|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 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) |
$333.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.59
|
| 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
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$419.58 |
| Max. Negotiated Rate |
$599.40 |
| Rate for Payer: Aetna Commercial |
$566.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.90
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$466.20
|
| Rate for Payer: Cofinity Commercial |
$572.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$466.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.80
|
| Rate for Payer: Healthscope Commercial |
$599.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.10
|
| Rate for Payer: PHP Commercial |
$566.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health SBD |
$419.58
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$319.99 |
| Max. Negotiated Rate |
$1,680.50 |
| Rate for Payer: Aetna Commercial |
$566.10
|
| Rate for Payer: Aetna Medicare |
$620.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.90
|
| 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 |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$572.76
|
| Rate for Payer: Cofinity Commercial |
$466.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$466.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$599.40
|
| 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 |
$566.10
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$566.10
|
| 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 |
$432.90
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health SBD |
$419.58
|
| 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 TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 13102
|
| Min. Negotiated Rate |
$68.33 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Aetna Commercial |
$91.56
|
| Rate for Payer: Aetna Medicare |
$71.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.56
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS MAPPO |
$68.33
|
| Rate for Payer: BCN Medicare Advantage |
$68.33
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$91.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.33
|
| Rate for Payer: Healthscope Commercial |
$126.41
|
| Rate for Payer: Healthscope Commercial |
$109.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.85
|
| Rate for Payer: Nomi Health Commercial |
$82.00
|
| Rate for Payer: PACE SWMI |
$68.33
|
| Rate for Payer: PHP Medicare Advantage |
$68.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health Medicare |
$68.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.33
|
| Rate for Payer: UHC Medicare Advantage |
$68.33
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health SBD |
$131.67
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$68.33 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Aetna Commercial |
$91.56
|
| Rate for Payer: Aetna Medicare |
$71.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.40
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS MAPPO |
$68.33
|
| Rate for Payer: BCN Medicare Advantage |
$68.33
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$91.56
|
| Rate for Payer: Cofinity Commercial |
$98.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.33
|
| Rate for Payer: Healthscope Commercial |
$126.41
|
| Rate for Payer: Healthscope Commercial |
$109.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.85
|
| Rate for Payer: Nomi Health Commercial |
$82.00
|
| Rate for Payer: PACE SWMI |
$68.33
|
| Rate for Payer: PHP Medicare Advantage |
$68.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health Medicare |
$68.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.33
|
| Rate for Payer: UHC Medicare Advantage |
$68.33
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health SBD |
$131.67
|
|
|
PR REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS 13153
|
| Min. Negotiated Rate |
$130.89 |
| Max. Negotiated Rate |
$307.45 |
| Rate for Payer: Aetna Commercial |
$175.39
|
| Rate for Payer: Aetna Medicare |
$136.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.39
|
| Rate for Payer: BCBS Complete |
$189.20
|
| Rate for Payer: BCBS MAPPO |
$130.89
|
| Rate for Payer: BCN Medicare Advantage |
$130.89
