|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
13102
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$135.45 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna Commercial |
$182.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.75
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Advantage |
$150.50
|
| Rate for Payer: Cofinity Commercial |
$184.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
| Rate for Payer: Healthscope Commercial |
$193.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.25
|
| Rate for Payer: PHP Commercial |
$182.75
|
| Rate for Payer: Priority Health SBD |
$135.45
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 13102
|
| Min. Negotiated Rate |
$38.13 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Aetna Commercial |
$79.80
|
| Rate for Payer: Aetna Medicare |
$61.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.75
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCBS MAPPO |
$59.55
|
| Rate for Payer: BCN Commercial |
$106.57
|
| Rate for Payer: BCN Medicare Advantage |
$59.55
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$85.75
|
| Rate for Payer: Cofinity Commercial |
$79.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.55
|
| Rate for Payer: Healthscope Commercial |
$95.28
|
| Rate for Payer: Healthscope Commercial |
$110.17
|
| Rate for Payer: Mclaren Medicaid |
$38.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.53
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.45
|
| Rate for Payer: Nomi Health Commercial |
$71.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.25
|
| Rate for Payer: PACE SWMI |
$59.55
|
| Rate for Payer: PHP Medicare Advantage |
$59.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$97.54
|
| Rate for Payer: Priority Health Medicare |
$59.55
|
| Rate for Payer: Priority Health SBD |
$97.54
|
| Rate for Payer: Priority Health Tiered Network |
$97.54
|
| Rate for Payer: Railroad Medicare Medicare |
$59.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.24
|
| Rate for Payer: UHC Core |
$128.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$59.55
|
| Rate for Payer: UHC Exchange |
$128.24
|
| Rate for Payer: UHC Medicaid |
$38.13
|
| Rate for Payer: UHCCP Medicaid |
$38.13
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
13102
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$320.44 |
| Rate for Payer: Aetna Commercial |
$182.75
|
| Rate for Payer: Aetna Medicare |
$107.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.75
|
| Rate for Payer: BCBS Complete |
$86.00
|
| Rate for Payer: BCBS Trust/PPO |
$320.44
|
| Rate for Payer: BCN Commercial |
$320.44
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Advantage |
$150.50
|
| Rate for Payer: Cofinity Commercial |
$184.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
| Rate for Payer: Healthscope Commercial |
$193.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.25
|
| Rate for Payer: PHP Commercial |
$182.75
|
| Rate for Payer: Priority Health SBD |
$135.45
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$38.13 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Aetna Commercial |
$79.80
|
| Rate for Payer: Aetna Medicare |
$61.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.75
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCBS MAPPO |
$59.55
|
| Rate for Payer: BCN Commercial |
$106.57
|
| Rate for Payer: BCN Medicare Advantage |
$59.55
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$85.75
|
| Rate for Payer: Cofinity Commercial |
$79.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.55
|
| Rate for Payer: Healthscope Commercial |
$95.28
|
| Rate for Payer: Healthscope Commercial |
$110.17
|
| Rate for Payer: Mclaren Medicaid |
$38.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.53
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.45
|
| Rate for Payer: Nomi Health Commercial |
$71.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.25
|
| Rate for Payer: PACE SWMI |
$59.55
|
| Rate for Payer: PHP Medicare Advantage |
$59.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$97.54
|
| Rate for Payer: Priority Health Medicare |
$59.55
|
| Rate for Payer: Priority Health SBD |
$97.54
|
| Rate for Payer: Priority Health Tiered Network |
$97.54
|
| Rate for Payer: Railroad Medicare Medicare |
$59.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.24
|
| Rate for Payer: UHC Core |
$128.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$59.55
|
| Rate for Payer: UHC Exchange |
$128.24
|
| Rate for Payer: UHC Medicaid |
$38.13
|
| Rate for Payer: UHCCP Medicaid |
$38.13
|
|
|
PR REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 13153
|
| Min. Negotiated Rate |
$72.42 |
| Max. Negotiated Rate |
$365.25 |
| Rate for Payer: Aetna Commercial |
$151.45
|
| Rate for Payer: Aetna Medicare |
$117.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.75
|
| Rate for Payer: BCBS Complete |
$76.04
|
| Rate for Payer: BCBS MAPPO |
$113.02
|
| Rate for Payer: BCN Commercial |
$204.18
|
| Rate for Payer: BCN Medicare Advantage |
$113.02
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cofinity Commercial |
$162.75
|
| Rate for Payer: Cofinity Commercial |
$151.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.02
|
| Rate for Payer: Healthscope Commercial |
$209.09
