|
PR REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE
|
Professional
|
Both
|
$762.00
|
|
|
Service Code
|
HCPCS 26591
|
| Min. Negotiated Rate |
$304.80 |
| Max. Negotiated Rate |
$835.79 |
| Rate for Payer: Aetna Commercial |
$605.39
|
| Rate for Payer: Aetna Medicare |
$469.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$605.39
|
| Rate for Payer: BCBS Complete |
$304.80
|
| Rate for Payer: BCBS MAPPO |
$451.78
|
| Rate for Payer: BCN Medicare Advantage |
$451.78
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cofinity Commercial |
$650.56
|
| Rate for Payer: Cofinity Commercial |
$605.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$451.78
|
| Rate for Payer: Healthscope Commercial |
$722.85
|
| Rate for Payer: Healthscope Commercial |
$835.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$474.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.30
|
| Rate for Payer: Nomi Health Commercial |
$542.14
|
| Rate for Payer: PACE SWMI |
$451.78
|
| Rate for Payer: PHP Medicare Advantage |
$451.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.30
|
| Rate for Payer: Priority Health Medicare |
$451.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$451.78
|
| Rate for Payer: UHC Medicare Advantage |
$451.78
|
|
|
PR REPAIR LACERATION DIAPHRAGM ANY APPROACH
|
Professional
|
Both
|
$4,732.00
|
|
|
Service Code
|
HCPCS 39501
|
| Min. Negotiated Rate |
$823.09 |
| Max. Negotiated Rate |
$3,075.80 |
| Rate for Payer: Aetna Commercial |
$1,102.94
|
| Rate for Payer: Aetna Medicare |
$856.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,185.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,102.94
|
| Rate for Payer: BCBS Complete |
$1,892.80
|
| Rate for Payer: BCBS MAPPO |
$823.09
|
| Rate for Payer: BCN Medicare Advantage |
$823.09
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Cofinity Commercial |
$1,185.25
|
| Rate for Payer: Cofinity Commercial |
$1,102.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$823.09
|
| Rate for Payer: Healthscope Commercial |
$1,522.72
|
| Rate for Payer: Healthscope Commercial |
$1,316.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$864.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,075.80
|
| Rate for Payer: Nomi Health Commercial |
$987.71
|
| Rate for Payer: PACE SWMI |
$823.09
|
| Rate for Payer: PHP Medicare Advantage |
$823.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.80
|
| Rate for Payer: Priority Health Medicare |
$823.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$823.09
|
| Rate for Payer: UHC Medicare Advantage |
$823.09
|
|
|
PR REPAIR LACERATION PALATE <2 CM
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
HCPCS 42180
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$330.28 |
| Rate for Payer: Aetna Commercial |
$239.23
|
| Rate for Payer: Aetna Medicare |
$185.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.23
|
| Rate for Payer: BCBS Complete |
$139.20
|
| Rate for Payer: BCBS MAPPO |
$178.53
|
| Rate for Payer: BCN Medicare Advantage |
$178.53
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cofinity Commercial |
$257.08
|
| Rate for Payer: Cofinity Commercial |
$239.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.53
|
| Rate for Payer: Healthscope Commercial |
$285.65
|
| Rate for Payer: Healthscope Commercial |
$330.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.20
|
| Rate for Payer: Nomi Health Commercial |
$214.24
|
| Rate for Payer: PACE SWMI |
$178.53
|
| Rate for Payer: PHP Medicare Advantage |
$178.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.20
|
| Rate for Payer: Priority Health Medicare |
$178.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.53
|
| Rate for Payer: UHC Medicare Advantage |
$178.53
|
|
|
PR REPAIR LACERATION PALATE >2 CM/COMPLEX
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
HCPCS 42182
|
| Min. Negotiated Rate |
$246.32 |
| Max. Negotiated Rate |
$479.05 |
| Rate for Payer: Aetna Commercial |
$330.07
|