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cofinity Commercial |
$188.48
|
| Rate for Payer: Cofinity Commercial |
$175.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.89
|
| Rate for Payer: Healthscope Commercial |
$209.42
|
| Rate for Payer: Healthscope Commercial |
$242.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.45
|
| Rate for Payer: Nomi Health Commercial |
$157.07
|
| Rate for Payer: PACE SWMI |
$130.89
|
| Rate for Payer: PHP Medicare Advantage |
$130.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.45
|
| Rate for Payer: Priority Health Medicare |
$130.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.89
|
| Rate for Payer: UHC Medicare Advantage |
$130.89
|
|
|
PR REPAIR CONGENITAL AV FISTULA EXTREMITIES
|
Professional
|
Both
|
$4,223.00
|
|
|
Service Code
|
HCPCS 35184
|
| Min. Negotiated Rate |
$929.71 |
| Max. Negotiated Rate |
$2,744.95 |
| Rate for Payer: Aetna Commercial |
$1,245.81
|
| Rate for Payer: Aetna Medicare |
$966.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,338.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,245.81
|
| Rate for Payer: BCBS Complete |
$1,689.20
|
| Rate for Payer: BCBS MAPPO |
$929.71
|
| Rate for Payer: BCN Medicare Advantage |
$929.71
|
| Rate for Payer: Cash Price |
$3,378.40
|
| Rate for Payer: Cash Price |
$3,378.40
|
| Rate for Payer: Cofinity Commercial |
$1,338.78
|
| Rate for Payer: Cofinity Commercial |
$1,245.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$929.71
|
| Rate for Payer: Healthscope Commercial |
$1,719.96
|
| Rate for Payer: Healthscope Commercial |
$1,487.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$976.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,744.95
|
| Rate for Payer: Nomi Health Commercial |
$1,115.65
|
| Rate for Payer: PACE SWMI |
$929.71
|
| Rate for Payer: PHP Medicare Advantage |
$929.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,744.95
|
| Rate for Payer: Priority Health Medicare |
$929.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$929.71
|
| Rate for Payer: UHC Medicare Advantage |
$929.71
|
|
|
PR REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA
|
Professional
|
Both
|
$1,951.00
|
|
|
Service Code
|
HCPCS 25425
|
| Min. Negotiated Rate |
$780.40 |
| Max. Negotiated Rate |
$1,720.11 |
| Rate for Payer: Aetna Commercial |
$1,245.92
|
| Rate for Payer: Aetna Medicare |
$966.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,338.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,245.92
|
| Rate for Payer: BCBS Complete |
$780.40
|
| Rate for Payer: BCBS MAPPO |
$929.79
|
| Rate for Payer: BCN Medicare Advantage |
$929.79
|
| Rate for Payer: Cash Price |
$1,560.80
|
| Rate for Payer: Cash Price |
$1,560.80
|
| Rate for Payer: Cofinity Commercial |
$1,338.90
|
| Rate for Payer: Cofinity Commercial |
$1,245.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$929.79
|
| Rate for Payer: Healthscope Commercial |
$1,487.66
|
| Rate for Payer: Healthscope Commercial |
$1,720.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$976.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,268.15
|
| Rate for Payer: Nomi Health Commercial |
$1,115.75
|
| Rate for Payer: PACE SWMI |
$929.79
|
| Rate for Payer: PHP Medicare Advantage |
$929.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,268.15
|
| Rate for Payer: Priority Health Medicare |
$929.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$929.79
|
| Rate for Payer: UHC Medicare Advantage |
$929.79
|
|
|
PR REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT
|
Professional
|
Both
|
$2,169.00
|
|
|
Service Code
|
HCPCS 27676
|
| Min. Negotiated Rate |
$587.75 |
| Max. Negotiated Rate |
$1,409.85 |
| Rate for Payer: Aetna Commercial |
$787.59
|
| Rate for Payer: Aetna Medicare |
$611.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.59
|
| Rate for Payer: BCBS Complete |
$867.60
|
| Rate for Payer: BCBS MAPPO |
$587.75
|
| Rate for Payer: BCN Medicare Advantage |
$587.75
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cofinity Commercial |
$846.36
|
| Rate for Payer: Cofinity Commercial |
$787.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$587.75
|
| Rate for Payer: Healthscope Commercial |
$940.40
|
| Rate for Payer: Healthscope Commercial |