|
| Rate for Payer: Healthscope Commercial |
$180.83
|
| Rate for Payer: Mclaren Medicaid |
$72.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.67
|
| Rate for Payer: Meridian Medicaid |
$76.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$124.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.60
|
| Rate for Payer: Nomi Health Commercial |
$135.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$365.25
|
| Rate for Payer: PACE SWMI |
$113.02
|
| Rate for Payer: PHP Medicare Advantage |
$113.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$186.87
|
| Rate for Payer: Priority Health Medicare |
$113.02
|
| Rate for Payer: Priority Health SBD |
$186.87
|
| Rate for Payer: Priority Health Tiered Network |
$186.87
|
| Rate for Payer: Railroad Medicare Medicare |
$113.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.48
|
| Rate for Payer: UHC Core |
$245.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$113.02
|
| Rate for Payer: UHC Exchange |
$245.48
|
| Rate for Payer: UHC Medicaid |
$72.42
|
| Rate for Payer: UHCCP Medicaid |
$72.42
|
|
|
PR REPAIR CONGENITAL AV FISTULA EXTREMITIES
|
Professional
|
Both
|
$4,350.00
|
|
|
Service Code
|
HCPCS 35184
|
| Min. Negotiated Rate |
$561.04 |
| Max. Negotiated Rate |
$3,262.50 |
| Rate for Payer: Aetna Commercial |
$1,193.14
|
| Rate for Payer: Aetna Medicare |
$926.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,193.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,282.18
|
| Rate for Payer: BCBS Complete |
$589.09
|
| Rate for Payer: BCBS MAPPO |
$890.40
|
| Rate for Payer: BCN Commercial |
$1,413.27
|
| Rate for Payer: BCN Medicare Advantage |
$890.40
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Cofinity Commercial |
$1,282.18
|
| Rate for Payer: Cofinity Commercial |
$1,193.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$890.40
|
| Rate for Payer: Healthscope Commercial |
$1,647.24
|
| Rate for Payer: Healthscope Commercial |
$1,424.64
|
| Rate for Payer: Mclaren Medicaid |
$561.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$934.92
|
| Rate for Payer: Meridian Medicaid |
$589.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$979.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,713.42
|
| Rate for Payer: Nomi Health Commercial |
$1,068.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,262.50
|
| Rate for Payer: PACE SWMI |
$890.40
|
| Rate for Payer: PHP Medicare Advantage |
$890.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$561.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,519.79
|
| Rate for Payer: Priority Health Medicare |
$890.40
|
| Rate for Payer: Priority Health SBD |
$1,519.79
|
| Rate for Payer: Priority Health Tiered Network |
$1,519.79
|
| Rate for Payer: Railroad Medicare Medicare |
$890.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,732.50
|
| Rate for Payer: UHC Core |
$1,732.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$890.40
|
| Rate for Payer: UHC Exchange |
$1,732.50
|
| Rate for Payer: UHC Medicaid |
$561.04
|
| Rate for Payer: UHCCP Medicaid |
$561.04
|
|
|
PR REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA
|
Professional
|
Both
|
$2,010.00
|
|
|
Service Code
|
HCPCS 25425
|
| Min. Negotiated Rate |
$568.28 |
| Max. Negotiated Rate |
$1,712.07 |
| Rate for Payer: Aetna Commercial |
$1,169.89
|
| Rate for Payer: Aetna Medicare |
$907.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,169.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,257.19
|
| Rate for Payer: BCBS Complete |
$596.69
|
| Rate for Payer: BCBS MAPPO |
$873.05
|
| Rate for Payer: BCN Commercial |
$1,464.57
|
| Rate for Payer: BCN Medicare Advantage |
$873.05
|
| Rate for Payer: Cash Price |
$1,608.00
|
| Rate for Payer: Cash Price |
$1,608.00
|
| Rate for Payer: Cofinity Commercial |
$1,257.19
|
| Rate for Payer: Cofinity Commercial |
$1,169.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$873.05
|
| Rate for Payer: Healthscope Commercial |
$1,615.14
|
| Rate for Payer: Healthscope Commercial |
$1,396.88
|
| Rate for Payer: Mclaren Medicaid |
$568.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$916.70
|
| Rate for Payer: Meridian Medicaid |
$596.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$960.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,712.07
|
| Rate for Payer: Nomi Health Commercial |
$1,047.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,507.50
|
| Rate for Payer: PACE SWMI |
$873.05
|
| Rate for Payer: PHP Medicare Advantage |
$873.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$568.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,565.57
|
| Rate for Payer: Priority Health Medicare |
$873.05
|
| Rate for Payer: Priority Health SBD |
$1,565.57
|
| Rate for Payer: Priority Health Tiered Network |
$1,565.57
|
| Rate for Payer: Railroad Medicare Medicare |
$873.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,687.28
|
| Rate for Payer: UHC Core |
$1,687.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$873.05
|
| Rate for Payer: UHC Exchange |
$1,687.28
|
| Rate for Payer: UHC Medicaid |
$568.28
|
| Rate for Payer: UHCCP Medicaid |
$568.28
|
|
|
PR REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT
|
Professional
|
Both
|
$2,234.00
|
|
|
Service Code
|
HCPCS 27676
|
| Min. Negotiated Rate |
