|
PR REPAIR BLOOD VESSEL VEIN GRAFT INTRA-ABDOMINAL
|
Professional
|
Both
|
$3,839.00
|
|
|
Service Code
|
HCPCS 35251
|
| Min. Negotiated Rate |
$1,535.60 |
| Max. Negotiated Rate |
$3,073.83 |
| Rate for Payer: Aetna Commercial |
$2,226.45
|
| Rate for Payer: Aetna Medicare |
$1,727.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,392.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,226.45
|
| Rate for Payer: BCBS Complete |
$1,535.60
|
| Rate for Payer: BCBS MAPPO |
$1,661.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,661.53
|
| Rate for Payer: Cash Price |
$3,071.20
|
| Rate for Payer: Cash Price |
$3,071.20
|
| Rate for Payer: Cofinity Commercial |
$2,392.60
|
| Rate for Payer: Cofinity Commercial |
$2,226.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,661.53
|
| Rate for Payer: Healthscope Commercial |
$2,658.45
|
| Rate for Payer: Healthscope Commercial |
$3,073.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,744.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,495.35
|
| Rate for Payer: Nomi Health Commercial |
$1,993.84
|
| Rate for Payer: PACE SWMI |
$1,661.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,661.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,495.35
|
| Rate for Payer: Priority Health Medicare |
$1,661.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,661.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,661.53
|
|
|
PR REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY
|
Professional
|
Both
|
$4,575.00
|
|
|
Service Code
|
HCPCS 35256
|
| Min. Negotiated Rate |
$978.13 |
| Max. Negotiated Rate |
$2,973.75 |
| Rate for Payer: Aetna Commercial |
$1,310.69
|
| Rate for Payer: Aetna Medicare |
$1,017.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,408.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,310.69
|
| Rate for Payer: BCBS Complete |
$1,830.00
|
| Rate for Payer: BCBS MAPPO |
$978.13
|
| Rate for Payer: BCN Medicare Advantage |
$978.13
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cofinity Commercial |
$1,408.51
|
| Rate for Payer: Cofinity Commercial |
$1,310.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$978.13
|
| Rate for Payer: Healthscope Commercial |
$1,809.54
|
| Rate for Payer: Healthscope Commercial |
$1,565.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,027.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,973.75
|
| Rate for Payer: Nomi Health Commercial |
$1,173.76
|
| Rate for Payer: PACE SWMI |
$978.13
|
| Rate for Payer: PHP Medicare Advantage |
$978.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,973.75
|
| Rate for Payer: Priority Health Medicare |
$978.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$978.13
|
| Rate for Payer: UHC Medicare Advantage |
$978.13
|
|
|
PR REPAIR BLOOD VESSEL W/GRAFT OTHER/THAN VEIN NECK
|
Professional
|
Both
|
$4,692.00
|
|
|
Service Code
|
HCPCS 35261
|
| Min. Negotiated Rate |
$945.40 |
| Max. Negotiated Rate |
$3,049.80 |
| Rate for Payer: Aetna Commercial |
$1,266.84
|
| Rate for Payer: Aetna Medicare |
$983.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,361.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,266.84
|
| Rate for Payer: BCBS Complete |
$1,876.80
|
| Rate for Payer: BCBS MAPPO |
$945.40
|
| Rate for Payer: BCN Medicare Advantage |
$945.40
|
| Rate for Payer: Cash Price |
$3,753.60
|
| Rate for Payer: Cash Price |
$3,753.60
|
| Rate for Payer: Cofinity Commercial |
$1,361.38
|
| Rate for Payer: Cofinity Commercial |
$1,266.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$945.40
|
| Rate for Payer: Healthscope Commercial |
$1,512.64
|
| Rate for Payer: Healthscope Commercial |
$1,748.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$992.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,049.80
|
| Rate for Payer: Nomi Health Commercial |
$1,134.48
|
| Rate for Payer: PACE SWMI |
$945.40
|
| Rate for Payer: PHP Medicare Advantage |
$945.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,049.80
|
| Rate for Payer: Priority Health Medicare |
$945.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$945.40
|
| Rate for Payer: UHC Medicare Advantage |
$945.40
|
|
|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT NECK
|
Professional
|
Both
|
$1,896.00
|
|
|
Service Code
|
HCPCS 35231
|
| Min. Negotiated Rate |
$758.40 |
| Max. Negotiated Rate |
$2,208.66 |
| Rate for Payer: Aetna Commercial |
$1,599.79
|
| Rate for Payer: Aetna Medicare |
$1,241.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,719.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,599.79
|
| Rate for Payer: BCBS Complete |
$758.40
|
| Rate for Payer: BCBS MAPPO |
