|
PR RESECTION HUMERAL HEAD
|
Professional
|
Both
|
$1,645.00
|
|
|
Service Code
|
HCPCS 23195
|
| Min. Negotiated Rate |
$658.00 |
| Max. Negotiated Rate |
$1,338.99 |
| Rate for Payer: Aetna Commercial |
$969.87
|
| Rate for Payer: Aetna Medicare |
$752.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$969.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,042.24
|
| Rate for Payer: BCBS Complete |
$658.00
|
| Rate for Payer: BCBS MAPPO |
$723.78
|
| Rate for Payer: BCN Medicare Advantage |
$723.78
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Cofinity Commercial |
$969.87
|
| Rate for Payer: Cofinity Commercial |
$1,042.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$723.78
|
| Rate for Payer: Healthscope Commercial |
$1,338.99
|
| Rate for Payer: Healthscope Commercial |
$1,158.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$759.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,069.25
|
| Rate for Payer: Nomi Health Commercial |
$868.54
|
| Rate for Payer: PACE SWMI |
$723.78
|
| Rate for Payer: PHP Medicare Advantage |
$723.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,069.25
|
| Rate for Payer: Priority Health Medicare |
$723.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$723.78
|
| Rate for Payer: UHC Medicare Advantage |
$723.78
|
|
|
PR RESECTION/INCISION SUBVALVULAR TISSUE
|
Professional
|
Both
|
$6,220.00
|
|
|
Service Code
|
HCPCS 33415
|
| Min. Negotiated Rate |
$1,944.37 |
| Max. Negotiated Rate |
$4,043.00 |
| Rate for Payer: Aetna Commercial |
$2,605.46
|
| Rate for Payer: Aetna Medicare |
$2,022.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,799.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,605.46
|
| Rate for Payer: BCBS Complete |
$2,488.00
|
| Rate for Payer: BCBS MAPPO |
$1,944.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,944.37
|
| Rate for Payer: Cash Price |
$4,976.00
|
| Rate for Payer: Cash Price |
$4,976.00
|
| Rate for Payer: Cofinity Commercial |
$2,799.89
|
| Rate for Payer: Cofinity Commercial |
$2,605.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,944.37
|
| Rate for Payer: Healthscope Commercial |
$3,110.99
|
| Rate for Payer: Healthscope Commercial |
$3,597.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,041.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,043.00
|
| Rate for Payer: Nomi Health Commercial |
$2,333.24
|
| Rate for Payer: PACE SWMI |
$1,944.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,944.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,043.00
|
| Rate for Payer: Priority Health Medicare |
$1,944.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,944.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,944.37
|
|
|
PR RESECTION MEDIASTINAL TUMOR
|
Professional
|
Both
|
$5,782.00
|
|
|
Service Code
|
HCPCS 39220
|
| Min. Negotiated Rate |
$1,094.00 |
| Max. Negotiated Rate |
$3,758.30 |
| Rate for Payer: Aetna Commercial |
$1,465.96
|
| Rate for Payer: Aetna Medicare |
$1,137.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,575.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,465.96
|
| Rate for Payer: BCBS Complete |
$2,312.80
|
| Rate for Payer: BCBS MAPPO |
$1,094.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,094.00
|
| Rate for Payer: Cash Price |
$4,625.60
|
| Rate for Payer: Cash Price |
$4,625.60
|
| Rate for Payer: Cofinity Commercial |
$1,575.36
|
| Rate for Payer: Cofinity Commercial |
$1,465.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,094.00
|
| Rate for Payer: Healthscope Commercial |
$2,023.90
|
| Rate for Payer: Healthscope Commercial |
$1,750.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,148.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,758.30
|
| Rate for Payer: Nomi Health Commercial |
$1,312.80
|
| Rate for Payer: PACE SWMI |
$1,094.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,094.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,758.30
|
| Rate for Payer: Priority Health Medicare |
$1,094.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,094.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,094.00
|
|
|
PR RESECTION OF MEDIASTINAL CYST
