Network |
$457.16
|
| Rate for Payer: Railroad Medicare Medicare |
$273.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$591.20
|
| Rate for Payer: UHC Core |
$591.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$273.87
|
| Rate for Payer: UHC Exchange |
$591.20
|
| Rate for Payer: UHC Medicaid |
$177.64
|
| Rate for Payer: UHCCP Medicaid |
$177.64
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM
|
Professional
|
Both
|
$623.00
|
|
|
Service Code
|
HCPCS 13131
|
| Min. Negotiated Rate |
$130.14 |
| Max. Negotiated Rate |
$467.25 |
| Rate for Payer: Aetna Commercial |
$268.00
|
| Rate for Payer: Aetna Medicare |
$208.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.00
|
| Rate for Payer: BCBS Complete |
$136.65
|
| Rate for Payer: BCBS MAPPO |
$200.00
|
| Rate for Payer: BCN Commercial |
$362.53
|
| Rate for Payer: BCN Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: Cofinity Commercial |
$288.00
|
| Rate for Payer: Cofinity Commercial |
$268.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.00
|
| Rate for Payer: Healthscope Commercial |
$370.00
|
| Rate for Payer: Healthscope Commercial |
$320.00
|
| Rate for Payer: Mclaren Medicaid |
$130.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.00
|
| Rate for Payer: Meridian Medicaid |
$136.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$220.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$422.55
|
| Rate for Payer: Nomi Health Commercial |
$240.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$467.25
|
| Rate for Payer: PACE SWMI |
$200.00
|
| Rate for Payer: PHP Medicare Advantage |
$200.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$331.81
|
| Rate for Payer: Priority Health Medicare |
$200.00
|
| Rate for Payer: Priority Health SBD |
$331.81
|
| Rate for Payer: Priority Health Tiered Network |
$331.81
|
| Rate for Payer: Railroad Medicare Medicare |
$200.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.68
|
| Rate for Payer: UHC Core |
$426.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$200.00
|
| Rate for Payer: UHC Exchange |
$426.68
|
| Rate for Payer: UHC Medicaid |
$130.14
|
| Rate for Payer: UHCCP Medicaid |
$130.14
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Professional
|
Both
|
$1,345.00
|
|
|
Service Code
|
HCPCS 13132
|
| Min. Negotiated Rate |
$160.18 |
| Max. Negotiated Rate |
$1,008.75 |
| Rate for Payer: Aetna Commercial |
$330.36
|
| Rate for Payer: Aetna Medicare |
$256.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.02
|
| Rate for Payer: BCBS Complete |
$168.19
|
| Rate for Payer: BCBS MAPPO |
$246.54
|
| Rate for Payer: BCN Commercial |
$451.17
|
| Rate for Payer: BCN Medicare Advantage |
$246.54
|
| Rate for Payer: Cash Price |
$1,076.00
|
| Rate for Payer: Cash Price |
$1,076.00
|
| Rate for Payer: Cofinity Commercial |
$355.02
|
| Rate for Payer: Cofinity Commercial |
$330.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.54
|
| Rate for Payer: Healthscope Commercial |
$456.10
|
| Rate for Payer: Healthscope Commercial |
$394.46
|
| Rate for Payer: Mclaren Medicaid |
$160.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.87
|
| Rate for Payer: Meridian Medicaid |
$168.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$271.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$529.94
|
| Rate for Payer: Nomi Health Commercial |
$295.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,008.75
|
| Rate for Payer: PACE SWMI |
$246.54
|
| Rate for Payer: PHP Medicare Advantage |
$246.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$412.94
|
| Rate for Payer: Priority Health Medicare |
$246.54
|
| Rate for Payer: Priority Health SBD |
$412.94
|
| Rate for Payer: Priority Health Tiered Network |
$412.94
|
| Rate for Payer: Railroad Medicare Medicare |
$246.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$534.41
|
| Rate for Payer: UHC Core |
$534.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$246.54
|
| Rate for Payer: UHC Exchange |
$534.41
|
| Rate for Payer: UHC Medicaid |
$160.18
|
| Rate for Payer: UHCCP Medicaid |
$160.18
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 13133
|
| Min. Negotiated Rate |
$65.18 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$135.98
|
| Rate for Payer: Aetna Medicare |
$105.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.13
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCBS MAPPO |
$101.48
|
| Rate for Payer: BCN Commercial |
$185.75
|
| Rate for Payer: BCN Medicare Advantage |
$101.48
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cofinity Commercial |
$146.13
|
| Rate for Payer: Cofinity Commercial |
$135.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.48
|
| Rate for Payer: Healthscope Commercial |
$187.74
|
| Rate for Payer: Healthscope Commercial |