$1,193.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,193.87
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cofinity Commercial |
$1,719.17
|
| Rate for Payer: Cofinity Commercial |
$1,599.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,193.87
|
| Rate for Payer: Healthscope Commercial |
$2,208.66
|
| Rate for Payer: Healthscope Commercial |
$1,910.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,253.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,232.40
|
| Rate for Payer: Nomi Health Commercial |
$1,432.64
|
| Rate for Payer: PACE SWMI |
$1,193.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,232.40
|
| Rate for Payer: Priority Health Medicare |
$1,193.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,193.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,193.87
|
|
|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY
|
Professional
|
Both
|
$3,698.00
|
|
|
Service Code
|
HCPCS 35236
|
| Min. Negotiated Rate |
$966.53 |
| Max. Negotiated Rate |
$2,403.70 |
| Rate for Payer: Aetna Commercial |
$1,295.15
|
| Rate for Payer: Aetna Medicare |
$1,005.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,391.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,295.15
|
| Rate for Payer: BCBS Complete |
$1,479.20
|
| Rate for Payer: BCBS MAPPO |
$966.53
|
| Rate for Payer: BCN Medicare Advantage |
$966.53
|
| Rate for Payer: Cash Price |
$2,958.40
|
| Rate for Payer: Cash Price |
$2,958.40
|
| Rate for Payer: Cofinity Commercial |
$1,391.80
|
| Rate for Payer: Cofinity Commercial |
$1,295.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$966.53
|
| Rate for Payer: Healthscope Commercial |
$1,546.45
|
| Rate for Payer: Healthscope Commercial |
$1,788.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,014.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,403.70
|
| Rate for Payer: Nomi Health Commercial |
$1,159.84
|
| Rate for Payer: PACE SWMI |
$966.53
|
| Rate for Payer: PHP Medicare Advantage |
$966.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,403.70
|
| Rate for Payer: Priority Health Medicare |
$966.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$966.53
|
| Rate for Payer: UHC Medicare Advantage |
$966.53
|
|
|
PR REPAIR BROW PTOSIS
|
Professional
|
Both
|
$1,326.00
|
|
|
Service Code
|
HCPCS 67900
|
| Min. Negotiated Rate |
$468.29 |
| Max. Negotiated Rate |
$866.34 |
| Rate for Payer: Aetna Commercial |
$627.51
|
| Rate for Payer: Aetna Medicare |
$487.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.51
|
| Rate for Payer: BCBS Complete |
$530.40
|
| Rate for Payer: BCBS MAPPO |
$468.29
|
| Rate for Payer: BCN Medicare Advantage |
$468.29
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cofinity Commercial |
$674.34
|
| Rate for Payer: Cofinity Commercial |
$627.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$468.29
|
| Rate for Payer: Healthscope Commercial |
$866.34
|
| Rate for Payer: Healthscope Commercial |
$749.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$491.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$861.90
|
| Rate for Payer: Nomi Health Commercial |
$561.95
|
| Rate for Payer: PACE SWMI |
$468.29
|
| Rate for Payer: PHP Medicare Advantage |
$468.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.90
|
| Rate for Payer: Priority Health Medicare |
$468.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$468.29
|
| Rate for Payer: UHC Medicare Advantage |
$468.29
|
|
|
PR REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS
|
Professional
|
Both
|
$7,686.00
|
|
|
Service Code
|
HCPCS 33305
|
| Min. Negotiated Rate |
$3,074.40 |
| Max. Negotiated Rate |
$7,248.80 |
| Rate for Payer: Aetna Commercial |
$5,250.48
|
| Rate for Payer: Aetna Medicare |
$4,075.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,642.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,250.48
|
| Rate for Payer: BCBS Complete |
$3,074.40
|
| Rate for Payer: BCBS MAPPO |
$3,918.27
|
| Rate for Payer: BCN Medicare Advantage |
$3,918.27
|
| Rate for Payer: Cash Price |
$6,148.80
|
| Rate for Payer: Cash Price |
$6,148.80
|
| Rate for Payer: Cofinity Commercial |
$5,642.31
|
| Rate for Payer: Cofinity Commercial |
$5,250.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,918.27
|
| Rate for Payer: Healthscope Commercial |
$6,269.23
|
| Rate for Payer: Healthscope Commercial |
$7,248.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,114.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,995.90
|
| Rate for Payer: Nomi Health Commercial |
$4,701.92
|
| Rate for Payer: PACE SWMI |
$3,918.27
|
| Rate for Payer: PHP Medicare Advantage |
