|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY
|
Professional
|
Both
|
$3,698.00
|
|
|
Service Code
|
HCPCS 35236
|
| Min. Negotiated Rate |
$636.02 |
| Max. Negotiated Rate |
$176,369.00 |
| Rate for Payer: Aetna Commercial |
$1,295.15
|
| Rate for Payer: Aetna Medicare |
$1,005.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,295.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,391.80
|
| Rate for Payer: BCBS Complete |
$667.82
|
| Rate for Payer: BCBS MAPPO |
$966.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,563.84
|
| Rate for Payer: BCN Commercial |
$1,427.91
|
| 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 |
$1,788.08
|
| Rate for Payer: Healthscope Commercial |
$1,546.45
|
| Rate for Payer: Mclaren Medicaid |
$636.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,014.86
|
| Rate for Payer: Meridian Medicaid |
$667.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176,369.00
|
| 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 Choice Medicaid |
$636.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,403.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,565.69
|
| Rate for Payer: Priority Health Medicare |
$966.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,565.69
|
| Rate for Payer: Priority Health SBD |
$1,565.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,172.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$966.53
|
| Rate for Payer: UHC Exchange |
$1,172.71
|
| Rate for Payer: UHC Medicare Advantage |
$966.53
|
| Rate for Payer: UHCCP Medicaid |
$636.02
|
|
|
PR REPAIR BROW PTOSIS
|
Professional
|
Both
|
$1,326.00
|
|
|
Service Code
|
HCPCS 67900
|
| Min. Negotiated Rate |
$183.32 |
| Max. Negotiated Rate |
$86,936.00 |
| Rate for Payer: Aetna Commercial |
$627.51
|
| Rate for Payer: Aetna Medicare |
$487.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.34
|
| Rate for Payer: BCBS Complete |
$336.60
|
| Rate for Payer: BCBS MAPPO |
$468.29
|
| Rate for Payer: BCBS Trust/PPO |
$183.32
|
| Rate for Payer: BCN Commercial |
$944.61
|
| 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: Mclaren Medicaid |
$320.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$491.70
|
| Rate for Payer: Meridian Medicaid |
$336.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86,936.00
|
| 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 Choice Medicaid |
$320.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$878.53
|
| Rate for Payer: Priority Health Medicare |
$468.29
|
| Rate for Payer: Priority Health Narrow Network |
$878.53
|
| Rate for Payer: Priority Health SBD |
$878.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$713.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$468.29
|
| Rate for Payer: UHC Exchange |
$713.81
|
| Rate for Payer: UHC Medicare Advantage |
$468.29
|
| Rate for Payer: UHCCP Medicaid |
$320.57
|
|
|
PR REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS
|
Professional
|
Both
|
$7,686.00
|
|
|
Service Code
|
HCPCS 33305
|
| Min. Negotiated Rate |
$786.64 |
| Max. Negotiated Rate |
$723,632.00 |
| Rate for Payer: Aetna Commercial |
$5,250.48
|
| Rate for Payer: Aetna Medicare |
$4,075.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,250.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,642.31
|
| Rate for Payer: BCBS Complete |
$2,688.94
|
| Rate for Payer: BCBS MAPPO |
$3,918.27
|
| Rate for Payer: BCBS Trust/PPO |
$786.64
|
| Rate for Payer: BCN Commercial |
$5,839.21
|
| 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 |
$7,248.80
|
| Rate for Payer: Healthscope Commercial |
$6,269.23
|
| Rate for Payer: Mclaren Medicaid |
$2,560.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,114.18
|
| Rate for Payer: Meridian Medicaid |
$2,688.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723,632.00
|
| 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 Choice Medicaid |
$2,560.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,995.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,391.47
|
| Rate for Payer: Priority Health Medicare |
$3,918.27
|
| Rate for Payer: Priority Health Narrow Network |
$6,391.47
|
| Rate for Payer: Priority Health SBD |
$6,391.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,919.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,918.27
|
| Rate for Payer: UHC Exchange |
$1,919.27
|
| Rate for Payer: UHC Medicare Advantage |
$3,918.27
|
| Rate for Payer: UHCCP Medicaid |
$2,560.90
|
|
|
PR REPAIR CARDIAC WOUND W/O BYPASS
|
Professional
|
Both
|
$4,597.00
|
|
|
Service Code
|
HCPCS 33300
|
| Min. Negotiated Rate |
$1,537.22 |