$162.37
|
| Rate for Payer: Mclaren Medicaid |
$65.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.55
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.65
|
| Rate for Payer: Nomi Health Commercial |
$121.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.00
|
| Rate for Payer: PACE SWMI |
$101.48
|
| Rate for Payer: PHP Medicare Advantage |
$101.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$170.00
|
| Rate for Payer: Priority Health Medicare |
$101.48
|
| Rate for Payer: Priority Health SBD |
$170.00
|
| Rate for Payer: Priority Health Tiered Network |
$170.00
|
| Rate for Payer: Railroad Medicare Medicare |
$101.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.14
|
| Rate for Payer: UHC Core |
$225.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.48
|
| Rate for Payer: UHC Exchange |
$225.14
|
| Rate for Payer: UHC Medicaid |
$65.18
|
| Rate for Payer: UHCCP Medicaid |
$65.18
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 13120
|
| Min. Negotiated Rate |
$126.52 |
| Max. Negotiated Rate |
$422.25 |
| Rate for Payer: Aetna Commercial |
$258.67
|
| Rate for Payer: Aetna Medicare |
$200.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.98
|
| Rate for Payer: BCBS Complete |
$132.85
|
| Rate for Payer: BCBS MAPPO |
$193.04
|
| Rate for Payer: BCN Commercial |
$345.10
|
| Rate for Payer: BCN Medicare Advantage |
$193.04
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cofinity Commercial |
$277.98
|
| Rate for Payer: Cofinity Commercial |
$258.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.04
|
| Rate for Payer: Healthscope Commercial |
$357.12
|
| Rate for Payer: Healthscope Commercial |
$308.86
|
| Rate for Payer: Mclaren Medicaid |
$126.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$202.69
|
| Rate for Payer: Meridian Medicaid |
$132.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$212.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$404.42
|
| Rate for Payer: Nomi Health Commercial |
$231.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.25
|
| Rate for Payer: PACE SWMI |
$193.04
|
| Rate for Payer: PHP Medicare Advantage |
$193.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$315.85
|
| Rate for Payer: Priority Health Medicare |
$193.04
|
| Rate for Payer: Priority Health SBD |
$315.85
|
| Rate for Payer: Priority Health Tiered Network |
$315.85
|
| Rate for Payer: Railroad Medicare Medicare |
$193.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.07
|
| Rate for Payer: UHC Core |
$403.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$193.04
|
| Rate for Payer: UHC Exchange |
$403.07
|
| Rate for Payer: UHC Medicaid |
$126.52
|
| Rate for Payer: UHCCP Medicaid |
$126.52
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
13121
|
| Min. Negotiated Rate |
$137.39 |
| Max. Negotiated Rate |
$693.75 |
| Rate for Payer: Aetna Commercial |
$283.01
|
| Rate for Payer: Aetna Medicare |
$219.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.13
|
| Rate for Payer: BCBS Complete |
$144.26
|
| Rate for Payer: BCBS MAPPO |
$211.20
|
| Rate for Payer: BCN Commercial |
$385.94
|
| Rate for Payer: BCN Medicare Advantage |
$211.20
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cofinity Commercial |
$304.13
|
| Rate for Payer: Cofinity Commercial |
$283.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.20
|
| Rate for Payer: Healthscope Commercial |
$390.72
|
| Rate for Payer: Healthscope Commercial |
$337.92
|
| Rate for Payer: Mclaren Medicaid |
$137.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$221.76
|
| Rate for Payer: Meridian Medicaid |
$144.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$232.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.57
|
| Rate for Payer: Nomi Health Commercial |
$253.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$693.75
|
| Rate for Payer: PACE SWMI |
$211.20
|
| Rate for Payer: PHP Medicare Advantage |
$211.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$353.24
|
| Rate for Payer: Priority Health Medicare |
$211.20
|
| Rate for Payer: Priority Health SBD |
$353.24
|
| Rate for Payer: Priority Health Tiered Network |
$353.24
|
| Rate for Payer: Railroad Medicare Medicare |
$211.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$454.56
|
| Rate for Payer: UHC Core |
$454.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.20
|
| Rate for Payer: UHC Exchange |
$454.56
|
| Rate for Payer: UHC Medicaid |
$137.39
|
| Rate for Payer: UHCCP Medicaid |
$137.39
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$582.75 |
| Max. Negotiated Rate |
$832.50 |
| Rate for Payer: Aetna Commercial |
$786.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.25
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cofinity Advantage |