$3,918.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,995.90
|
| Rate for Payer: Priority Health Medicare |
$3,918.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,918.27
|
| Rate for Payer: UHC Medicare Advantage |
$3,918.27
|
|
|
PR REPAIR CARDIAC WOUND W/O BYPASS
|
Professional
|
Both
|
$4,597.00
|
|
|
Service Code
|
HCPCS 33300
|
| Min. Negotiated Rate |
$1,838.80 |
| Max. Negotiated Rate |
$4,341.93 |
| Rate for Payer: Aetna Commercial |
$3,144.97
|
| Rate for Payer: Aetna Medicare |
$2,440.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,379.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,144.97
|
| Rate for Payer: BCBS Complete |
$1,838.80
|
| Rate for Payer: BCBS MAPPO |
$2,346.99
|
| Rate for Payer: BCN Medicare Advantage |
$2,346.99
|
| Rate for Payer: Cash Price |
$3,677.60
|
| Rate for Payer: Cash Price |
$3,677.60
|
| Rate for Payer: Cofinity Commercial |
$3,379.67
|
| Rate for Payer: Cofinity Commercial |
$3,144.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,346.99
|
| Rate for Payer: Healthscope Commercial |
$4,341.93
|
| Rate for Payer: Healthscope Commercial |
$3,755.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,464.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,988.05
|
| Rate for Payer: Nomi Health Commercial |
$2,816.39
|
| Rate for Payer: PACE SWMI |
$2,346.99
|
| Rate for Payer: PHP Medicare Advantage |
$2,346.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,988.05
|
| Rate for Payer: Priority Health Medicare |
$2,346.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,346.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,346.99
|
|
|
PR REPAIR CHOANAL ATRESIA INTRANASAL
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
HCPCS 30540
|
| Min. Negotiated Rate |
$490.80 |
| Max. Negotiated Rate |
$1,269.36 |
| Rate for Payer: Aetna Commercial |
$919.43
|
| Rate for Payer: Aetna Medicare |
$713.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$988.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$919.43
|
| Rate for Payer: BCBS Complete |
$490.80
|
| Rate for Payer: BCBS MAPPO |
$686.14
|
| Rate for Payer: BCN Medicare Advantage |
$686.14
|
| Rate for Payer: Cash Price |
$981.60
|
| Rate for Payer: Cash Price |
$981.60
|
| Rate for Payer: Cofinity Commercial |
$988.04
|
| Rate for Payer: Cofinity Commercial |
$919.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.14
|
| Rate for Payer: Healthscope Commercial |
$1,097.82
|
| Rate for Payer: Healthscope Commercial |
$1,269.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.55
|
| Rate for Payer: Nomi Health Commercial |
$823.37
|
| Rate for Payer: PACE SWMI |
$686.14
|
| Rate for Payer: PHP Medicare Advantage |
$686.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.55
|
| Rate for Payer: Priority Health Medicare |
$686.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.14
|
| Rate for Payer: UHC Medicare Advantage |
$686.14
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 13151
|
| Min. Negotiated Rate |
$263.21 |
| Max. Negotiated Rate |
$603.20 |
| Rate for Payer: Aetna Commercial |
$352.70
|
| Rate for Payer: Aetna Medicare |
$273.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.70
|
| Rate for Payer: BCBS Complete |
$371.20
|
| Rate for Payer: BCBS MAPPO |
$263.21
|
| Rate for Payer: BCN Medicare Advantage |
$263.21
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cofinity Commercial |
$379.02
|
| Rate for Payer: Cofinity Commercial |
$352.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.21
|
| Rate for Payer: Healthscope Commercial |
$486.94
|
| Rate for Payer: Healthscope Commercial |
$421.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.20
|
| Rate for Payer: Nomi Health Commercial |
$315.85
|
| Rate for Payer: PACE SWMI |
$263.21
|
| Rate for Payer: PHP Medicare Advantage |
$263.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.20
|
| Rate for Payer: Priority Health Medicare |
$263.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.21
|
| Rate for Payer: UHC Medicare Advantage |
$263.21
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Professional
|
Both
|
$1,232.00
|
|
|
Service Code
|
HCPCS 13152
|
| Min. Negotiated Rate |
$316.36 |
| Max. Negotiated Rate |
$800.80 |
| Rate for Payer: Aetna Commercial |
$423.92
|
| Rate for Payer: Aetna Medicare |
$329.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.92
|
| Rate for Payer: BCBS Complete |
$492.80
|
| Rate for Payer: BCBS MAPPO |
$316.36
|
| Rate for Payer: BCN Medicare Advantage |
$316.36
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cofinity Commercial |
$455.56
|
| Rate for Payer: Cofinity Commercial |