| Max. Negotiated Rate |
$431,320.00 |
| Rate for Payer: Aetna Commercial |
$3,144.97
|
| Rate for Payer: Aetna Medicare |
$2,440.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,144.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,379.67
|
| Rate for Payer: BCBS Complete |
$1,614.08
|
| Rate for Payer: BCBS MAPPO |
$2,346.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,283.84
|
| Rate for Payer: BCN Commercial |
$3,485.73
|
| 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: Mclaren Medicaid |
$1,537.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,464.34
|
| Rate for Payer: Meridian Medicaid |
$1,614.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431,320.00
|
| 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 Choice Medicaid |
$1,537.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,988.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,818.50
|
| Rate for Payer: Priority Health Medicare |
$2,346.99
|
| Rate for Payer: Priority Health Narrow Network |
$3,818.50
|
| Rate for Payer: Priority Health SBD |
$3,818.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,604.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,346.99
|
| Rate for Payer: UHC Exchange |
$1,604.31
|
| Rate for Payer: UHC Medicare Advantage |
$2,346.99
|
| Rate for Payer: UHCCP Medicaid |
$1,537.22
|
|
|
PR REPAIR CHOANAL ATRESIA INTRANASAL
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
HCPCS 30540
|
| Min. Negotiated Rate |
$472.43 |
| Max. Negotiated Rate |
$130,133.00 |
| Rate for Payer: Aetna Commercial |
$919.43
|
| Rate for Payer: Aetna Medicare |
$713.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$919.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$988.04
|
| Rate for Payer: BCBS Complete |
$496.05
|
| Rate for Payer: BCBS MAPPO |
$686.14
|
| Rate for Payer: BCBS Trust/PPO |
$614.94
|
| Rate for Payer: BCN Commercial |
$1,096.60
|
| 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 |
$1,269.36
|
| Rate for Payer: Healthscope Commercial |
$1,097.82
|
| Rate for Payer: Mclaren Medicaid |
$472.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.45
|
| Rate for Payer: Meridian Medicaid |
$496.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130,133.00
|
| 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 Choice Medicaid |
$472.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,036.31
|
| Rate for Payer: Priority Health Medicare |
$686.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,036.31
|
| Rate for Payer: Priority Health SBD |
$1,036.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$677.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.14
|
| Rate for Payer: UHC Exchange |
$677.49
|
| Rate for Payer: UHC Medicare Advantage |
$686.14
|
| Rate for Payer: UHCCP Medicaid |
$472.43
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 13151
|
| Min. Negotiated Rate |
$177.86 |
| Max. Negotiated Rate |
$48,744.00 |
| Rate for Payer: Aetna Commercial |
$352.70
|
| Rate for Payer: Aetna Medicare |
$273.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.02
|
| Rate for Payer: BCBS Complete |
$186.75
|
| Rate for Payer: BCBS MAPPO |
$263.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,139.30
|
| Rate for Payer: BCN Commercial |
$622.09
|
| 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: Mclaren Medicaid |
$177.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.37
|
| Rate for Payer: Meridian Medicaid |
$186.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48,744.00
|
| 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 Choice Medicaid |
$177.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$373.86
|
| Rate for Payer: Priority Health Medicare |
$263.21
|
| Rate for Payer: Priority Health Narrow Network |
$373.86
|
| Rate for Payer: Priority Health SBD |
$373.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$402.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.21
|
| Rate for Payer: UHC Exchange |
$402.90
|
| Rate for Payer: UHC Medicare Advantage |
$263.21
|
| Rate for Payer: UHCCP Medicaid |
$177.86
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Professional
|
Both
|
$1,232.00
|
|
|
Service Code
|
HCPCS 13152
|
| Min. Negotiated Rate |
$213.64 |
| Max. Negotiated Rate |
$58,788.00 |
| Rate for Payer: Aetna Commercial |
$423.92
|
| Rate for Payer: Aetna Medicare |
$329.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.56
|
| Rate for Payer: BCBS Complete |
$224.32
|
| Rate for Payer: BCBS MAPPO |
$316.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,272.50
|
| Rate for Payer: BCN Commercial |
$729.10