|
Professional
|
Both
|
$5,041.00
|
|
|
Service Code
|
HCPCS 39200
|
| Min. Negotiated Rate |
$837.84 |
| Max. Negotiated Rate |
$3,276.65 |
| Rate for Payer: Aetna Commercial |
$1,122.71
|
| Rate for Payer: Aetna Medicare |
$871.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,206.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,122.71
|
| Rate for Payer: BCBS Complete |
$2,016.40
|
| Rate for Payer: BCBS MAPPO |
$837.84
|
| Rate for Payer: BCN Medicare Advantage |
$837.84
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Cofinity Commercial |
$1,206.49
|
| Rate for Payer: Cofinity Commercial |
$1,122.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$837.84
|
| Rate for Payer: Healthscope Commercial |
$1,340.54
|
| Rate for Payer: Healthscope Commercial |
$1,550.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$879.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,276.65
|
| Rate for Payer: Nomi Health Commercial |
$1,005.41
|
| Rate for Payer: PACE SWMI |
$837.84
|
| Rate for Payer: PHP Medicare Advantage |
$837.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,276.65
|
| Rate for Payer: Priority Health Medicare |
$837.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$837.84
|
| Rate for Payer: UHC Medicare Advantage |
$837.84
|
|
|
PR RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 28126
|
| Min. Negotiated Rate |
$238.62 |
| Max. Negotiated Rate |
$450.45 |
| Rate for Payer: Aetna Commercial |
$319.75
|
| Rate for Payer: Aetna Medicare |
$248.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.75
|
| Rate for Payer: BCBS Complete |
$277.20
|
| Rate for Payer: BCBS MAPPO |
$238.62
|
| Rate for Payer: BCN Medicare Advantage |
$238.62
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Commercial |
$343.61
|
| Rate for Payer: Cofinity Commercial |
$319.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.62
|
| Rate for Payer: Healthscope Commercial |
$441.45
|
| Rate for Payer: Healthscope Commercial |
$381.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$450.45
|
| Rate for Payer: Nomi Health Commercial |
$286.34
|
| Rate for Payer: PACE SWMI |
$238.62
|
| Rate for Payer: PHP Medicare Advantage |
$238.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.45
|
| Rate for Payer: Priority Health Medicare |
$238.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.62
|
| Rate for Payer: UHC Medicare Advantage |
$238.62
|
|
|
PR RESECTION PERICARDIAL CYST/TUMOR
|
Professional
|
Both
|
$2,869.00
|
|
|
Service Code
|
HCPCS 33050
|
| Min. Negotiated Rate |
$968.05 |
| Max. Negotiated Rate |
$1,864.85 |
| Rate for Payer: Aetna Commercial |
$1,297.19
|
| Rate for Payer: Aetna Medicare |
$1,006.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,393.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,297.19
|
| Rate for Payer: BCBS Complete |
$1,147.60
|
| Rate for Payer: BCBS MAPPO |
$968.05
|
| Rate for Payer: BCN Medicare Advantage |
$968.05
|
| Rate for Payer: Cash Price |
$2,295.20
|
| Rate for Payer: Cash Price |
$2,295.20
|
| Rate for Payer: Cofinity Commercial |
$1,393.99
|
| Rate for Payer: Cofinity Commercial |
$1,297.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$968.05
|
| Rate for Payer: Healthscope Commercial |
$1,548.88
|
| Rate for Payer: Healthscope Commercial |
$1,790.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,016.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,864.85
|
| Rate for Payer: Nomi Health Commercial |
$1,161.66
|
| Rate for Payer: PACE SWMI |
$968.05
|
| Rate for Payer: PHP Medicare Advantage |
$968.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,864.85
|
| Rate for Payer: Priority Health Medicare |
$968.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$968.05
|
| Rate for Payer: UHC Medicare Advantage |
$968.05
|
|
|
PR RESECTION RIBS EXTRAPLEURAL ALL STAGES
|
Professional
|
Both
|
$3,144.00
|
|
|
Service Code
|
HCPCS 32900
|
| Min. Negotiated Rate |
$1,257.60 |
| Max. Negotiated Rate |
$2,593.48 |
| Rate for Payer: Aetna Commercial |
$1,878.52
|
| Rate for Payer: Aetna Medicare |
$1,457.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,018.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,878.52