$1,087.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$617.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,409.85
|
| Rate for Payer: Nomi Health Commercial |
$705.30
|
| Rate for Payer: PACE SWMI |
$587.75
|
| Rate for Payer: PHP Medicare Advantage |
$587.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,409.85
|
| Rate for Payer: Priority Health Medicare |
$587.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$587.75
|
| Rate for Payer: UHC Medicare Advantage |
$587.75
|
|
|
PR REPAIR ECTROPION EXTENSIVE
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 67917
|
| Min. Negotiated Rate |
$421.77 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$565.17
|
| Rate for Payer: Aetna Medicare |
$438.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$607.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.17
|
| Rate for Payer: BCBS Complete |
$500.00
|
| Rate for Payer: BCBS MAPPO |
$421.77
|
| Rate for Payer: BCN Medicare Advantage |
$421.77
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cofinity Commercial |
$607.35
|
| Rate for Payer: Cofinity Commercial |
$565.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.77
|
| Rate for Payer: Healthscope Commercial |
$674.83
|
| Rate for Payer: Healthscope Commercial |
$780.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$812.50
|
| Rate for Payer: Nomi Health Commercial |
$506.12
|
| Rate for Payer: PACE SWMI |
$421.77
|
| Rate for Payer: PHP Medicare Advantage |
$421.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$812.50
|
| Rate for Payer: Priority Health Medicare |
$421.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$421.77
|
| Rate for Payer: UHC Medicare Advantage |
$421.77
|
|
|
PR REPAIR ENTEROCELE ABDOMINAL APPROACH SPX
|
Professional
|
Both
|
$2,063.00
|
|
|
Service Code
|
HCPCS 57270
|
| Min. Negotiated Rate |
$778.02 |
| Max. Negotiated Rate |
$1,439.34 |
| Rate for Payer: Aetna Commercial |
$1,042.55
|
| Rate for Payer: Aetna Medicare |
$809.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,120.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,042.55
|
| Rate for Payer: BCBS Complete |
$825.20
|
| Rate for Payer: BCBS MAPPO |
$778.02
|
| Rate for Payer: BCN Medicare Advantage |
$778.02
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Cofinity Commercial |
$1,120.35
|
| Rate for Payer: Cofinity Commercial |
$1,042.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$778.02
|
| Rate for Payer: Healthscope Commercial |
$1,439.34
|
| Rate for Payer: Healthscope Commercial |
$1,244.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$816.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.95
|
| Rate for Payer: Nomi Health Commercial |
$933.62
|
| Rate for Payer: PACE SWMI |
$778.02
|
| Rate for Payer: PHP Medicare Advantage |
$778.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,340.95
|
| Rate for Payer: Priority Health Medicare |
$778.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$778.02
|
| Rate for Payer: UHC Medicare Advantage |
$778.02
|
|
|
PR REPAIR ENTEROCELE VAGINAL APPROACH SPX
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 57268
|
| Min. Negotiated Rate |
$482.90 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Aetna Commercial |
$647.09
|
| Rate for Payer: Aetna Medicare |
$502.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$695.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$647.09
|
| Rate for Payer: BCBS Complete |
$612.00
|
| Rate for Payer: BCBS MAPPO |
$482.90
|
| Rate for Payer: BCN Medicare Advantage |
$482.90
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$695.38
|
| Rate for Payer: Cofinity Commercial |
$647.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$482.90
|
| Rate for Payer: Healthscope Commercial |
$772.64
|
| Rate for Payer: Healthscope Commercial |
$893.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$507.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$994.50
|
| Rate for Payer: Nomi Health Commercial |
$579.48
|
| Rate for Payer: PACE SWMI |
$482.90
|
| Rate for Payer: PHP Medicare Advantage |
$482.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health Medicare |
$482.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$482.90
|
| Rate for Payer: UHC Medicare Advantage |
$482.90
|
|
|
PR REPAIR ENTROPION SUTURE
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
HCPCS 67921