$423.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.36
|
| Rate for Payer: Healthscope Commercial |
$506.18
|
| Rate for Payer: Healthscope Commercial |
$585.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$800.80
|
| Rate for Payer: Nomi Health Commercial |
$379.63
|
| Rate for Payer: PACE SWMI |
$316.36
|
| Rate for Payer: PHP Medicare Advantage |
$316.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$800.80
|
| Rate for Payer: Priority Health Medicare |
$316.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.36
|
| Rate for Payer: UHC Medicare Advantage |
$316.36
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 13131
|
| Min. Negotiated Rate |
$229.33 |
| Max. Negotiated Rate |
$424.26 |
| Rate for Payer: Aetna Commercial |
$307.30
|
| Rate for Payer: Aetna Medicare |
$238.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.30
|
| Rate for Payer: BCBS Complete |
$242.00
|
| Rate for Payer: BCBS MAPPO |
$229.33
|
| Rate for Payer: BCN Medicare Advantage |
$229.33
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cofinity Commercial |
$330.24
|
| Rate for Payer: Cofinity Commercial |
$307.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.33
|
| Rate for Payer: Healthscope Commercial |
$424.26
|
| Rate for Payer: Healthscope Commercial |
$366.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.25
|
| Rate for Payer: Nomi Health Commercial |
$275.20
|
| Rate for Payer: PACE SWMI |
$229.33
|
| Rate for Payer: PHP Medicare Advantage |
$229.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.25
|
| Rate for Payer: Priority Health Medicare |
$229.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.33
|
| Rate for Payer: UHC Medicare Advantage |
$229.33
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Professional
|
Both
|
$1,306.00
|
|
|
Service Code
|
HCPCS 13132
|
| Min. Negotiated Rate |
$285.40 |
| Max. Negotiated Rate |
$848.90 |
| Rate for Payer: Aetna Commercial |
$382.44
|
| Rate for Payer: Aetna Medicare |
$296.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.44
|
| Rate for Payer: BCBS Complete |
$522.40
|
| Rate for Payer: BCBS MAPPO |
$285.40
|
| Rate for Payer: BCN Medicare Advantage |
$285.40
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Cofinity Commercial |
$410.98
|
| Rate for Payer: Cofinity Commercial |
$382.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.40
|
| Rate for Payer: Healthscope Commercial |
$456.64
|
| Rate for Payer: Healthscope Commercial |
$527.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$299.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$848.90
|
| Rate for Payer: Nomi Health Commercial |
$342.48
|
| Rate for Payer: PACE SWMI |
$285.40
|
| Rate for Payer: PHP Medicare Advantage |
$285.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.90
|
| Rate for Payer: Priority Health Medicare |
$285.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.40
|
| Rate for Payer: UHC Medicare Advantage |
$285.40
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 13133
|
| Min. Negotiated Rate |
$118.59 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Commercial |
$158.91
|
| Rate for Payer: Aetna Medicare |
$123.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.91
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: BCBS MAPPO |
$118.59
|
| Rate for Payer: BCN Medicare Advantage |
$118.59
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$170.77
|
| Rate for Payer: Cofinity Commercial |
$158.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.59
|
| Rate for Payer: Healthscope Commercial |
$219.39
|
| Rate for Payer: Healthscope Commercial |
$189.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.20
|
| Rate for Payer: Nomi Health Commercial |
$142.31
|
| Rate for Payer: PACE SWMI |
$118.59
|
| Rate for Payer: PHP Medicare Advantage |
$118.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health Medicare |
$118.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.59
|
| Rate for Payer: UHC Medicare Advantage |
$118.59
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
HCPCS 13120
|
| Min. Negotiated Rate |
$216.90 |
| Max. Negotiated Rate |
$401.26 |
| Rate for Payer: Aetna Commercial |
$290.65
|
| Rate for Payer: Aetna Medicare |
$225.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.65
|
| Rate for Payer: BCBS Complete |
$218.80
|
| Rate for Payer: BCBS MAPPO |
$216.90
|
| Rate for Payer: BCN Medicare Advantage |
$216.90
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cofinity Commercial |
$312.34
|
| Rate for Payer: Cofinity Commercial |
$290.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.90
|