|
| Rate for Payer: BCBS Complete |
$1,257.60
|
| Rate for Payer: BCBS MAPPO |
$1,401.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,401.88
|
| Rate for Payer: Cash Price |
$2,515.20
|
| Rate for Payer: Cash Price |
$2,515.20
|
| Rate for Payer: Cofinity Commercial |
$2,018.71
|
| Rate for Payer: Cofinity Commercial |
$1,878.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,401.88
|
| Rate for Payer: Healthscope Commercial |
$2,593.48
|
| Rate for Payer: Healthscope Commercial |
$2,243.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,471.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,043.60
|
| Rate for Payer: Nomi Health Commercial |
$1,682.26
|
| Rate for Payer: PACE SWMI |
$1,401.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,401.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,043.60
|
| Rate for Payer: Priority Health Medicare |
$1,401.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,401.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,401.88
|
|
|
PR RESECTION SCROTUM
|
Professional
|
Both
|
$1,586.00
|
|
|
Service Code
|
HCPCS 55150
|
| Min. Negotiated Rate |
$472.41 |
| Max. Negotiated Rate |
$1,030.90 |
| Rate for Payer: Aetna Commercial |
$633.03
|
| Rate for Payer: Aetna Medicare |
$491.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$680.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.03
|
| Rate for Payer: BCBS Complete |
$634.40
|
| Rate for Payer: BCBS MAPPO |
$472.41
|
| Rate for Payer: BCN Medicare Advantage |
$472.41
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cofinity Commercial |
$680.27
|
| Rate for Payer: Cofinity Commercial |
$633.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$472.41
|
| Rate for Payer: Healthscope Commercial |
$755.86
|
| Rate for Payer: Healthscope Commercial |
$873.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$496.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.90
|
| Rate for Payer: Nomi Health Commercial |
$566.89
|
| Rate for Payer: PACE SWMI |
$472.41
|
| Rate for Payer: PHP Medicare Advantage |
$472.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,030.90
|
| Rate for Payer: Priority Health Medicare |
$472.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$472.41
|
| Rate for Payer: UHC Medicare Advantage |
$472.41
|
|
|
PR RESECTION/TRANSPLANTATION LONG TENDON BICEPS
|
Professional
|
Both
|
$1,353.00
|
|
|
Service Code
|
HCPCS 23440
|
| Min. Negotiated Rate |
$541.20 |
| Max. Negotiated Rate |
$1,352.24 |
| Rate for Payer: Aetna Commercial |
$979.46
|
| Rate for Payer: Aetna Medicare |
$760.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,052.55
|
| Rate for Payer: BCBS Complete |
$541.20
|
| Rate for Payer: BCBS MAPPO |
$730.94
|
| Rate for Payer: BCN Medicare Advantage |
$730.94
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cofinity Commercial |
$979.46
|
| Rate for Payer: Cofinity Commercial |
$1,052.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$730.94
|
| Rate for Payer: Healthscope Commercial |
$1,352.24
|
| Rate for Payer: Healthscope Commercial |
$1,169.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$767.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$879.45
|
| Rate for Payer: Nomi Health Commercial |
$877.13
|
| Rate for Payer: PACE SWMI |
$730.94
|
| Rate for Payer: PHP Medicare Advantage |
$730.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.45
|
| Rate for Payer: Priority Health Medicare |
$730.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$730.94
|
| Rate for Payer: UHC Medicare Advantage |
$730.94
|
|
|
PR RESPIRATORY FLOW VOLUME LOOP
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 94375
|
| Min. Negotiated Rate |
$35.54 |
| Max. Negotiated Rate |
$72.80 |
| Rate for Payer: Aetna Commercial |
$47.62
|
| Rate for Payer: Aetna Medicare |
$36.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.62
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$35.54
|
| Rate for Payer: BCN Medicare Advantage |
$35.54
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$51.18
|
| Rate for Payer: Cofinity Commercial |