|
| 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 |
$585.27
|
| Rate for Payer: Healthscope Commercial |
$506.18
|
| Rate for Payer: Mclaren Medicaid |
$213.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.18
|
| Rate for Payer: Meridian Medicaid |
$224.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58,788.00
|
| 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 Choice Medicaid |
$213.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$800.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$450.61
|
| Rate for Payer: Priority Health Medicare |
$316.36
|
| Rate for Payer: Priority Health Narrow Network |
$450.61
|
| Rate for Payer: Priority Health SBD |
$450.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.36
|
| Rate for Payer: UHC Exchange |
$578.82
|
| Rate for Payer: UHC Medicare Advantage |
$316.36
|
| Rate for Payer: UHCCP Medicaid |
$213.64
|
|
|
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 |
$5.64 |
| Max. Negotiated Rate |
$42,255.00 |
| Rate for Payer: Aetna Commercial |
$307.30
|
| Rate for Payer: Aetna Medicare |
$238.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.24
|
| Rate for Payer: BCBS Complete |
$162.81
|
| Rate for Payer: BCBS MAPPO |
$229.33
|
| Rate for Payer: BCBS Trust/PPO |
$5.64
|
| Rate for Payer: BCN Commercial |
$570.29
|
| 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: Mclaren Medicaid |
$155.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.80
|
| Rate for Payer: Meridian Medicaid |
$162.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,255.00
|
| 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 Choice Medicaid |
$155.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$325.54
|
| Rate for Payer: Priority Health Medicare |
$229.33
|
| Rate for Payer: Priority Health Narrow Network |
$325.54
|
| Rate for Payer: Priority Health SBD |
$325.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.33
|
| Rate for Payer: UHC Exchange |
$315.04
|
| Rate for Payer: UHC Medicare Advantage |
$229.33
|
| Rate for Payer: UHCCP Medicaid |
$155.06
|
|
|
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 |
$192.98 |
| Max. Negotiated Rate |
$52,994.00 |
| Rate for Payer: Aetna Commercial |
$382.44
|
| Rate for Payer: Aetna Medicare |
$296.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.98
|
| Rate for Payer: BCBS Complete |
$202.63
|
| Rate for Payer: BCBS MAPPO |
$285.40
|
| Rate for Payer: BCBS Trust/PPO |
$349.63
|
| Rate for Payer: BCN Commercial |
$691.96
|
| 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 |
$527.99
|
| Rate for Payer: Healthscope Commercial |
$456.64
|
| Rate for Payer: Mclaren Medicaid |
$192.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$299.67
|
| Rate for Payer: Meridian Medicaid |
$202.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52,994.00
|
| 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 Choice Medicaid |
$192.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$406.37
|
| Rate for Payer: Priority Health Medicare |
$285.40
|
| Rate for Payer: Priority Health Narrow Network |
$406.37
|
| Rate for Payer: Priority Health SBD |
$406.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.40
|
| Rate for Payer: UHC Exchange |
$441.37
|
| Rate for Payer: UHC Medicare Advantage |
$285.40
|
| Rate for Payer: UHCCP Medicaid |
$192.98
|
|
|
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 |
$79.45 |
| Max. Negotiated Rate |
$21,965.00 |
| Rate for Payer: Aetna Commercial |
$158.91
|
| Rate for Payer: Aetna Medicare |
$123.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.77
|
| Rate for Payer: BCBS Complete |
$83.42
|
| Rate for Payer: BCBS MAPPO |
$118.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,316.25
|
| Rate for Payer: BCN Commercial |
$245.80
|
| 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: Mclaren Medicaid |
$79.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.52
|
| Rate for Payer: Meridian Medicaid |
$83.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,965.00
|
| 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 Choice Medicaid |
$79.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.96
|
| Rate for Payer: Priority Health Medicare |
$118.59
|
| Rate for Payer: Priority Health Narrow Network |
$167.96
|
| Rate for Payer: Priority Health SBD |
$167.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.59
|
| Rate for Payer: UHC Exchange |
$142.72
|
| Rate for Payer: UHC Medicare Advantage |
$118.59
|
| Rate for Payer: UHCCP Medicaid |
$79.45
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
HCPCS 13120
|
| Min. Negotiated Rate |