| Rate for Payer: Aetna Medicare |
$256.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.07
|
| Rate for Payer: BCBS Complete |
$294.80
|
| Rate for Payer: BCBS MAPPO |
$246.32
|
| Rate for Payer: BCN Medicare Advantage |
$246.32
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$354.70
|
| Rate for Payer: Cofinity Commercial |
$330.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.32
|
| Rate for Payer: Healthscope Commercial |
$455.69
|
| Rate for Payer: Healthscope Commercial |
$394.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.05
|
| Rate for Payer: Nomi Health Commercial |
$295.58
|
| Rate for Payer: PACE SWMI |
$246.32
|
| Rate for Payer: PHP Medicare Advantage |
$246.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.05
|
| Rate for Payer: Priority Health Medicare |
$246.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$246.32
|
| Rate for Payer: UHC Medicare Advantage |
$246.32
|
|
|
PR REPAIR LATERAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$2,298.00
|
|
|
Service Code
|
HCPCS 24343
|
| Min. Negotiated Rate |
$692.27 |
| Max. Negotiated Rate |
$1,493.70 |
| Rate for Payer: Aetna Commercial |
$927.64
|
| Rate for Payer: Aetna Medicare |
$719.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$996.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$927.64
|
| Rate for Payer: BCBS Complete |
$919.20
|
| Rate for Payer: BCBS MAPPO |
$692.27
|
| Rate for Payer: BCN Medicare Advantage |
$692.27
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cofinity Commercial |
$996.87
|
| Rate for Payer: Cofinity Commercial |
$927.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$692.27
|
| Rate for Payer: Healthscope Commercial |
$1,107.63
|
| Rate for Payer: Healthscope Commercial |
$1,280.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$726.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,493.70
|
| Rate for Payer: Nomi Health Commercial |
$830.72
|
| Rate for Payer: PACE SWMI |
$692.27
|
| Rate for Payer: PHP Medicare Advantage |
$692.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.70
|
| Rate for Payer: Priority Health Medicare |
$692.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$692.27
|
| Rate for Payer: UHC Medicare Advantage |
$692.27
|
|
|
PR REPAIR LIP FULL THICKNESS <HALF VERTICAL HEIGHT
|
Professional
|
Both
|
$983.00
|
|
|
Service Code
|
HCPCS 40652
|
| Min. Negotiated Rate |
$346.08 |
| Max. Negotiated Rate |
$640.25 |
| Rate for Payer: Aetna Commercial |
$463.75
|
| Rate for Payer: Aetna Medicare |
$359.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.75
|
| Rate for Payer: BCBS Complete |
$393.20
|
| Rate for Payer: BCBS MAPPO |
$346.08
|
| Rate for Payer: BCN Medicare Advantage |
$346.08
|
| Rate for Payer: Cash Price |
$786.40
|
| Rate for Payer: Cash Price |
$786.40
|
| Rate for Payer: Cofinity Commercial |
$498.36
|
| Rate for Payer: Cofinity Commercial |
$463.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.08
|
| Rate for Payer: Healthscope Commercial |
$640.25
|
| Rate for Payer: Healthscope Commercial |
$553.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$363.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.95
|
| Rate for Payer: Nomi Health Commercial |
$415.30
|
| Rate for Payer: PACE SWMI |
$346.08
|
| Rate for Payer: PHP Medicare Advantage |
$346.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.95
|
| Rate for Payer: Priority Health Medicare |
$346.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$346.08
|
| Rate for Payer: UHC Medicare Advantage |
$346.08
|
|
|
PR REPAIR LIP FULL THICKNESS VERMILION ONLY
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 40650
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$562.16 |
| Rate for Payer: Aetna Commercial |
$407.19
|
| Rate for Payer: Aetna Medicare |
$316.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$407.19
|
| Rate for Payer: BCBS Complete |
$277.20
|
| Rate for Payer: BCBS MAPPO |
$303.87
|
| Rate for Payer: BCN Medicare Advantage |
$303.87