$47.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.54
|
| Rate for Payer: Healthscope Commercial |
$56.86
|
| Rate for Payer: Healthscope Commercial |
$65.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.80
|
| Rate for Payer: Nomi Health Commercial |
$42.65
|
| Rate for Payer: PACE SWMI |
$35.54
|
| Rate for Payer: PHP Medicare Advantage |
$35.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health Medicare |
$35.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.54
|
| Rate for Payer: UHC Medicare Advantage |
$35.54
|
|
|
PR RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG E
|
Professional
|
Both
|
$3,690.00
|
|
|
Service Code
|
HCPCS 90378
|
| Min. Negotiated Rate |
$1,476.00 |
| Max. Negotiated Rate |
$2,398.50 |
| Rate for Payer: Aetna Medicare |
$1,845.00
|
| Rate for Payer: BCBS Complete |
$1,476.00
|
| Rate for Payer: Cash Price |
$2,952.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,398.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,398.50
|
|
|
PR REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 37222
|
| Min. Negotiated Rate |
$177.40 |
| Max. Negotiated Rate |
$387.40 |
| Rate for Payer: Aetna Commercial |
$237.72
|
| Rate for Payer: Aetna Medicare |
$184.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.46
|
| Rate for Payer: BCBS Complete |
$238.40
|
| Rate for Payer: BCBS MAPPO |
$177.40
|
| Rate for Payer: BCN Medicare Advantage |
$177.40
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cofinity Commercial |
$255.46
|
| Rate for Payer: Cofinity Commercial |
$237.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.40
|
| Rate for Payer: Healthscope Commercial |
$328.19
|
| Rate for Payer: Healthscope Commercial |
$283.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$387.40
|
| Rate for Payer: Nomi Health Commercial |
$212.88
|
| Rate for Payer: PACE SWMI |
$177.40
|
| Rate for Payer: PHP Medicare Advantage |
$177.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.40
|
| Rate for Payer: Priority Health Medicare |
$177.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.40
|
| Rate for Payer: UHC Medicare Advantage |
$177.40
|
|
|
PR REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 37220
|
| Min. Negotiated Rate |
$381.29 |
| Max. Negotiated Rate |
$705.39 |
| Rate for Payer: Aetna Commercial |
$510.93
|
| Rate for Payer: Aetna Medicare |
$396.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.06
|
| Rate for Payer: BCBS Complete |
$387.60
|
| Rate for Payer: BCBS MAPPO |
$381.29
|
| Rate for Payer: BCN Medicare Advantage |
$381.29
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$510.93
|
| Rate for Payer: Cofinity Commercial |
$549.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$381.29
|
| Rate for Payer: Healthscope Commercial |
$610.06
|
| Rate for Payer: Healthscope Commercial |
$705.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$400.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$629.85
|
| Rate for Payer: Nomi Health Commercial |
$457.55
|
| Rate for Payer: PACE SWMI |
$381.29
|
| Rate for Payer: PHP Medicare Advantage |
$381.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health Medicare |
$381.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$381.29
|
| Rate for Payer: UHC Medicare Advantage |
$381.29
|
|
|
PR REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT
|
Professional
|
Both
|
$4,999.00
|
|
|
Service Code
|
HCPCS 24371
|
| Min. Negotiated Rate |
$1,698.92 |
| Max. Negotiated Rate |
$3,249.35 |
| Rate for Payer: Aetna Commercial |
$2,276.55
|
| Rate for Payer: Aetna Medicare |
$1,766.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,446.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,276.55
|
| Rate for Payer: BCBS Complete |
$1,999.60
|
| Rate for Payer: BCBS MAPPO |
$1,698.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,698.92
|
| Rate for Payer: Cash Price |
$3,999.20
|
| Rate for Payer: Cash Price |
$3,999.20
|
| Rate for Payer: Cofinity Commercial |
$2,446.44
|
| Rate for Payer: Cofinity Commercial |
$2,276.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,698.92
|
| Rate for Payer: Healthscope Commercial |