| Rate for Payer: Healthscope Commercial |
$347.04
|
| Rate for Payer: Healthscope Commercial |
$401.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.55
|
| Rate for Payer: Nomi Health Commercial |
$260.28
|
| Rate for Payer: PACE SWMI |
$216.90
|
| Rate for Payer: PHP Medicare Advantage |
$216.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.55
|
| Rate for Payer: Priority Health Medicare |
$216.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.90
|
| Rate for Payer: UHC Medicare Advantage |
$216.90
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$565.74 |
| Max. Negotiated Rate |
$808.20 |
| Rate for Payer: Aetna Commercial |
$763.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$583.70
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$628.60
|
| Rate for Payer: Cofinity Commercial |
$772.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$628.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$718.40
|
| Rate for Payer: Healthscope Commercial |
$808.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$763.30
|
| Rate for Payer: PHP Commercial |
$763.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health SBD |
$565.74
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
13121
|
| Min. Negotiated Rate |
$244.04 |
| Max. Negotiated Rate |
$583.70 |
| Rate for Payer: Aetna Commercial |
$327.01
|
| Rate for Payer: Aetna Medicare |
$253.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.42
|
| Rate for Payer: BCBS Complete |
$359.20
|
| Rate for Payer: BCBS MAPPO |
$244.04
|
| Rate for Payer: BCN Medicare Advantage |
$244.04
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$327.01
|
| Rate for Payer: Cofinity Commercial |
$351.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.04
|
| Rate for Payer: Healthscope Commercial |
$451.47
|
| Rate for Payer: Healthscope Commercial |
$390.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.70
|
| Rate for Payer: Nomi Health Commercial |
$292.85
|
| Rate for Payer: PACE SWMI |
$244.04
|
| Rate for Payer: PHP Medicare Advantage |
$244.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health Medicare |
$244.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.04
|
| Rate for Payer: UHC Medicare Advantage |
$244.04
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$319.99 |
| Max. Negotiated Rate |
$1,680.50 |
| Rate for Payer: Aetna Commercial |
$763.30
|
| Rate for Payer: Aetna Medicare |
$620.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$583.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$772.28
|
| Rate for Payer: Cofinity Commercial |
$628.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$628.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$718.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$808.20
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$763.30
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$763.30
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health SBD |
$565.74
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$336.11
|
| Rate for Payer: VA VA |
$597.00
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
HCPCS 13121
|
| Min. Negotiated Rate |
$244.04 |
| Max. Negotiated Rate |
$583.70 |
| Rate for Payer: Aetna Commercial |
$327.01
|
| Rate for Payer: Aetna Medicare |
$253.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.01
|
| Rate for Payer: BCBS Complete |
$359.20
|
| Rate for Payer: BCBS MAPPO |
$244.04
|
| Rate for Payer: BCN Medicare Advantage |
$244.04
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$351.42
|
| Rate for Payer: Cofinity Commercial |
$327.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.04
|
| Rate for Payer: Healthscope Commercial |
$451.47
|
| Rate for Payer: Healthscope Commercial |
$390.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.70
|
| Rate for Payer: Nomi Health Commercial |
$292.85
|
| Rate for Payer: PACE SWMI |
$244.04
|
| Rate for Payer: PHP Medicare Advantage |
$244.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health Medicare |
$244.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.04
|
| Rate for Payer: UHC Medicare Advantage |
$244.04
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 13122
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Commercial |
$104.68
|
| Rate for Payer: Aetna Medicare |
$81.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.68
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS MAPPO |
$78.12
|
| Rate for Payer: BCN Medicare Advantage |
$78.12
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$112.49
|
| Rate for Payer: Cofinity Commercial |
$104.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$124.99