$366.15 |
| Max. Negotiated Rate |
$1,675.50 |
| Rate for Payer: PHP Medicare Advantage |
$559.62
|
| Rate for Payer: Aetna Commercial |
$749.89
|
| Rate for Payer: Aetna Medicare |
$582.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$749.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.85
|
| Rate for Payer: BCBS Complete |
$384.46
|
| Rate for Payer: BCBS MAPPO |
$559.62
|
| Rate for Payer: BCN Commercial |
$929.73
|
| Rate for Payer: BCN Medicare Advantage |
$559.62
|
| Rate for Payer: Cash Price |
$1,787.20
|
| Rate for Payer: Cash Price |
$1,787.20
|
| Rate for Payer: Cofinity Commercial |
$805.85
|
| Rate for Payer: Cofinity Commercial |
$749.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$559.62
|
| Rate for Payer: Healthscope Commercial |
$895.39
|
| Rate for Payer: Healthscope Commercial |
$1,035.30
|
| Rate for Payer: Mclaren Medicaid |
$366.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$587.60
|
| Rate for Payer: Meridian Medicaid |
$384.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$615.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,073.29
|
| Rate for Payer: Nomi Health Commercial |
$671.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,675.50
|
| Rate for Payer: PACE SWMI |
$559.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$366.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$993.86
|
| Rate for Payer: Priority Health Medicare |
$559.62
|
| Rate for Payer: Priority Health SBD |
$993.86
|
| Rate for Payer: Priority Health Tiered Network |
$993.86
|
| Rate for Payer: Railroad Medicare Medicare |
$559.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,044.82
|
| Rate for Payer: UHC Core |
$1,044.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$559.62
|
| Rate for Payer: UHC Exchange |
$1,044.82
|
| Rate for Payer: UHC Medicaid |
$366.15
|
| Rate for Payer: UHCCP Medicaid |
$366.15
|
|
|
PR REPAIR ECTROPION EXTENSIVE
|
Professional
|
Both
|
$1,288.00
|
|
|
Service Code
|
HCPCS 67917
|
| Min. Negotiated Rate |
$250.06 |
| Max. Negotiated Rate |
$966.00 |
| Rate for Payer: Aetna Commercial |
$506.88
|
| Rate for Payer: Aetna Medicare |
$393.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$506.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$544.71
|
| Rate for Payer: BCBS Complete |
$262.56
|
| Rate for Payer: BCBS MAPPO |
$378.27
|
| Rate for Payer: BCN Commercial |
$676.75
|
| Rate for Payer: BCN Medicare Advantage |
$378.27
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cofinity Commercial |
$544.71
|
| Rate for Payer: Cofinity Commercial |
$506.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.27
|
| Rate for Payer: Healthscope Commercial |
$699.80
|
| Rate for Payer: Healthscope Commercial |
$605.23
|
| Rate for Payer: Mclaren Medicaid |
$250.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.18
|
| Rate for Payer: Meridian Medicaid |
$262.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$416.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.86
|
| Rate for Payer: Nomi Health Commercial |
$453.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$966.00
|
| Rate for Payer: PACE SWMI |
$378.27
|
| Rate for Payer: PHP Medicare Advantage |
$378.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$250.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$792.72
|
| Rate for Payer: Priority Health Medicare |
$378.27
|
| Rate for Payer: Priority Health SBD |
$792.72
|
| Rate for Payer: Priority Health Tiered Network |
$792.72
|
| Rate for Payer: Railroad Medicare Medicare |
$378.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$777.12
|
| Rate for Payer: UHC Core |
$777.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$378.27
|
| Rate for Payer: UHC Exchange |
$777.12
|
| Rate for Payer: UHC Medicaid |
$250.06
|
| Rate for Payer: UHCCP Medicaid |
$250.06
|
|
|
PR REPAIR ENTEROCELE ABDOMINAL APPROACH SPX
|
Professional
|
Both
|
$2,125.00
|
|
|
Service Code
|
HCPCS 57270
|
| Min. Negotiated Rate |
$459.65 |
| Max. Negotiated Rate |
$1,593.75 |
| Rate for Payer: Aetna Commercial |
$955.97
|
| Rate for Payer: Aetna Medicare |
$741.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,027.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$955.97
|
| Rate for Payer: BCBS Complete |
$482.63
|
| Rate for Payer: BCBS MAPPO |
$713.41
|
| Rate for Payer: BCN Commercial |
$1,217.06
|
| Rate for Payer: BCN Medicare Advantage |
$713.41
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cofinity Commercial |
$955.97
|
| Rate for Payer: Cofinity Commercial |
$1,027.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$713.41
|
| Rate for Payer: Healthscope Commercial |
$1,319.81
|
| Rate for Payer: Healthscope Commercial |
$1,141.46
|
| Rate for Payer: Mclaren Medicaid |
$459.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$749.08
|
| Rate for Payer: Meridian Medicaid |
$482.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$784.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,453.88
|
| Rate for Payer: Nomi Health Commercial |
$856.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,593.75
|
| Rate for Payer: PACE SWMI |
$713.41
|
| Rate for Payer: PHP Medicare Advantage |
$713.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,232.63
|
| Rate for Payer: Priority Health Medicare |
$713.41
|