|
| Min. Negotiated Rate |
$269.60 |
| Max. Negotiated Rate |
$532.04 |
| Rate for Payer: Aetna Commercial |
$385.37
|
| Rate for Payer: Aetna Medicare |
$299.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.37
|
| Rate for Payer: BCBS Complete |
$269.60
|
| Rate for Payer: BCBS MAPPO |
$287.59
|
| Rate for Payer: BCN Medicare Advantage |
$287.59
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cofinity Commercial |
$414.13
|
| Rate for Payer: Cofinity Commercial |
$385.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.59
|
| Rate for Payer: Healthscope Commercial |
$532.04
|
| Rate for Payer: Healthscope Commercial |
$460.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$301.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$438.10
|
| Rate for Payer: Nomi Health Commercial |
$345.11
|
| Rate for Payer: PACE SWMI |
$287.59
|
| Rate for Payer: PHP Medicare Advantage |
$287.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.10
|
| Rate for Payer: Priority Health Medicare |
$287.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.59
|
| Rate for Payer: UHC Medicare Advantage |
$287.59
|
|
|
PR REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 26433
|
| Min. Negotiated Rate |
$530.19 |
| Max. Negotiated Rate |
$980.85 |
| Rate for Payer: Aetna Commercial |
$710.45
|
| Rate for Payer: Aetna Medicare |
$551.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.45
|
| Rate for Payer: BCBS Complete |
$555.20
|
| Rate for Payer: BCBS MAPPO |
$530.19
|
| Rate for Payer: BCN Medicare Advantage |
$530.19
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$763.47
|
| Rate for Payer: Cofinity Commercial |
$710.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.19
|
| Rate for Payer: Healthscope Commercial |
$848.30
|
| Rate for Payer: Healthscope Commercial |
$980.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$556.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$902.20
|
| Rate for Payer: Nomi Health Commercial |
$636.23
|
| Rate for Payer: PACE SWMI |
$530.19
|
| Rate for Payer: PHP Medicare Advantage |
$530.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health Medicare |
$530.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$530.19
|
| Rate for Payer: UHC Medicare Advantage |
$530.19
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH
|
Professional
|
Both
|
$1,788.00
|
|
|
Service Code
|
HCPCS 26420
|
| Min. Negotiated Rate |
$690.78 |
| Max. Negotiated Rate |
$1,277.94 |
| Rate for Payer: Aetna Commercial |
$925.65
|
| Rate for Payer: Aetna Medicare |
$718.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$994.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$925.65
|
| Rate for Payer: BCBS Complete |
$715.20
|
| Rate for Payer: BCBS MAPPO |
$690.78
|
| Rate for Payer: BCN Medicare Advantage |
$690.78
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cofinity Commercial |
$994.72
|
| Rate for Payer: Cofinity Commercial |
$925.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$690.78
|
| Rate for Payer: Healthscope Commercial |
$1,277.94
|
| Rate for Payer: Healthscope Commercial |
$1,105.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$725.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,162.20
|
| Rate for Payer: Nomi Health Commercial |
$828.94
|
| Rate for Payer: PACE SWMI |
$690.78
|
| Rate for Payer: PHP Medicare Advantage |
$690.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,162.20
|
| Rate for Payer: Priority Health Medicare |
$690.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$690.78
|
| Rate for Payer: UHC Medicare Advantage |
$690.78
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH
|
Professional
|
Both
|
$1,309.00
|
|
|
Service Code
|
HCPCS 26418
|
| Min. Negotiated Rate |
$523.60 |
| Max. Negotiated Rate |
$1,066.77 |
| Rate for Payer: Aetna Commercial |
$772.68
|
| Rate for Payer: Aetna Medicare |
$599.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.68
|
| Rate for Payer: BCBS Complete |
$523.60
|
| Rate for Payer: BCBS MAPPO |
$576.63
|
| Rate for Payer: BCN Medicare Advantage |
$576.63
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cofinity Commercial |
$830.35
|
| Rate for Payer: Cofinity Commercial |
$772.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$576.63
|
| Rate for Payer: Healthscope Commercial |