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Commercial |
$437.57
|
| Rate for Payer: Cofinity Commercial |
$407.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.87
|
| Rate for Payer: Healthscope Commercial |
$486.19
|
| Rate for Payer: Healthscope Commercial |
$562.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$319.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$450.45
|
| Rate for Payer: Nomi Health Commercial |
$364.64
|
| Rate for Payer: PACE SWMI |
$303.87
|
| Rate for Payer: PHP Medicare Advantage |
$303.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.45
|
| Rate for Payer: Priority Health Medicare |
$303.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.87
|
| Rate for Payer: UHC Medicare Advantage |
$303.87
|
|
|
PR REPAIR LUMBAR HERNIA
|
Professional
|
Both
|
$1,203.00
|
|
|
Service Code
|
HCPCS 49540
|
| Min. Negotiated Rate |
$481.20 |
| Max. Negotiated Rate |
$1,214.53 |
| Rate for Payer: Aetna Commercial |
$879.71
|
| Rate for Payer: Aetna Medicare |
$682.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$945.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$879.71
|
| Rate for Payer: BCBS Complete |
$481.20
|
| Rate for Payer: BCBS MAPPO |
$656.50
|
| Rate for Payer: BCN Medicare Advantage |
$656.50
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cofinity Commercial |
$945.36
|
| Rate for Payer: Cofinity Commercial |
$879.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$656.50
|
| Rate for Payer: Healthscope Commercial |
$1,214.53
|
| Rate for Payer: Healthscope Commercial |
$1,050.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$689.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.95
|
| Rate for Payer: Nomi Health Commercial |
$787.80
|
| Rate for Payer: PACE SWMI |
$656.50
|
| Rate for Payer: PHP Medicare Advantage |
$656.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$781.95
|
| Rate for Payer: Priority Health Medicare |
$656.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$656.50
|
| Rate for Payer: UHC Medicare Advantage |
$656.50
|
|
|
PR REPAIR LUNG HERNIA THROUGH CHEST WALL
|
Professional
|
Both
|
$2,356.00
|
|
|
Service Code
|
HCPCS 32800
|
| Min. Negotiated Rate |
$911.28 |
| Max. Negotiated Rate |
$1,685.87 |
| Rate for Payer: Aetna Commercial |
$1,221.12
|
| Rate for Payer: Aetna Medicare |
$947.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,312.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,221.12
|
| Rate for Payer: BCBS Complete |
$942.40
|
| Rate for Payer: BCBS MAPPO |
$911.28
|
| Rate for Payer: BCN Medicare Advantage |
$911.28
|
| Rate for Payer: Cash Price |
$1,884.80
|
| Rate for Payer: Cash Price |
$1,884.80
|
| Rate for Payer: Cofinity Commercial |
$1,312.24
|
| Rate for Payer: Cofinity Commercial |
$1,221.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$911.28
|
| Rate for Payer: Healthscope Commercial |
$1,458.05
|
| Rate for Payer: Healthscope Commercial |
$1,685.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$956.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,531.40
|
| Rate for Payer: Nomi Health Commercial |
$1,093.54
|
| Rate for Payer: PACE SWMI |
$911.28
|
| Rate for Payer: PHP Medicare Advantage |
$911.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,531.40
|
| Rate for Payer: Priority Health Medicare |
$911.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$911.28
|
| Rate for Payer: UHC Medicare Advantage |
$911.28
|
|
|
PR REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$2,298.00
|
|
|
Service Code
|
HCPCS 24345
|
| Min. Negotiated Rate |
$686.08 |
| Max. Negotiated Rate |
$1,493.70 |
| Rate for Payer: Aetna Commercial |
$919.35
|
| Rate for Payer: Aetna Medicare |
$713.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$987.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$919.35
|
| Rate for Payer: BCBS Complete |
$919.20
|
| Rate for Payer: BCBS MAPPO |
$686.08
|
| Rate for Payer: BCN Medicare Advantage |
$686.08
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cofinity Commercial |