$84.02 |
| Max. Negotiated Rate |
$40,442.00 |
| Rate for Payer: Aetna Commercial |
$290.65
|
| Rate for Payer: Aetna Medicare |
$225.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.34
|
| Rate for Payer: BCBS Complete |
$154.99
|
| Rate for Payer: BCBS MAPPO |
$216.90
|
| Rate for Payer: BCBS Trust/PPO |
$84.02
|
| Rate for Payer: BCN Commercial |
$522.88
|
| 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 |
$401.26
|
| Rate for Payer: Healthscope Commercial |
$347.04
|
| Rate for Payer: Mclaren Medicaid |
$147.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.74
|
| Rate for Payer: Meridian Medicaid |
$154.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,442.00
|
| 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 Choice Medicaid |
$147.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.00
|
| Rate for Payer: Priority Health Medicare |
$216.90
|
| Rate for Payer: Priority Health Narrow Network |
$312.00
|
| Rate for Payer: Priority Health SBD |
$312.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.90
|
| Rate for Payer: UHC Exchange |
$284.57
|
| Rate for Payer: UHC Medicare Advantage |
$216.90
|
| Rate for Payer: UHCCP Medicaid |
$147.61
|
|
|
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 |
$269.26 |
| Max. Negotiated Rate |
$1,885.01 |
| Rate for Payer: Aetna Commercial |
$763.30
|
| Rate for Payer: Aetna Medicare |
$623.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$583.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$749.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$749.69
|
| Rate for Payer: BCBS Complete |
$337.54
|
| Rate for Payer: BCBS MAPPO |
$599.75
|
| Rate for Payer: BCBS Trust/PPO |
$373.96
|
| Rate for Payer: BCN Commercial |
$373.96
|
| Rate for Payer: BCN Medicare Advantage |
$599.75
|
| Rate for Payer: Cash Price |
$718.40
|
| 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 |
$599.75
|
| Rate for Payer: Healthscope Commercial |
$808.20
|
| Rate for Payer: Mclaren Medicaid |
$321.47
|
| Rate for Payer: Mclaren Medicare |
$599.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.74
|
| Rate for Payer: Meridian Medicaid |
$337.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$763.30
|
| Rate for Payer: Nomi Health Commercial |
$1,259.48
|
| Rate for Payer: PACE Medicare |
$569.76
|
| Rate for Payer: PACE SWMI |
$599.75
|
| Rate for Payer: PHP Commercial |
$763.30
|
| Rate for Payer: PHP Medicare Advantage |
$599.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,885.01
|
| Rate for Payer: Priority Health Medicare |
$599.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,508.01
|
| Rate for Payer: Priority Health SBD |
$565.74
|
| Rate for Payer: Railroad Medicare Medicare |
$599.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.26
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.75
|
| Rate for Payer: UHC Medicare Advantage |
$599.75
|
| Rate for Payer: UHCCP Medicaid |
$337.66
|
| Rate for Payer: VA VA |
$599.75
|
|
|
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 |
$165.08 |
| Max. Negotiated Rate |
$44,957.00 |
| 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 |
$173.33
|
| Rate for Payer: BCBS MAPPO |
$244.04
|
| Rate for Payer: BCBS Trust/PPO |
$347.82
|
| Rate for Payer: BCN Commercial |
$624.53
|
| 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: Mclaren Medicaid |
$165.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.24
|
| Rate for Payer: Meridian Medicaid |
$173.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44,957.00
|
| 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 Choice Medicaid |
$165.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$346.77
|
| Rate for Payer: Priority Health Medicare |
$244.04
|
| Rate for Payer: Priority Health Narrow Network |
$346.77
|
| Rate for Payer: Priority Health SBD |
$346.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.04
|
| Rate for Payer: UHC Exchange |
$354.06
|
| Rate for Payer: UHC Medicare Advantage |
$244.04
|
| Rate for Payer: UHCCP Medicaid |
$165.08
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
HCPCS 13121
|
| Min. Negotiated Rate |
$165.08 |
| Max. Negotiated Rate |
$44,957.00 |
| 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 |
$173.33
|
| Rate for Payer: BCBS MAPPO |
$244.04
|
| Rate for Payer: BCBS Trust/PPO |
$347.82
|
| Rate for Payer: BCN Commercial |
$624.53
|
| 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: Mclaren Medicaid |
$165.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.24
|
| Rate for Payer: Meridian Medicaid |
$173.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44,957.00