| Rate for Payer: Priority Health SBD |
$1,232.63
|
| Rate for Payer: Priority Health Tiered Network |
$1,232.63
|
| Rate for Payer: Railroad Medicare Medicare |
$713.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,430.87
|
| Rate for Payer: UHC Core |
$1,430.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$713.41
|
| Rate for Payer: UHC Exchange |
$1,430.87
|
| Rate for Payer: UHC Medicaid |
$459.65
|
| Rate for Payer: UHCCP Medicaid |
$459.65
|
|
|
PR REPAIR ENTEROCELE VAGINAL APPROACH SPX
|
Professional
|
Both
|
$1,576.00
|
|
|
Service Code
|
HCPCS 57268
|
| Min. Negotiated Rate |
$291.17 |
| Max. Negotiated Rate |
$1,182.00 |
| Rate for Payer: Aetna Commercial |
$599.61
|
| Rate for Payer: Aetna Medicare |
$465.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.36
|
| Rate for Payer: BCBS Complete |
$305.73
|
| Rate for Payer: BCBS MAPPO |
$447.47
|
| Rate for Payer: BCN Commercial |
$761.91
|
| Rate for Payer: BCN Medicare Advantage |
$447.47
|
| Rate for Payer: Cash Price |
$1,260.80
|
| Rate for Payer: Cash Price |
$1,260.80
|
| Rate for Payer: Cofinity Commercial |
$644.36
|
| Rate for Payer: Cofinity Commercial |
$599.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.47
|
| Rate for Payer: Healthscope Commercial |
$827.82
|
| Rate for Payer: Healthscope Commercial |
$715.95
|
| Rate for Payer: Mclaren Medicaid |
$291.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.84
|
| Rate for Payer: Meridian Medicaid |
$305.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$492.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$899.84
|
| Rate for Payer: Nomi Health Commercial |
$536.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.00
|
| Rate for Payer: PACE SWMI |
$447.47
|
| Rate for Payer: PHP Medicare Advantage |
$447.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$291.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$771.65
|
| Rate for Payer: Priority Health Medicare |
$447.47
|
| Rate for Payer: Priority Health SBD |
$771.65
|
| Rate for Payer: Priority Health Tiered Network |
$771.65
|
| Rate for Payer: Railroad Medicare Medicare |
$447.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$871.57
|
| Rate for Payer: UHC Core |
$871.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$447.47
|
| Rate for Payer: UHC Exchange |
$871.57
|
| Rate for Payer: UHC Medicaid |
$291.17
|
| Rate for Payer: UHCCP Medicaid |
$291.17
|
|
|
PR REPAIR ENTROPION SUTURE
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
HCPCS 67921
|
| Min. Negotiated Rate |
$176.36 |
| Max. Negotiated Rate |
$544.81 |
| Rate for Payer: Aetna Commercial |
$354.03
|
| Rate for Payer: Aetna Medicare |
$274.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$380.45
|
| Rate for Payer: BCBS Complete |
$185.18
|
| Rate for Payer: BCBS MAPPO |
$264.20
|
| Rate for Payer: BCN Commercial |
$465.12
|
| Rate for Payer: BCN Medicare Advantage |
$264.20
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cofinity Commercial |
$380.45
|
| Rate for Payer: Cofinity Commercial |
$354.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$264.20
|
| Rate for Payer: Healthscope Commercial |
$488.77
|
| Rate for Payer: Healthscope Commercial |
$422.72
|
| Rate for Payer: Mclaren Medicaid |
$176.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$277.41
|
| Rate for Payer: Meridian Medicaid |
$185.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$290.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$532.22
|
| Rate for Payer: Nomi Health Commercial |
$317.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$520.50
|
| Rate for Payer: PACE SWMI |
$264.20
|
| Rate for Payer: PHP Medicare Advantage |
$264.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$544.81
|
| Rate for Payer: Priority Health Medicare |
$264.20
|
| Rate for Payer: Priority Health SBD |
$544.81
|
| Rate for Payer: Priority Health Tiered Network |
$544.81
|
| Rate for Payer: Railroad Medicare Medicare |
$264.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$523.29
|
| Rate for Payer: UHC Core |
$523.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$264.20
|
| Rate for Payer: UHC Exchange |
$523.29
|
| Rate for Payer: UHC Medicaid |
$176.36
|
| Rate for Payer: UHCCP Medicaid |
$176.36
|
|
|
PR REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
HCPCS 26433
|
| Min. Negotiated Rate |
$362.10 |
| Max. Negotiated Rate |
$1,072.50 |
| Rate for Payer: Aetna Commercial |
$721.12
|
| Rate for Payer: Aetna Medicare |
$559.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$721.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$774.94
|
| Rate for Payer: BCBS Complete |
$380.20
|
| Rate for Payer: BCBS MAPPO |
$538.15
|
| Rate for Payer: BCN Commercial |
$860.51
|
| Rate for Payer: BCN Medicare Advantage |
$538.15
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cofinity Commercial |
$774.94
|
| Rate for Payer: Cofinity Commercial |
$721.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$538.15
|
| Rate for Payer: Healthscope Commercial |
$995.58
|
| Rate for Payer: Healthscope Commercial |
$861.04
|
| Rate for Payer: Mclaren Medicaid |
$362.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$565.06
|
| Rate for Payer: Meridian Medicaid |
$380.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,006.25
|