$987.96
|
| Rate for Payer: Cofinity Commercial |
$919.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.08
|
| Rate for Payer: Healthscope Commercial |
$1,269.25
|
| Rate for Payer: Healthscope Commercial |
$1,097.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,493.70
|
| Rate for Payer: Nomi Health Commercial |
$823.30
|
| Rate for Payer: PACE SWMI |
$686.08
|
| Rate for Payer: PHP Medicare Advantage |
$686.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.70
|
| Rate for Payer: Priority Health Medicare |
$686.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.08
|
| Rate for Payer: UHC Medicare Advantage |
$686.08
|
|
|
PR REPAIR MENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$4,458.00
|
|
|
Service Code
|
HCPCS 63700
|
| Min. Negotiated Rate |
$1,301.93 |
| Max. Negotiated Rate |
$2,897.70 |
| Rate for Payer: Aetna Commercial |
$1,744.59
|
| Rate for Payer: Aetna Medicare |
$1,354.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,874.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,744.59
|
| Rate for Payer: BCBS Complete |
$1,783.20
|
| Rate for Payer: BCBS MAPPO |
$1,301.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,301.93
|
| Rate for Payer: Cash Price |
$3,566.40
|
| Rate for Payer: Cash Price |
$3,566.40
|
| Rate for Payer: Cofinity Commercial |
$1,874.78
|
| Rate for Payer: Cofinity Commercial |
$1,744.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,301.93
|
| Rate for Payer: Healthscope Commercial |
$2,083.09
|
| Rate for Payer: Healthscope Commercial |
$2,408.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,367.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,897.70
|
| Rate for Payer: Nomi Health Commercial |
$1,562.32
|
| Rate for Payer: PACE SWMI |
$1,301.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,301.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,897.70
|
| Rate for Payer: Priority Health Medicare |
$1,301.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,301.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,301.93
|
|
|
PR REPAIR MYELOMENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$5,092.00
|
|
|
Service Code
|
HCPCS 63704
|
| Min. Negotiated Rate |
$1,654.57 |
| Max. Negotiated Rate |
$3,309.80 |
| Rate for Payer: Aetna Commercial |
$2,217.12
|
| Rate for Payer: Aetna Medicare |
$1,720.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,382.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,217.12
|
| Rate for Payer: BCBS Complete |
$2,036.80
|
| Rate for Payer: BCBS MAPPO |
$1,654.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,654.57
|
| Rate for Payer: Cash Price |
$4,073.60
|
| Rate for Payer: Cash Price |
$4,073.60
|
| Rate for Payer: Cofinity Commercial |
$2,382.58
|
| Rate for Payer: Cofinity Commercial |
$2,217.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,654.57
|
| Rate for Payer: Healthscope Commercial |
$3,060.95
|
| Rate for Payer: Healthscope Commercial |
$2,647.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,737.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,309.80
|
| Rate for Payer: Nomi Health Commercial |
$1,985.48
|
| Rate for Payer: PACE SWMI |
$1,654.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,654.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,309.80
|
| Rate for Payer: Priority Health Medicare |
$1,654.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,654.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,654.57
|
|
|
PR REPAIR MYELOMENINGOCELE > 5 CM DIAMETER
|
Professional
|
Both
|
$5,361.00
|
|
|
Service Code
|
HCPCS 63706
|
| Min. Negotiated Rate |
$1,836.61 |
| Max. Negotiated Rate |
$3,484.65 |
| Rate for Payer: Aetna Commercial |
$2,461.06
|
| Rate for Payer: Aetna Medicare |
$1,910.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,644.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,461.06
|
| Rate for Payer: BCBS Complete |
$2,144.40
|
| Rate for Payer: BCBS MAPPO |