|
| 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 Choice Medicaid |
$165.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$346.77
|
| Rate for Payer: Priority Health Medicare |
$244.04
|
| Rate for Payer: Priority Health Narrow Network |
$346.77
|
| Rate for Payer: Priority Health SBD |
$346.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.04
|
| Rate for Payer: UHC Exchange |
$354.06
|
| Rate for Payer: UHC Medicare Advantage |
$244.04
|
| Rate for Payer: UHCCP Medicaid |
$165.08
|
|
|
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 |
$52.19 |
| Max. Negotiated Rate |
$14,618.00 |
| 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 |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$78.12
|
| Rate for Payer: BCBS Trust/PPO |
$377.55
|
| Rate for Payer: BCN Commercial |
$186.67
|
| 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 |
$144.52
|
| Rate for Payer: Healthscope Commercial |
$124.99
|
| Rate for Payer: Mclaren Medicaid |
$52.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.03
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,618.00
|
| 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 Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.62
|
| Rate for Payer: Priority Health Medicare |
$78.12
|
| Rate for Payer: Priority Health Narrow Network |
$110.62
|
| Rate for Payer: Priority Health SBD |
$110.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.12
|
| Rate for Payer: UHC Exchange |
$103.12
|
| Rate for Payer: UHC Medicare Advantage |
$78.12
|
| Rate for Payer: UHCCP Medicaid |
$52.19
|
|
|
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 |
$87.09 |
| Max. Negotiated Rate |
$878.00 |
| 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: BCBS Trust/PPO |
$800.44
|
| Rate for Payer: BCN Commercial |
$800.44
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.09
|
| Rate for Payer: UHC Core |
$878.00
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 13122
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$14,618.00 |
| 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 |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$78.12
|
| Rate for Payer: BCBS Trust/PPO |
$377.55
|
| Rate for Payer: BCN Commercial |
$186.67
|
| 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 |
$144.52
|
| Rate for Payer: Healthscope Commercial |
$124.99
|
| Rate for Payer: Mclaren Medicaid |
$52.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.03
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,618.00
|
| 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 Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.62
|
| Rate for Payer: Priority Health Medicare |
$78.12
|
| Rate for Payer: Priority Health Narrow Network |
$110.62
|
| Rate for Payer: Priority Health SBD |
$110.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.12
|
| Rate for Payer: UHC Exchange |
$103.12
|
| Rate for Payer: UHC Medicare Advantage |
$78.12
|
| Rate for Payer: UHCCP Medicaid |
$52.19
|
|
|
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 TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
HCPCS 13100
|
| Min. Negotiated Rate |
$128.65 |
| Max. Negotiated Rate |
$35,064.00 |
| Rate for Payer: Aetna Commercial |
$254.51
|
| Rate for Payer: Aetna Medicare |
$197.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.50
|
| Rate for Payer: BCBS Complete |
$135.08
|
| Rate for Payer: BCBS MAPPO |
$189.93
|
| Rate for Payer: BCBS Trust/PPO |
$293.06
|
| Rate for Payer: BCN Commercial |
$501.39
|
| 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: Mclaren Medicaid |
$128.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.43
|
| Rate for Payer: Meridian Medicaid |
$135.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35,064.00
|
| 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 Choice Medicaid |
$128.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.01
|
| Rate for Payer: Priority Health Medicare |
$189.93
|
| Rate for Payer: Priority Health Narrow Network |
$270.01
|
| Rate for Payer: Priority Health SBD |
$270.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.93
|
| Rate for Payer: UHC Exchange |
$272.29
|
| Rate for Payer: UHC Medicare Advantage |
$189.93
|
| Rate for Payer: UHCCP Medicaid |
$128.65
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 13101
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$43,099.00 |
| 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 |
$165.50
|
| Rate for Payer: BCBS MAPPO |
$231.78
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$583.97
|