| Rate for Payer: Nomi Health Commercial |
$645.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,072.50
|
| Rate for Payer: PACE SWMI |
$538.15
|
| Rate for Payer: PHP Medicare Advantage |
$538.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$919.87
|
| Rate for Payer: Priority Health Medicare |
$538.15
|
| Rate for Payer: Priority Health SBD |
$919.87
|
| Rate for Payer: Priority Health Tiered Network |
$919.87
|
| Rate for Payer: Railroad Medicare Medicare |
$538.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$927.07
|
| Rate for Payer: UHC Core |
$927.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$538.15
|
| Rate for Payer: UHC Exchange |
$927.07
|
| Rate for Payer: UHC Medicaid |
$362.10
|
| Rate for Payer: UHCCP Medicaid |
$362.10
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH
|
Professional
|
Both
|
$1,842.00
|
|
|
Service Code
|
HCPCS 26420
|
| Min. Negotiated Rate |
$457.95 |
| Max. Negotiated Rate |
$1,381.50 |
| Rate for Payer: Aetna Commercial |
$917.30
|
| Rate for Payer: Aetna Medicare |
$711.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$985.75
|
| Rate for Payer: BCBS Complete |
$480.85
|
| Rate for Payer: BCBS MAPPO |
$684.55
|
| Rate for Payer: BCN Commercial |
$1,114.98
|
| Rate for Payer: BCN Medicare Advantage |
$684.55
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cofinity Commercial |
$985.75
|
| Rate for Payer: Cofinity Commercial |
$917.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$684.55
|
| Rate for Payer: Healthscope Commercial |
$1,266.42
|
| Rate for Payer: Healthscope Commercial |
$1,095.28
|
| Rate for Payer: Mclaren Medicaid |
$457.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$718.78
|
| Rate for Payer: Meridian Medicaid |
$480.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$753.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,307.52
|
| Rate for Payer: Nomi Health Commercial |
$821.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,381.50
|
| Rate for Payer: PACE SWMI |
$684.55
|
| Rate for Payer: PHP Medicare Advantage |
$684.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$457.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,191.88
|
| Rate for Payer: Priority Health Medicare |
$684.55
|
| Rate for Payer: Priority Health SBD |
$1,191.88
|
| Rate for Payer: Priority Health Tiered Network |
$1,191.88
|
| Rate for Payer: Railroad Medicare Medicare |
$684.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,231.29
|
| Rate for Payer: UHC Core |
$1,231.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$684.55
|
| Rate for Payer: UHC Exchange |
$1,231.29
|
| Rate for Payer: UHC Medicaid |
$457.95
|
| Rate for Payer: UHCCP Medicaid |
$457.95
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH
|
Professional
|
Both
|
$1,348.00
|
|
|
Service Code
|
HCPCS 26418
|
| Min. Negotiated Rate |
$400.23 |
| Max. Negotiated Rate |
$1,094.83 |
| Rate for Payer: PHP Medicare Advantage |
$591.80
|
| Rate for Payer: Aetna Commercial |
$793.01
|
| Rate for Payer: Aetna Medicare |
$615.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$852.19
|
| Rate for Payer: BCBS Complete |
$420.24
|
| Rate for Payer: BCBS MAPPO |
$591.80
|
| Rate for Payer: BCN Commercial |
$940.68
|
| Rate for Payer: BCN Medicare Advantage |
$591.80
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cofinity Commercial |
$852.19
|
| Rate for Payer: Cofinity Commercial |
$793.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$591.80
|
| Rate for Payer: Healthscope Commercial |
$946.88
|
| Rate for Payer: Healthscope Commercial |
$1,094.83
|
| Rate for Payer: Mclaren Medicaid |
$400.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$621.39
|
| Rate for Payer: Meridian Medicaid |
$420.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$650.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,091.09
|
| Rate for Payer: Nomi Health Commercial |
$710.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,011.00
|
| Rate for Payer: PACE SWMI |
$591.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,005.57
|
| Rate for Payer: Priority Health Medicare |
$591.80
|
| Rate for Payer: Priority Health SBD |
$1,005.57
|
| Rate for Payer: Priority Health Tiered Network |
$1,005.57
|
| Rate for Payer: Railroad Medicare Medicare |
$591.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,006.64
|
| Rate for Payer: UHC Core |
$1,006.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$591.80
|
| Rate for Payer: UHC Exchange |
$1,006.64
|
| Rate for Payer: UHC Medicaid |
$400.23
|
| Rate for Payer: UHCCP Medicaid |
$400.23
|
|
|
PR REPAIR EXTENSOR TENDON HAND W/GRAFT EACH
|
Professional
|
Both
|
$1,991.00
|
|
|
Service Code
|
HCPCS 26412
|
| Min. Negotiated Rate |
$443.47 |
| Max. Negotiated Rate |
$1,493.25 |
| Rate for Payer: Aetna Commercial |
$887.08
|
| Rate for Payer: Aetna Medicare |
$688.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$887.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$953.28
|
| Rate for Payer: BCBS Complete |
$465.64
|
| Rate for Payer: BCBS MAPPO |
$662.00
|
| Rate for Payer: BCN Commercial |
$1,076.14
|
| Rate for Payer: BCN Medicare Advantage |
$662.00
|
| Rate for Payer: Cash Price |
$1,592.80
|
| Rate for Payer: Cash Price |
$1,592.80
|
| Rate for Payer: Cofinity Commercial |
$953.28
|