$1,836.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,836.61
|
| Rate for Payer: Cash Price |
$4,288.80
|
| Rate for Payer: Cash Price |
$4,288.80
|
| Rate for Payer: Cofinity Commercial |
$2,644.72
|
| Rate for Payer: Cofinity Commercial |
$2,461.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,836.61
|
| Rate for Payer: Healthscope Commercial |
$2,938.58
|
| Rate for Payer: Healthscope Commercial |
$3,397.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,928.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,484.65
|
| Rate for Payer: Nomi Health Commercial |
$2,203.93
|
| Rate for Payer: PACE SWMI |
$1,836.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,836.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,484.65
|
| Rate for Payer: Priority Health Medicare |
$1,836.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,836.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,836.61
|
|
|
PR REPAIR NAIL BED
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
HCPCS 11760
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$257.40 |
| Rate for Payer: Aetna Commercial |
$138.64
|
| Rate for Payer: Aetna Medicare |
$107.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.64
|
| Rate for Payer: BCBS Complete |
$158.40
|
| Rate for Payer: BCBS MAPPO |
$103.46
|
| Rate for Payer: BCN Medicare Advantage |
$103.46
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cofinity Commercial |
$148.98
|
| Rate for Payer: Cofinity Commercial |
$138.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.46
|
| Rate for Payer: Healthscope Commercial |
$191.40
|
| Rate for Payer: Healthscope Commercial |
$165.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.40
|
| Rate for Payer: Nomi Health Commercial |
$124.15
|
| Rate for Payer: PACE SWMI |
$103.46
|
| Rate for Payer: PHP Medicare Advantage |
$103.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.40
|
| Rate for Payer: Priority Health Medicare |
$103.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.46
|
| Rate for Payer: UHC Medicare Advantage |
$103.46
|
|
|
PR REPAIR NASAL SEPTAL PERFORATIONS
|
Professional
|
Both
|
$1,816.00
|
|
|
Service Code
|
HCPCS 30630
|
| Min. Negotiated Rate |
$621.18 |
| Max. Negotiated Rate |
$1,180.40 |
| Rate for Payer: Aetna Commercial |
$832.38
|
| Rate for Payer: Aetna Medicare |
$646.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$832.38
|
| Rate for Payer: BCBS Complete |
$726.40
|
| Rate for Payer: BCBS MAPPO |
$621.18
|
| Rate for Payer: BCN Medicare Advantage |
$621.18
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Cofinity Commercial |
$894.50
|
| Rate for Payer: Cofinity Commercial |
$832.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$621.18
|
| Rate for Payer: Healthscope Commercial |
$1,149.18
|
| Rate for Payer: Healthscope Commercial |
$993.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$652.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,180.40
|
| Rate for Payer: Nomi Health Commercial |
$745.42
|
| Rate for Payer: PACE SWMI |
$621.18
|
| Rate for Payer: PHP Medicare Advantage |
$621.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,180.40
|
| Rate for Payer: Priority Health Medicare |
$621.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$621.18
|
| Rate for Payer: UHC Medicare Advantage |
$621.18
|
|
|
PR REPAIR NASAL VESTIBULAR STENOSIS
|
Professional
|
Both
|
$1,687.00
|
|
|
Service Code
|
HCPCS 30465
|
| Min. Negotiated Rate |
$674.80 |
| Max. Negotiated Rate |
$1,770.01 |
| Rate for Payer: Aetna Commercial |
$1,282.06
|
| Rate for Payer: Aetna Medicare |
$995.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,377.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,282.06
|
| Rate for Payer: BCBS Complete |
$674.80
|
| Rate for Payer: BCBS MAPPO |
$956.76
|
| Rate for Payer: BCN Medicare Advantage |
$956.76
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Cofinity Commercial |
$1,377.73
|
| Rate for Payer: Cofinity Commercial |
$1,282.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$956.76