$647.50
|
| Rate for Payer: Cofinity Commercial |
$795.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.00
|
| Rate for Payer: Healthscope Commercial |
$832.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$786.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$693.75
|
| Rate for Payer: PHP Commercial |
$786.25
|
| Rate for Payer: Priority Health SBD |
$582.75
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$786.25
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$478.99
|
| Rate for Payer: BCN Commercial |
$478.99
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cofinity Advantage |
$647.50
|
| Rate for Payer: Cofinity Commercial |
$795.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$832.50
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$786.25
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$693.75
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$786.25
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$582.75
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 13121
|
| Min. Negotiated Rate |
$137.39 |
| Max. Negotiated Rate |
$693.75 |
| Rate for Payer: Aetna Commercial |
$283.01
|
| Rate for Payer: Aetna Medicare |
$219.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.13
|
| Rate for Payer: BCBS Complete |
$144.26
|
| Rate for Payer: BCBS MAPPO |
$211.20
|
| Rate for Payer: BCN Commercial |
$385.94
|
| Rate for Payer: BCN Medicare Advantage |
$211.20
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cofinity Commercial |
$304.13
|
| Rate for Payer: Cofinity Commercial |
$283.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.20
|
| Rate for Payer: Healthscope Commercial |
$390.72
|
| Rate for Payer: Healthscope Commercial |
$337.92
|
| Rate for Payer: Mclaren Medicaid |
$137.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$221.76
|
| Rate for Payer: Meridian Medicaid |
$144.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$232.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.57
|
| Rate for Payer: Nomi Health Commercial |
$253.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$693.75
|
| Rate for Payer: PACE SWMI |
$211.20
|
| Rate for Payer: PHP Medicare Advantage |
$211.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$353.24
|
| Rate for Payer: Priority Health Medicare |
$211.20
|
| Rate for Payer: Priority Health SBD |
$353.24
|
| Rate for Payer: Priority Health Tiered Network |
$353.24
|
| Rate for Payer: Railroad Medicare Medicare |
$211.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$454.56
|
| Rate for Payer: UHC Core |
$454.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.20
|
| Rate for Payer: UHC Exchange |
$454.56
|
| Rate for Payer: UHC Medicaid |
$137.39
|
| Rate for Payer: UHCCP Medicaid |
$137.39
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$1,025.27 |
| Rate for Payer: Aetna Commercial |
$245.65
|
| Rate for Payer: Aetna Medicare |
$144.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.85
|
| Rate for Payer: BCBS Complete |
$115.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,025.27
|
| Rate for Payer: BCN Commercial |
$1,025.27
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cofinity Advantage |
$202.30
|
| Rate for Payer: Cofinity Commercial |
$248.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.20
|
| Rate for Payer: Healthscope Commercial |
$260.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
| Rate for Payer: PHP Commercial |
$245.65
|
| Rate for Payer: Priority Health SBD |
$182.07
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 13122
|
| Min. Negotiated Rate |
$43.24 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: PHP Medicare Advantage |
$67.49
|
| Rate for Payer: Aetna Commercial |
$90.44
|
| Rate for Payer: Aetna Medicare |
$70.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.19
|
| Rate for Payer: BCBS Complete |
$45.40
|
| Rate for Payer: BCBS MAPPO |
$67.49
|
| Rate for Payer: BCN Commercial |
$122.01
|
| Rate for Payer: BCN Medicare Advantage |
$67.49
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cofinity Commercial |
$97.19
|
| Rate for Payer: Cofinity Commercial |
$90.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.49
|
| Rate for Payer: Healthscope Commercial |
$124.86
|
| Rate for Payer: Healthscope Commercial |
$107.98
|
| Rate for Payer: Mclaren Medicaid |
$43.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.86
|
| Rate for Payer: Meridian Medicaid |
$45.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.18
|
| Rate for Payer: Nomi Health Commercial |
$80.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
| Rate for Payer: PACE SWMI |
$67.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$111.67
|
| Rate for Payer: Priority Health Medicare |
$67.49
|