| 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 |
$428.79
|
| Rate for Payer: Healthscope Commercial |
$370.85
|
| Rate for Payer: Mclaren Medicaid |
$157.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.37
|
| Rate for Payer: Meridian Medicaid |
$165.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43,099.00
|
| 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 Choice Medicaid |
$157.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$332.32
|
| Rate for Payer: Priority Health Medicare |
$231.78
|
| Rate for Payer: Priority Health Narrow Network |
$332.32
|
| Rate for Payer: Priority Health SBD |
$332.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.78
|
| Rate for Payer: UHC Exchange |
$313.86
|
| Rate for Payer: UHC Medicare Advantage |
$231.78
|
| Rate for Payer: UHCCP Medicaid |
$157.62
|
|
|
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 |
$256.68 |
| Max. Negotiated Rate |
$1,885.01 |
| Rate for Payer: Aetna Commercial |
$566.10
|
| Rate for Payer: Aetna Medicare |
$623.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$749.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$749.69
|
| Rate for Payer: BCBS Complete |
$337.54
|
| Rate for Payer: BCBS MAPPO |
$599.75
|
| Rate for Payer: BCBS Trust/PPO |
$373.96
|
| Rate for Payer: BCN Commercial |
$373.96
|
| Rate for Payer: BCN Medicare Advantage |
$599.75
|
| Rate for Payer: Cash Price |
$532.80
|
| 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 |
$599.75
|
| Rate for Payer: Healthscope Commercial |
$599.40
|
| Rate for Payer: Mclaren Medicaid |
$321.47
|
| Rate for Payer: Mclaren Medicare |
$599.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.74
|
| Rate for Payer: Meridian Medicaid |
$337.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.10
|
| Rate for Payer: Nomi Health Commercial |
$1,259.48
|
| Rate for Payer: PACE Medicare |
$569.76
|
| Rate for Payer: PACE SWMI |
$599.75
|
| Rate for Payer: PHP Commercial |
$566.10
|
| Rate for Payer: PHP Medicare Advantage |
$599.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,885.01
|
| Rate for Payer: Priority Health Medicare |
$599.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,508.01
|
| Rate for Payer: Priority Health SBD |
$419.58
|
| Rate for Payer: Railroad Medicare Medicare |
$599.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.68
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.75
|
| Rate for Payer: UHC Medicare Advantage |
$599.75
|
| Rate for Payer: UHCCP Medicaid |
$337.66
|
| Rate for Payer: VA VA |
$599.75
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$43,099.00 |
| 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 |
$165.50
|
| Rate for Payer: BCBS MAPPO |
$231.78
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$583.97
|
| 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 |
$428.79
|
| Rate for Payer: Healthscope Commercial |
$370.85
|
| Rate for Payer: Mclaren Medicaid |
$157.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.37
|
| Rate for Payer: Meridian Medicaid |
$165.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43,099.00
|
| 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 Choice Medicaid |
$157.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$332.32
|
| Rate for Payer: Priority Health Medicare |
$231.78
|
| Rate for Payer: Priority Health Narrow Network |
$332.32
|
| Rate for Payer: Priority Health SBD |
$332.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.78
|
| Rate for Payer: UHC Exchange |
$313.86
|
| Rate for Payer: UHC Medicare Advantage |
$231.78
|
| Rate for Payer: UHCCP Medicaid |
$157.62
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$12,645.00 |
| 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 |
$47.86
|
| Rate for Payer: BCBS MAPPO |
$68.33
|
| Rate for Payer: BCBS Trust/PPO |
$483.39
|
| Rate for Payer: BCN Commercial |
$171.04
|
| 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: Mclaren Medicaid |
$45.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.75
|
| Rate for Payer: Meridian Medicaid |
$47.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,645.00
|
| 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 Choice Medicaid |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.17
|
| Rate for Payer: Priority Health Medicare |
$68.33
|
| Rate for Payer: Priority Health Narrow Network |
$96.17
|
| Rate for Payer: Priority Health SBD |
$96.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.33
|
| Rate for Payer: UHC Exchange |
$83.30
|
| Rate for Payer: UHC Medicare Advantage |
$68.33
|
| Rate for Payer: UHCCP Medicaid |
$45.58
|
|