|
| Rate for Payer: Healthscope Commercial |
$1,770.01
|
| Rate for Payer: Healthscope Commercial |
$1,530.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,004.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,096.55
|
| Rate for Payer: Nomi Health Commercial |
$1,148.11
|
| Rate for Payer: PACE SWMI |
$956.76
|
| Rate for Payer: PHP Medicare Advantage |
$956.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,096.55
|
| Rate for Payer: Priority Health Medicare |
$956.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$956.76
|
| Rate for Payer: UHC Medicare Advantage |
$956.76
|
|
|
PR REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$4,602.00
|
|
|
Service Code
|
HCPCS 24435
|
| Min. Negotiated Rate |
$1,040.63 |
| Max. Negotiated Rate |
$2,991.30 |
| Rate for Payer: Aetna Commercial |
$1,394.44
|
| Rate for Payer: Aetna Medicare |
$1,082.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,498.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,394.44
|
| Rate for Payer: BCBS Complete |
$1,840.80
|
| Rate for Payer: BCBS MAPPO |
$1,040.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,040.63
|
| Rate for Payer: Cash Price |
$3,681.60
|
| Rate for Payer: Cash Price |
$3,681.60
|
| Rate for Payer: Cofinity Commercial |
$1,498.51
|
| Rate for Payer: Cofinity Commercial |
$1,394.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,040.63
|
| Rate for Payer: Healthscope Commercial |
$1,665.01
|
| Rate for Payer: Healthscope Commercial |
$1,925.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,092.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,991.30
|
| Rate for Payer: Nomi Health Commercial |
$1,248.76
|
| Rate for Payer: PACE SWMI |
$1,040.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,040.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,991.30
|
| Rate for Payer: Priority Health Medicare |
$1,040.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,040.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,040.63
|
|
|
PR REPAIR NON/MALUNION HUMERUS W/O GRAFT
|
Professional
|
Both
|
$2,891.00
|
|
|
Service Code
|
HCPCS 24430
|
| Min. Negotiated Rate |
$1,018.61 |
| Max. Negotiated Rate |
$1,884.43 |
| Rate for Payer: Aetna Commercial |
$1,364.94
|
| Rate for Payer: Aetna Medicare |
$1,059.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,466.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,364.94
|
| Rate for Payer: BCBS Complete |
$1,156.40
|
| Rate for Payer: BCBS MAPPO |
$1,018.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,018.61
|
| Rate for Payer: Cash Price |
$2,312.80
|
| Rate for Payer: Cash Price |
$2,312.80
|
| Rate for Payer: Cofinity Commercial |
$1,466.80
|
| Rate for Payer: Cofinity Commercial |
$1,364.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,018.61
|
| Rate for Payer: Healthscope Commercial |
$1,884.43
|
| Rate for Payer: Healthscope Commercial |
$1,629.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,069.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,879.15
|
| Rate for Payer: Nomi Health Commercial |
$1,222.33
|
| Rate for Payer: PACE SWMI |
$1,018.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,018.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,879.15
|
| Rate for Payer: Priority Health Medicare |
$1,018.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,018.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,018.61
|
|
|
PR REPAIR NONUNION CARPAL BONE EACH BONE
|
Professional
|
Both
|
$1,401.00
|
|
|
Service Code
|
HCPCS 25431
|
| Min. Negotiated Rate |
$560.40 |
| Max. Negotiated Rate |
$1,411.14 |
| Rate for Payer: Aetna Commercial |
$1,022.13
|
| Rate for Payer: Aetna Medicare |
$793.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,098.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,022.13
|
| Rate for Payer: BCBS Complete |
$560.40
|
| Rate for Payer: BCBS MAPPO |
$762.78
|
| Rate for Payer: BCN Medicare Advantage |
$762.78