|
| Rate for Payer: Healthscope Commercial |
$144.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.65
|
| Rate for Payer: Nomi Health Commercial |
$93.74
|
| Rate for Payer: PACE SWMI |
$78.12
|
| Rate for Payer: PHP Medicare Advantage |
$78.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health Medicare |
$78.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.12
|
| Rate for Payer: UHC Medicare Advantage |
$78.12
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$177.03 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna Commercial |
$238.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.65
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$196.70
|
| Rate for Payer: Cofinity Commercial |
$241.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Healthscope Commercial |
$252.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.85
|
| Rate for Payer: PHP Commercial |
$238.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health SBD |
$177.03
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna Commercial |
$238.85
|
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.65
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$196.70
|
| Rate for Payer: Cofinity Commercial |
$241.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Healthscope Commercial |
$252.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.85
|
| Rate for Payer: PHP Commercial |
$238.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health SBD |
$177.03
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 13122
|
| Hospital Charge Code |
13122
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Commercial |
$104.68
|
| Rate for Payer: Aetna Medicare |
$81.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.49
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS MAPPO |
$78.12
|
| Rate for Payer: BCN Medicare Advantage |
$78.12
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$112.49
|
| Rate for Payer: Cofinity Commercial |
$104.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$124.99
|
| Rate for Payer: Healthscope Commercial |
$144.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.65
|
| Rate for Payer: Nomi Health Commercial |
$93.74
|
| Rate for Payer: PACE SWMI |
$78.12
|
| Rate for Payer: PHP Medicare Advantage |
$78.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health Medicare |
$78.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.12
|
| Rate for Payer: UHC Medicare Advantage |
$78.12
|
|
|
PR REPAIR COMPLEX TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
HCPCS 13100
|
| Min. Negotiated Rate |
$189.93 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna Commercial |
$254.51
|
| Rate for Payer: Aetna Medicare |
$197.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.51
|
| Rate for Payer: BCBS Complete |
$220.80
|
| Rate for Payer: BCBS MAPPO |
$189.93
|
| Rate for Payer: BCN Medicare Advantage |
$189.93
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cofinity Commercial |
$273.50
|
| Rate for Payer: Cofinity Commercial |
$254.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.93
|
| Rate for Payer: Healthscope Commercial |
$351.37
|
| Rate for Payer: Healthscope Commercial |
$303.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.80
|
| Rate for Payer: Nomi Health Commercial |
$227.92
|
| Rate for Payer: PACE SWMI |
$189.93
|
| Rate for Payer: PHP Medicare Advantage |
$189.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.80
|
| Rate for Payer: Priority Health Medicare |
$189.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.93
|
| Rate for Payer: UHC Medicare Advantage |
$189.93
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$231.78 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Aetna Commercial |
$310.59
|
| Rate for Payer: Aetna Medicare |
$241.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.76
|
| Rate for Payer: BCBS Complete |
$266.40
|
| Rate for Payer: BCBS MAPPO |
$231.78
|
| Rate for Payer: BCN Medicare Advantage |
$231.78
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$333.76
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.78
|
| Rate for Payer: Healthscope Commercial |
$370.85
|
| Rate for Payer: Healthscope Commercial |
$428.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.90
|
| Rate for Payer: Nomi Health Commercial |
$278.14
|
| Rate for Payer: PACE SWMI |
$231.78
|
| Rate for Payer: PHP Medicare Advantage |
$231.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health Medicare |
$231.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.78
|
| Rate for Payer: UHC Medicare Advantage |
$231.78
|
|