| Rate for Payer: Priority Health SBD |
$111.67
|
| Rate for Payer: Priority Health Tiered Network |
$111.67
|
| Rate for Payer: Railroad Medicare Medicare |
$67.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.74
|
| Rate for Payer: UHC Core |
$147.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$67.49
|
| Rate for Payer: UHC Exchange |
$147.74
|
| Rate for Payer: UHC Medicaid |
$43.24
|
| Rate for Payer: UHCCP Medicaid |
$43.24
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$182.07 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Aetna Commercial |
$245.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.85
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cofinity Advantage |
$202.30
|
| Rate for Payer: Cofinity Commercial |
$248.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.20
|
| Rate for Payer: Healthscope Commercial |
$260.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
| Rate for Payer: PHP Commercial |
$245.65
|
| Rate for Payer: Priority Health SBD |
$182.07
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 13122
|
| Hospital Charge Code |
13122
|
| Min. Negotiated Rate |
$43.24 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Aetna Commercial |
$90.44
|
| Rate for Payer: Aetna Medicare |
$70.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.19
|
| Rate for Payer: BCBS Complete |
$45.40
|
| Rate for Payer: BCBS MAPPO |
$67.49
|
| Rate for Payer: BCN Commercial |
$122.01
|
| Rate for Payer: BCN Medicare Advantage |
$67.49
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cofinity Commercial |
$97.19
|
| Rate for Payer: Cofinity Commercial |
$90.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.49
|
| Rate for Payer: Healthscope Commercial |
$124.86
|
| Rate for Payer: Healthscope Commercial |
$107.98
|
| Rate for Payer: Mclaren Medicaid |
$43.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.86
|
| Rate for Payer: Meridian Medicaid |
$45.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.18
|
| Rate for Payer: Nomi Health Commercial |
$80.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
| Rate for Payer: PACE SWMI |
$67.49
|
| Rate for Payer: PHP Medicare Advantage |
$67.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$111.67
|
| Rate for Payer: Priority Health Medicare |
$67.49
|
| Rate for Payer: Priority Health SBD |
$111.67
|
| Rate for Payer: Priority Health Tiered Network |
$111.67
|
| Rate for Payer: Railroad Medicare Medicare |
$67.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.74
|
| Rate for Payer: UHC Core |
$147.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$67.49
|
| Rate for Payer: UHC Exchange |
$147.74
|
| Rate for Payer: UHC Medicaid |
$43.24
|
| Rate for Payer: UHCCP Medicaid |
$43.24
|
|
|
PR REPAIR COMPLEX TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$569.00
|
|
|
Service Code
|
HCPCS 13100
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$426.75 |
| Rate for Payer: Aetna Commercial |
$224.52
|
| Rate for Payer: Aetna Medicare |
$174.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.27
|
| Rate for Payer: BCBS Complete |
$114.73
|
| Rate for Payer: BCBS MAPPO |
$167.55
|
| Rate for Payer: BCN Commercial |
$300.78
|
| Rate for Payer: BCN Medicare Advantage |
$167.55
|
| Rate for Payer: Cash Price |
$455.20
|
| Rate for Payer: Cash Price |
$455.20
|
| Rate for Payer: Cofinity Commercial |
$241.27
|
| Rate for Payer: Cofinity Commercial |
$224.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.55
|
| Rate for Payer: Healthscope Commercial |
$309.97
|
| Rate for Payer: Healthscope Commercial |
$268.08
|
| Rate for Payer: Mclaren Medicaid |
$109.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.93
|
| Rate for Payer: Meridian Medicaid |
$114.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$184.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.64
|
| Rate for Payer: Nomi Health Commercial |
$201.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$426.75
|
| Rate for Payer: PACE SWMI |
$167.55
|
| Rate for Payer: PHP Medicare Advantage |
$167.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$275.29
|
| Rate for Payer: Priority Health Medicare |
$167.55
|
| Rate for Payer: Priority Health SBD |
$275.29
|
| Rate for Payer: Priority Health Tiered Network |
$275.29
|
| Rate for Payer: Railroad Medicare Medicare |
$167.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.69
|
| Rate for Payer: UHC Core |
$351.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$167.55
|
| Rate for Payer: UHC Exchange |
$351.69
|
| Rate for Payer: UHC Medicaid |
$109.27
|
| Rate for Payer: UHCCP Medicaid |
$109.27
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$133.98 |
| Max. Negotiated Rate |
$514.50 |
| Rate for Payer: Aetna Commercial |
$274.18
|
| Rate for Payer: Aetna Medicare |