$1,066.77
|
| Rate for Payer: Healthscope Commercial |
$922.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$605.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$850.85
|
| Rate for Payer: Nomi Health Commercial |
$691.96
|
| Rate for Payer: PACE SWMI |
$576.63
|
| Rate for Payer: PHP Medicare Advantage |
$576.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.85
|
| Rate for Payer: Priority Health Medicare |
$576.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$576.63
|
| Rate for Payer: UHC Medicare Advantage |
$576.63
|
|
|
PR REPAIR EXTENSOR TENDON HAND W/GRAFT EACH
|
Professional
|
Both
|
$1,933.00
|
|
|
Service Code
|
HCPCS 26412
|
| Min. Negotiated Rate |
$665.88 |
| Max. Negotiated Rate |
$1,256.45 |
| Rate for Payer: Aetna Commercial |
$892.28
|
| Rate for Payer: Aetna Medicare |
$692.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$958.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$892.28
|
| Rate for Payer: BCBS Complete |
$773.20
|
| Rate for Payer: BCBS MAPPO |
$665.88
|
| Rate for Payer: BCN Medicare Advantage |
$665.88
|
| Rate for Payer: Cash Price |
$1,546.40
|
| Rate for Payer: Cash Price |
$1,546.40
|
| Rate for Payer: Cofinity Commercial |
$958.87
|
| Rate for Payer: Cofinity Commercial |
$892.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$665.88
|
| Rate for Payer: Healthscope Commercial |
$1,231.88
|
| Rate for Payer: Healthscope Commercial |
$1,065.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$699.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,256.45
|
| Rate for Payer: Nomi Health Commercial |
$799.06
|
| Rate for Payer: PACE SWMI |
$665.88
|
| Rate for Payer: PHP Medicare Advantage |
$665.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,256.45
|
| Rate for Payer: Priority Health Medicare |
$665.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$665.88
|
| Rate for Payer: UHC Medicare Advantage |
$665.88
|
|
|
PR REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH
|
Professional
|
Both
|
$1,257.00
|
|
|
Service Code
|
HCPCS 26410
|
| Min. Negotiated Rate |
$502.80 |
| Max. Negotiated Rate |
$1,029.89 |
| Rate for Payer: Aetna Commercial |
$745.98
|
| Rate for Payer: Aetna Medicare |
$578.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$801.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$745.98
|
| Rate for Payer: BCBS Complete |
$502.80
|
| Rate for Payer: BCBS MAPPO |
$556.70
|
| Rate for Payer: BCN Medicare Advantage |
$556.70
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Cofinity Commercial |
$801.65
|
| Rate for Payer: Cofinity Commercial |
$745.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$556.70
|
| Rate for Payer: Healthscope Commercial |
$1,029.89
|
| Rate for Payer: Healthscope Commercial |
$890.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$584.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$817.05
|
| Rate for Payer: Nomi Health Commercial |
$668.04
|
| Rate for Payer: PACE SWMI |
$556.70
|
| Rate for Payer: PHP Medicare Advantage |
$556.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.05
|
| Rate for Payer: Priority Health Medicare |
$556.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$556.70
|
| Rate for Payer: UHC Medicare Advantage |
$556.70
|
|
|
PR REPAIR FASCIAL DEFECT LEG
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 27656
|
| Min. Negotiated Rate |
$324.14 |
| Max. Negotiated Rate |
$601.25 |
| Rate for Payer: Aetna Commercial |
$434.35
|
| Rate for Payer: Aetna Medicare |
$337.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.35
|
| Rate for Payer: BCBS Complete |
$370.00
|
| Rate for Payer: BCBS MAPPO |
$324.14
|
| Rate for Payer: BCN Medicare Advantage |
$324.14
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cofinity Commercial |
$466.76
|
| Rate for Payer: Cofinity Commercial |
$434.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.14
|
| Rate for Payer: Healthscope Commercial |
$599.66
|
| Rate for Payer: Healthscope Commercial |
$518.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$340.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.25
|
| Rate for Payer: Nomi Health Commercial |
$388.97
|
| Rate for Payer: PACE SWMI |
$324.14
|
| Rate for Payer: PHP Medicare Advantage |
$324.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.25
|