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cofinity Commercial |
$1,098.40
|
| Rate for Payer: Cofinity Commercial |
$1,022.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$762.78
|
| Rate for Payer: Healthscope Commercial |
$1,220.45
|
| Rate for Payer: Healthscope Commercial |
$1,411.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$800.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.65
|
| Rate for Payer: Nomi Health Commercial |
$915.34
|
| Rate for Payer: PACE SWMI |
$762.78
|
| Rate for Payer: PHP Medicare Advantage |
$762.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.65
|
| Rate for Payer: Priority Health Medicare |
$762.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$762.78
|
| Rate for Payer: UHC Medicare Advantage |
$762.78
|
|
|
PR REPAIR NONUNION/MALUNION TARSAL BONES
|
Professional
|
Both
|
$1,318.00
|
|
|
Service Code
|
HCPCS 28320
|
| Min. Negotiated Rate |
$527.20 |
| Max. Negotiated Rate |
$1,095.50 |
| Rate for Payer: Aetna Commercial |
$793.49
|
| Rate for Payer: Aetna Medicare |
$615.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$852.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.49
|
| Rate for Payer: BCBS Complete |
$527.20
|
| Rate for Payer: BCBS MAPPO |
$592.16
|
| Rate for Payer: BCN Medicare Advantage |
$592.16
|
| Rate for Payer: Cash Price |
$1,054.40
|
| Rate for Payer: Cash Price |
$1,054.40
|
| Rate for Payer: Cofinity Commercial |
$852.71
|
| Rate for Payer: Cofinity Commercial |
$793.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$592.16
|
| Rate for Payer: Healthscope Commercial |
$947.46
|
| Rate for Payer: Healthscope Commercial |
$1,095.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$621.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$856.70
|
| Rate for Payer: Nomi Health Commercial |
$710.59
|
| Rate for Payer: PACE SWMI |
$592.16
|
| Rate for Payer: PHP Medicare Advantage |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$856.70
|
| Rate for Payer: Priority Health Medicare |
$592.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$592.16
|
| Rate for Payer: UHC Medicare Advantage |
$592.16
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/O GRAFT
|
Professional
|
Both
|
$3,903.00
|
|
|
Service Code
|
HCPCS 27720
|
| Min. Negotiated Rate |
$841.45 |
| Max. Negotiated Rate |
$2,536.95 |
| Rate for Payer: Aetna Commercial |
$1,127.54
|
| Rate for Payer: Aetna Medicare |
$875.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,211.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,127.54
|
| Rate for Payer: BCBS Complete |
$1,561.20
|
| Rate for Payer: BCBS MAPPO |
$841.45
|
| Rate for Payer: BCN Medicare Advantage |
$841.45
|
| Rate for Payer: Cash Price |
$3,122.40
|
| Rate for Payer: Cash Price |
$3,122.40
|
| Rate for Payer: Cofinity Commercial |
$1,211.69
|
| Rate for Payer: Cofinity Commercial |
$1,127.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$841.45
|
| Rate for Payer: Healthscope Commercial |
$1,346.32
|
| Rate for Payer: Healthscope Commercial |
$1,556.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$883.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,536.95
|
| Rate for Payer: Nomi Health Commercial |
$1,009.74
|
| Rate for Payer: PACE SWMI |
$841.45
|
| Rate for Payer: PHP Medicare Advantage |
$841.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,536.95
|
| Rate for Payer: Priority Health Medicare |
$841.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$841.45
|
| Rate for Payer: UHC Medicare Advantage |
$841.45
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT
|
Professional
|
Both
|
$3,827.00
|
|
|
Service Code
|
HCPCS 27722
|
| Min. Negotiated Rate |
$863.98 |
| Max. Negotiated Rate |
$2,487.55 |
| Rate for Payer: Aetna Commercial |
$1,157.73
|
| Rate for Payer: Aetna Medicare |
$898.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,244.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,157.73
|
| Rate for Payer: BCBS Complete |
$1,530.80
|
| Rate for Payer: BCBS MAPPO |