$212.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.64
|
| Rate for Payer: BCBS Complete |
$140.68
|
| Rate for Payer: BCBS MAPPO |
$204.61
|
| Rate for Payer: BCN Commercial |
$368.50
|
| Rate for Payer: BCN Medicare Advantage |
$204.61
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$274.18
|
| Rate for Payer: Cofinity Commercial |
$294.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.61
|
| Rate for Payer: Healthscope Commercial |
$378.53
|
| Rate for Payer: Healthscope Commercial |
$327.38
|
| Rate for Payer: Mclaren Medicaid |
$133.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$214.84
|
| Rate for Payer: Meridian Medicaid |
$140.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$225.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$430.99
|
| Rate for Payer: Nomi Health Commercial |
$245.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$514.50
|
| Rate for Payer: PACE SWMI |
$204.61
|
| Rate for Payer: PHP Medicare Advantage |
$204.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$337.27
|
| Rate for Payer: Priority Health Medicare |
$204.61
|
| Rate for Payer: Priority Health SBD |
$337.27
|
| Rate for Payer: Priority Health Tiered Network |
$337.27
|
| Rate for Payer: Railroad Medicare Medicare |
$204.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.00
|
| Rate for Payer: UHC Core |
$431.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$204.61
|
| Rate for Payer: UHC Exchange |
$431.00
|
| Rate for Payer: UHC Medicaid |
$133.98
|
| Rate for Payer: UHCCP Medicaid |
$133.98
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
13101
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$432.18 |
| Max. Negotiated Rate |
$617.40 |
| Rate for Payer: Aetna Commercial |
$583.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.90
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Advantage |
$480.20
|
| Rate for Payer: Cofinity Commercial |
$589.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.80
|
| Rate for Payer: Healthscope Commercial |
$617.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$514.50
|
| Rate for Payer: PHP Commercial |
$583.10
|
| Rate for Payer: Priority Health SBD |
$432.18
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
13101
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$2,381.49 |
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: Aetna Commercial |
$583.10
|
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$478.99
|
| Rate for Payer: BCN Commercial |
$478.99
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Advantage |
$480.20
|
| Rate for Payer: Cofinity Commercial |
$589.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$617.40
|
| Rate for Payer: Mclaren Medicaid |
$385.14
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.10
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$514.50
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$583.10
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health SBD |
$432.18
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 13101
|
| Min. Negotiated Rate |
$133.98 |
| Max. Negotiated Rate |
$514.50 |
| Rate for Payer: Aetna Commercial |
$274.18
|
| Rate for Payer: Aetna Medicare |
$212.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.64
|
| Rate for Payer: BCBS Complete |
$140.68
|
| Rate for Payer: BCBS MAPPO |
$204.61
|
| Rate for Payer: BCN Commercial |
$368.50
|
| Rate for Payer: BCN Medicare Advantage |
$204.61
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$294.64
|
| Rate for Payer: Cofinity Commercial |
$274.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.61
|
| Rate for Payer: Healthscope Commercial |
$378.53
|
| Rate for Payer: Healthscope Commercial |
$327.38
|
| Rate for Payer: Mclaren Medicaid |
$133.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$214.84
|
| Rate for Payer: Meridian Medicaid |
$140.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$225.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$430.99
|
| Rate for Payer: Nomi Health Commercial |
$245.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$514.50
|
| Rate for Payer: PACE SWMI |
$204.61
|
| Rate for Payer: PHP Medicare Advantage |
$204.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$337.27
|
| Rate for Payer: Priority Health Medicare |
$204.61
|
| Rate for Payer: Priority Health SBD |
$337.27
|
| Rate for Payer: Priority Health Tiered Network |
$337.27
|
| Rate for Payer: Railroad Medicare Medicare |
$204.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.00
|
| Rate for Payer: UHC Core |
$431.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$204.61
|
| Rate for Payer: UHC Exchange |
$431.00
|
| Rate for Payer: UHC Medicaid |
$133.98
|
| Rate for Payer: UHCCP Medicaid |
$133.98
|
|