| Rate for Payer: Cofinity Commercial |
$887.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$662.00
|
| Rate for Payer: Healthscope Commercial |
$1,224.70
|
| Rate for Payer: Healthscope Commercial |
$1,059.20
|
| Rate for Payer: Mclaren Medicaid |
$443.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$695.10
|
| Rate for Payer: Meridian Medicaid |
$465.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$728.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,261.42
|
| Rate for Payer: Nomi Health Commercial |
$794.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,493.25
|
| Rate for Payer: PACE SWMI |
$662.00
|
| Rate for Payer: PHP Medicare Advantage |
$662.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,150.36
|
| Rate for Payer: Priority Health Medicare |
$662.00
|
| Rate for Payer: Priority Health SBD |
$1,150.36
|
| Rate for Payer: Priority Health Tiered Network |
$1,150.36
|
| Rate for Payer: Railroad Medicare Medicare |
$662.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,175.51
|
| Rate for Payer: UHC Core |
$1,175.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$662.00
|
| Rate for Payer: UHC Exchange |
$1,175.51
|
| Rate for Payer: UHC Medicaid |
$443.47
|
| Rate for Payer: UHCCP Medicaid |
$443.47
|
|
|
PR REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH
|
Professional
|
Both
|
$1,295.00
|
|
|
Service Code
|
HCPCS 26410
|
| Min. Negotiated Rate |
$381.70 |
| Max. Negotiated Rate |
$1,055.09 |
| Rate for Payer: Aetna Commercial |
$759.08
|
| Rate for Payer: Aetna Medicare |
$589.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$759.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$815.73
|
| Rate for Payer: BCBS Complete |
$400.79
|
| Rate for Payer: BCBS MAPPO |
$566.48
|
| Rate for Payer: BCN Commercial |
$904.83
|
| Rate for Payer: BCN Medicare Advantage |
$566.48
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cofinity Commercial |
$815.73
|
| Rate for Payer: Cofinity Commercial |
$759.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$566.48
|
| Rate for Payer: Healthscope Commercial |
$906.37
|
| Rate for Payer: Healthscope Commercial |
$1,047.99
|
| Rate for Payer: Mclaren Medicaid |
$381.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$594.80
|
| Rate for Payer: Meridian Medicaid |
$400.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$623.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,055.09
|
| Rate for Payer: Nomi Health Commercial |
$679.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$971.25
|
| Rate for Payer: PACE SWMI |
$566.48
|
| Rate for Payer: PHP Medicare Advantage |
$566.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$381.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$967.25
|
| Rate for Payer: Priority Health Medicare |
$566.48
|
| Rate for Payer: Priority Health SBD |
$967.25
|
| Rate for Payer: Priority Health Tiered Network |
$967.25
|
| Rate for Payer: Railroad Medicare Medicare |
$566.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$981.50
|
| Rate for Payer: UHC Core |
$981.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$566.48
|
| Rate for Payer: UHC Exchange |
$981.50
|
| Rate for Payer: UHC Medicaid |
$381.70
|
| Rate for Payer: UHCCP Medicaid |
$381.70
|
|
|
PR REPAIR FASCIAL DEFECT LEG
|
Professional
|
Both
|
$953.00
|
|
|
Service Code
|
HCPCS 27656
|
| Min. Negotiated Rate |
$204.69 |
| Max. Negotiated Rate |
$714.75 |
| Rate for Payer: Aetna Commercial |
$416.47
|
| Rate for Payer: Aetna Medicare |
$323.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.55
|
| Rate for Payer: BCBS Complete |
$214.92
|
| Rate for Payer: BCBS MAPPO |
$310.80
|
| Rate for Payer: BCN Commercial |
$516.41
|
| Rate for Payer: BCN Medicare Advantage |
$310.80
|
| Rate for Payer: Cash Price |
$762.40
|
| Rate for Payer: Cash Price |
$762.40
|
| Rate for Payer: Cofinity Commercial |
$447.55
|
| Rate for Payer: Cofinity Commercial |
$416.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$310.80
|
| Rate for Payer: Healthscope Commercial |
$574.98
|
| Rate for Payer: Healthscope Commercial |
$497.28
|
| Rate for Payer: Mclaren Medicaid |
$204.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$326.34
|
| Rate for Payer: Meridian Medicaid |
$214.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$341.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$610.58
|
| Rate for Payer: Nomi Health Commercial |
$372.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$714.75
|
| Rate for Payer: PACE SWMI |
$310.80
|
| Rate for Payer: PHP Medicare Advantage |
$310.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$552.02
|
| Rate for Payer: Priority Health Medicare |
$310.80
|
| Rate for Payer: Priority Health SBD |
$552.02
|
| Rate for Payer: Priority Health Tiered Network |
$552.02
|
| Rate for Payer: Railroad Medicare Medicare |
$310.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$686.17
|
| Rate for Payer: UHC Core |
$686.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$310.80
|
| Rate for Payer: UHC Exchange |
$686.17
|
| Rate for Payer: UHC Medicaid |
$204.69
|
| Rate for Payer: UHCCP Medicaid |
$204.69
|
|
|
PR REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION
|
Professional
|
Both
|
$4,154.00
|
|
|
Service Code
|
HCPCS 27726
|
| Min. Negotiated Rate |
$558.06 |