| Rate for Payer: Priority Health Medicare |
$324.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.14
|
| Rate for Payer: UHC Medicare Advantage |
$324.14
|
|
|
PR REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION
|
Professional
|
Both
|
$4,033.00
|
|
|
Service Code
|
HCPCS 27726
|
| Min. Negotiated Rate |
$924.08 |
| Max. Negotiated Rate |
$2,621.45 |
| Rate for Payer: Aetna Commercial |
$1,238.27
|
| Rate for Payer: Aetna Medicare |
$961.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,330.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,238.27
|
| Rate for Payer: BCBS Complete |
$1,613.20
|
| Rate for Payer: BCBS MAPPO |
$924.08
|
| Rate for Payer: BCN Medicare Advantage |
$924.08
|
| Rate for Payer: Cash Price |
$3,226.40
|
| Rate for Payer: Cash Price |
$3,226.40
|
| Rate for Payer: Cofinity Commercial |
$1,330.68
|
| Rate for Payer: Cofinity Commercial |
$1,238.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$924.08
|
| Rate for Payer: Healthscope Commercial |
$1,478.53
|
| Rate for Payer: Healthscope Commercial |
$1,709.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$970.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,621.45
|
| Rate for Payer: Nomi Health Commercial |
$1,108.90
|
| Rate for Payer: PACE SWMI |
$924.08
|
| Rate for Payer: PHP Medicare Advantage |
$924.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,621.45
|
| Rate for Payer: Priority Health Medicare |
$924.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$924.08
|
| Rate for Payer: UHC Medicare Advantage |
$924.08
|
|
|
PR REPAIR FIRST ABDOMINAL WALL HERNIA
|
Professional
|
Both
|
$2,106.00
|
|
|
Service Code
|
HCPCS 49560
|
| Min. Negotiated Rate |
$842.40 |
| Max. Negotiated Rate |
$1,368.90 |
| Rate for Payer: Aetna Medicare |
$1,053.00
|
| Rate for Payer: BCBS Complete |
$842.40
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,368.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,368.90
|
|
|
PR REPAIR FISTULA OROMAXILLARY
|
Professional
|
Both
|
$1,483.00
|
|
|
Service Code
|
HCPCS 30580
|
| Min. Negotiated Rate |
$440.14 |
| Max. Negotiated Rate |
$963.95 |
| Rate for Payer: Aetna Commercial |
$589.79
|
| Rate for Payer: Aetna Medicare |
$457.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$589.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.80
|
| Rate for Payer: BCBS Complete |
$593.20
|
| Rate for Payer: BCBS MAPPO |
$440.14
|
| Rate for Payer: BCN Medicare Advantage |
$440.14
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cofinity Commercial |
$633.80
|
| Rate for Payer: Cofinity Commercial |
$589.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$440.14
|
| Rate for Payer: Healthscope Commercial |
$814.26
|
| Rate for Payer: Healthscope Commercial |
$704.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$462.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$963.95
|
| Rate for Payer: Nomi Health Commercial |
$528.17
|
| Rate for Payer: PACE SWMI |
$440.14
|
| Rate for Payer: PHP Medicare Advantage |
$440.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.95
|
| Rate for Payer: Priority Health Medicare |
$440.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$440.14
|
| Rate for Payer: UHC Medicare Advantage |
$440.14
|
|
|
PR REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 27658
|
| Min. Negotiated Rate |
$356.27 |
| Max. Negotiated Rate |
$845.65 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Aetna Medicare |
$370.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.03
|
| Rate for Payer: BCBS Complete |
$520.40
|
| Rate for Payer: BCBS MAPPO |
$356.27
|
| Rate for Payer: BCN Medicare Advantage |
$356.27
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$477.40
|
| Rate for Payer: Cofinity Commercial |
$513.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$356.27
|
| Rate for Payer: Healthscope Commercial |
$570.03
|
| Rate for Payer: Healthscope Commercial |
$659.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.65
|
| Rate for Payer: Nomi Health Commercial |
$427.52
|
| Rate for Payer: PACE SWMI |
$356.27
|
| Rate for Payer: PHP Medicare Advantage |
$356.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health Medicare |
$356.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$356.27
|
| Rate for Payer: UHC Medicare Advantage |
$356.27
|
|