$863.98
|
| Rate for Payer: BCN Medicare Advantage |
$863.98
|
| Rate for Payer: Cash Price |
$3,061.60
|
| Rate for Payer: Cash Price |
$3,061.60
|
| Rate for Payer: Cofinity Commercial |
$1,244.13
|
| Rate for Payer: Cofinity Commercial |
$1,157.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$863.98
|
| Rate for Payer: Healthscope Commercial |
$1,598.36
|
| Rate for Payer: Healthscope Commercial |
$1,382.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$907.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,487.55
|
| Rate for Payer: Nomi Health Commercial |
$1,036.78
|
| Rate for Payer: PACE SWMI |
$863.98
|
| Rate for Payer: PHP Medicare Advantage |
$863.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,487.55
|
| Rate for Payer: Priority Health Medicare |
$863.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$863.98
|
| Rate for Payer: UHC Medicare Advantage |
$863.98
|
|
|
PR REPAIR OF TRAUMATIC CORPOREAL TEAR(S)
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 54437
|
| Min. Negotiated Rate |
$555.20 |
| Max. Negotiated Rate |
$1,201.15 |
| Rate for Payer: Aetna Commercial |
$870.02
|
| Rate for Payer: Aetna Medicare |
$675.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$934.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$870.02
|
| Rate for Payer: BCBS Complete |
$555.20
|
| Rate for Payer: BCBS MAPPO |
$649.27
|
| Rate for Payer: BCN Medicare Advantage |
$649.27
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$934.95
|
| Rate for Payer: Cofinity Commercial |
$870.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$649.27
|
| Rate for Payer: Healthscope Commercial |
$1,038.83
|
| Rate for Payer: Healthscope Commercial |
$1,201.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$681.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$902.20
|
| Rate for Payer: Nomi Health Commercial |
$779.12
|
| Rate for Payer: PACE SWMI |
$649.27
|
| Rate for Payer: PHP Medicare Advantage |
$649.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health Medicare |
$649.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$649.27
|
| Rate for Payer: UHC Medicare Advantage |
$649.27
|
|
|
PR REPAIR PATENT DUCTUS ARTERIOSUS BY LIGATION
|
Professional
|
Both
|
$4,402.00
|
|
|
Service Code
|
HCPCS 33820
|
| Min. Negotiated Rate |
$931.08 |
| Max. Negotiated Rate |
$2,861.30 |
| Rate for Payer: Aetna Commercial |
$1,247.65
|
| Rate for Payer: Aetna Medicare |
$968.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,340.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,247.65
|
| Rate for Payer: BCBS Complete |
$1,760.80
|
| Rate for Payer: BCBS MAPPO |
$931.08
|
| Rate for Payer: BCN Medicare Advantage |
$931.08
|
| Rate for Payer: Cash Price |
$3,521.60
|
| Rate for Payer: Cash Price |
$3,521.60
|
| Rate for Payer: Cofinity Commercial |
$1,340.76
|
| Rate for Payer: Cofinity Commercial |
$1,247.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.08
|
| Rate for Payer: Healthscope Commercial |
$1,489.73
|
| Rate for Payer: Healthscope Commercial |
$1,722.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$977.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,861.30
|
| Rate for Payer: Nomi Health Commercial |
$1,117.30
|
| Rate for Payer: PACE SWMI |
$931.08
|
| Rate for Payer: PHP Medicare Advantage |
$931.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,861.30
|
| Rate for Payer: Priority Health Medicare |
$931.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$931.08
|
| Rate for Payer: UHC Medicare Advantage |
$931.08
|
|
|
PR REPAIR PECTUS EXCAVATM/CARINATM MINLY W/THRSC
|
Professional
|
Both
|
$4,141.00
|
|
|
Service Code
|
HCPCS 21743
|
| Min. Negotiated Rate |
$1,656.40 |
| Max. Negotiated Rate |
$2,691.65 |
| Rate for Payer: Aetna Medicare |
$2,070.50
|
| Rate for Payer: BCBS Complete |
$1,656.40
|
| Rate for Payer: Cash Price |
$3,312.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,691.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,691.65
|
|