| Max. Negotiated Rate |
$3,115.50 |
| Rate for Payer: Aetna Commercial |
$1,151.74
|
| Rate for Payer: Aetna Medicare |
$893.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,151.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,237.69
|
| Rate for Payer: BCBS Complete |
$585.96
|
| Rate for Payer: BCBS MAPPO |
$859.51
|
| Rate for Payer: BCN Commercial |
$1,452.61
|
| Rate for Payer: BCN Medicare Advantage |
$859.51
|
| Rate for Payer: Cash Price |
$3,323.20
|
| Rate for Payer: Cash Price |
$3,323.20
|
| Rate for Payer: Cofinity Commercial |
$1,237.69
|
| Rate for Payer: Cofinity Commercial |
$1,151.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$859.51
|
| Rate for Payer: Healthscope Commercial |
$1,590.09
|
| Rate for Payer: Healthscope Commercial |
$1,375.22
|
| Rate for Payer: Mclaren Medicaid |
$558.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$902.49
|
| Rate for Payer: Meridian Medicaid |
$585.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$945.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,701.04
|
| Rate for Payer: Nomi Health Commercial |
$1,031.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,115.50
|
| Rate for Payer: PACE SWMI |
$859.51
|
| Rate for Payer: PHP Medicare Advantage |
$859.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$558.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,552.80
|
| Rate for Payer: Priority Health Medicare |
$859.51
|
| Rate for Payer: Priority Health SBD |
$1,552.80
|
| Rate for Payer: Priority Health Tiered Network |
$1,552.80
|
| Rate for Payer: Railroad Medicare Medicare |
$859.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,679.81
|
| Rate for Payer: UHC Core |
$1,679.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$859.51
|
| Rate for Payer: UHC Exchange |
$1,679.81
|
| Rate for Payer: UHC Medicaid |
$558.06
|
| Rate for Payer: UHCCP Medicaid |
$558.06
|
|
|
PR REPAIR FIRST ABDOMINAL WALL HERNIA
|
Professional
|
Both
|
$2,169.00
|
|
|
Service Code
|
HCPCS 49560
|
| Min. Negotiated Rate |
$867.60 |
| Max. Negotiated Rate |
$1,626.75 |
| Rate for Payer: Aetna Medicare |
$1,084.50
|
| Rate for Payer: BCBS Complete |
$867.60
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,409.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,626.75
|
|
|
PR REPAIR FISTULA OROMAXILLARY
|
Professional
|
Both
|
$1,527.00
|
|
|
Service Code
|
HCPCS 30580
|
| Min. Negotiated Rate |
$267.74 |
| Max. Negotiated Rate |
$1,145.25 |
| Rate for Payer: Aetna Commercial |
$548.10
|
| Rate for Payer: Aetna Medicare |
$425.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$548.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$589.00
|
| Rate for Payer: BCBS Complete |
$281.13
|
| Rate for Payer: BCBS MAPPO |
$409.03
|
| Rate for Payer: BCN Commercial |
$700.17
|
| Rate for Payer: BCN Medicare Advantage |
$409.03
|
| Rate for Payer: Cash Price |
$1,221.60
|
| Rate for Payer: Cash Price |
$1,221.60
|
| Rate for Payer: Cofinity Commercial |
$589.00
|
| Rate for Payer: Cofinity Commercial |
$548.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$409.03
|
| Rate for Payer: Healthscope Commercial |
$654.45
|
| Rate for Payer: Healthscope Commercial |
$756.71
|
| Rate for Payer: Mclaren Medicaid |
$267.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$429.48
|
| Rate for Payer: Meridian Medicaid |
$281.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$449.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$809.12
|
| Rate for Payer: Nomi Health Commercial |
$490.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,145.25
|
| Rate for Payer: PACE SWMI |
$409.03
|
| Rate for Payer: PHP Medicare Advantage |
$409.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$659.34
|
| Rate for Payer: Priority Health Medicare |
$409.03
|
| Rate for Payer: Priority Health SBD |
$659.34
|
| Rate for Payer: Priority Health Tiered Network |
$659.34
|
| Rate for Payer: Railroad Medicare Medicare |
$409.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$823.26
|
| Rate for Payer: UHC Core |
$823.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$409.03
|
| Rate for Payer: UHC Exchange |
$823.26
|
| Rate for Payer: UHC Medicaid |
$267.74
|
| Rate for Payer: UHCCP Medicaid |
$267.74
|
|
|
PR REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 27658
|
| Min. Negotiated Rate |
$227.70 |
| Max. Negotiated Rate |
$1,005.00 |
| Rate for Payer: Aetna Commercial |
$463.61
|
| Rate for Payer: Aetna Medicare |
$359.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.21
|
| Rate for Payer: BCBS Complete |
$239.09
|
| Rate for Payer: BCBS MAPPO |
$345.98
|
| Rate for Payer: BCN Commercial |
$566.70
|
| Rate for Payer: BCN Medicare Advantage |
$345.98
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cofinity Commercial |
$498.21
|
| Rate for Payer: Cofinity Commercial |
$463.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.98
|
| Rate for Payer: Healthscope Commercial |
$640.06
|
| Rate for Payer: Healthscope Commercial |
$553.57
|
| Rate for Payer: Mclaren Medicaid |
$227.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$363.28
|
| Rate for Payer: Meridian Medicaid |
$239.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$380.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$652.50
|
| Rate for Payer: Nomi Health Commercial |
$415.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,005.00
|
| Rate for Payer: PACE SWMI |
$345.98
|
| Rate for Payer: PHP Medicare Advantage |
$345.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$605.78
|
| Rate for Payer: Priority Health Medicare |
$345.98
|
| Rate for Payer: Priority Health SBD |
$605.78
|
| Rate for Payer: Priority Health Tiered Network |
$605.78
|
| Rate for Payer: Railroad Medicare Medicare |
$345.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$641.80
|
| Rate for Payer: UHC Core |
$641.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$345.98
|
| Rate for Payer: UHC Exchange |
$641.80
|
| Rate for Payer: UHC Medicaid |
$227.70
|
| Rate for Payer: UHCCP Medicaid |
$227.70
|
|
|
PR REPAIR INCOMPLETE CIRCUMCISION
|
Professional
|
Both
|
$421.00
|
|
|
Service Code
|
HCPCS 54163
|
| Min. Negotiated Rate |
$132.06 |
| Max. Negotiated Rate |
$382.68 |
| Rate for Payer: Aetna Commercial |
$270.02
|
| Rate for Payer: Aetna Medicare |
$209.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.17
|
| Rate for Payer: BCBS Complete |
$138.66
|
| Rate for Payer: BCBS MAPPO |
$201.51
|
| Rate for Payer: BCN Commercial |
$331.65
|
| Rate for Payer: BCN Medicare Advantage |
$201.51
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Cofinity Commercial |
$290.17
|
| Rate for Payer: Cofinity Commercial |
$270.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.51
|
| Rate for Payer: Healthscope Commercial |
$372.79
|
| Rate for Payer: Healthscope Commercial |
$322.42
|
| Rate for Payer: Mclaren Medicaid |
$132.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.59
|
| Rate for Payer: Meridian Medicaid |
$138.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.68
|
| Rate for Payer: Nomi Health Commercial |
$241.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.75
|
| Rate for Payer: PACE SWMI |
$201.51
|
| Rate for Payer: PHP Medicare Advantage |
$201.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$132.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$361.28
|
| Rate for Payer: Priority Health Medicare |
$201.51
|
| Rate for Payer: Priority Health SBD |
$361.28
|
| Rate for Payer: Priority Health Tiered Network |
$361.28
|
| Rate for Payer: Railroad Medicare Medicare |
$201.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.03
|
| Rate for Payer: UHC Core |
$380.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.51
|
| Rate for Payer: UHC Exchange |
$380.03
|
| Rate for Payer: UHC Medicaid |
$132.06
|
| Rate for Payer: UHCCP Medicaid |
$132.06
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM
|
Professional
|
Both
|
$1,048.00
|
|
|
Service Code
|
HCPCS 12055
|
| Min. Negotiated Rate |
$187.65 |
| Max. Negotiated Rate |
$786.00 |
| Rate for Payer: Aetna Commercial |
$385.61
|
| Rate for Payer: Aetna Medicare |
$299.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.39
|
| Rate for Payer: BCBS Complete |
$197.03
|
| Rate for Payer: BCBS MAPPO |
$287.77
|
| Rate for Payer: BCN Commercial |
$452.66
|
| Rate for Payer: BCN Medicare Advantage |
$287.77
|
| Rate for Payer: Cash Price |
$838.40
|
| Rate for Payer: Cash Price |
$838.40
|
| Rate for Payer: Cofinity Commercial |
$414.39
|
| Rate for Payer: Cofinity Commercial |
$385.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.77
|
| Rate for Payer: Healthscope Commercial |
$532.37
|
| Rate for Payer: Healthscope Commercial |
$460.43
|
| Rate for Payer: Mclaren Medicaid |
$187.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.16
|
| Rate for Payer: Meridian Medicaid |
$197.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$316.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$529.47
|
| Rate for Payer: Nomi Health Commercial |
$345.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$786.00
|
| Rate for Payer: PACE SWMI |
$287.77
|
| Rate for Payer: PHP Medicare Advantage |
$287.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$414.31
|
| Rate for Payer: Priority Health Medicare |
$287.77
|
| Rate for Payer: Priority Health SBD |
$414.31
|
| Rate for Payer: Priority Health Tiered Network |
$414.31
|
| Rate for Payer: Railroad Medicare Medicare |
$287.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$525.78
|
| Rate for Payer: UHC Core |
$525.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$287.77
|
| Rate for Payer: UHC Exchange |
$525.78
|
| Rate for Payer: UHC Medicaid |
$187.65
|
| Rate for Payer: UHCCP Medicaid |
$187.65
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
12051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.54 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$389.30
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.70
|
| 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 |
$181.54
|
| Rate for Payer: BCN Commercial |
$181.54
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cofinity Advantage |
$320.60
|
| Rate for Payer: Cofinity Commercial |
$393.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$412.20
|
| 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 |
$389.30
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.50
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$389.30
|
| 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 |
$288.54
|
| 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
|
|