$3,143.00
|
| Rate for Payer: Healthscope Commercial |
$2,718.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,783.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,249.35
|
| Rate for Payer: Nomi Health Commercial |
$2,038.70
|
| Rate for Payer: PACE SWMI |
$1,698.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,698.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,249.35
|
| Rate for Payer: Priority Health Medicare |
$1,698.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,698.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,698.92
|
|
|
PR REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT
|
Professional
|
Both
|
$3,780.00
|
|
|
Service Code
|
HCPCS 24370
|
| Min. Negotiated Rate |
$1,479.30 |
| Max. Negotiated Rate |
$2,736.70 |
| Rate for Payer: Aetna Commercial |
$1,982.26
|
| Rate for Payer: Aetna Medicare |
$1,538.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,130.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,982.26
|
| Rate for Payer: BCBS Complete |
$1,512.00
|
| Rate for Payer: BCBS MAPPO |
$1,479.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,479.30
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cofinity Commercial |
$2,130.19
|
| Rate for Payer: Cofinity Commercial |
$1,982.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,479.30
|
| Rate for Payer: Healthscope Commercial |
$2,366.88
|
| Rate for Payer: Healthscope Commercial |
$2,736.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,553.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,457.00
|
| Rate for Payer: Nomi Health Commercial |
$1,775.16
|
| Rate for Payer: PACE SWMI |
$1,479.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,479.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,457.00
|
| Rate for Payer: Priority Health Medicare |
$1,479.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,479.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,479.30
|
|
|
PR REVISION OF LARYNX, UNSPECIFIED
|
Professional
|
Both
|
$2,060.00
|
|
|
Service Code
|
HCPCS 31588
|
| Min. Negotiated Rate |
$824.00 |
| Max. Negotiated Rate |
$1,339.00 |
| Rate for Payer: Aetna Medicare |
$1,030.00
|
| Rate for Payer: BCBS Complete |
$824.00
|
| Rate for Payer: Cash Price |
$1,648.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,339.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,339.00
|
|
|
PR REVISION OF RECONSTRUCTED BREAST
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 19380
|
| Hospital Charge Code |
19380
|
| Min. Negotiated Rate |
$487.20 |
| Max. Negotiated Rate |
$1,430.29 |
| Rate for Payer: Aetna Commercial |
$1,035.99
|
| Rate for Payer: Aetna Medicare |
$804.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,113.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,035.99
|
| Rate for Payer: BCBS Complete |
$487.20
|
| Rate for Payer: BCBS MAPPO |
$773.13
|
| Rate for Payer: BCN Medicare Advantage |
$773.13
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$1,113.31
|
| Rate for Payer: Cofinity Commercial |
$1,035.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$773.13
|
| Rate for Payer: Healthscope Commercial |
$1,430.29
|
| Rate for Payer: Healthscope Commercial |
$1,237.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$811.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$791.70
|
| Rate for Payer: Nomi Health Commercial |
$927.76
|
| Rate for Payer: PACE SWMI |
$773.13
|
| Rate for Payer: PHP Medicare Advantage |
$773.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health Medicare |
$773.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$773.13
|
| Rate for Payer: UHC Medicare Advantage |
$773.13
|
|
|
PR REVISION OF RECONSTRUCTED BREAST
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 19380
|
| Min. Negotiated Rate |
$487.20 |
| Max. Negotiated Rate |
$1,430.29 |
| Rate for Payer: Aetna Commercial |
$1,035.99
|
| Rate for Payer: Aetna Medicare |
$804.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,035.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,113.31
|
| Rate for Payer: BCBS Complete |
$487.20
|
| Rate for Payer: BCBS MAPPO |
$773.13
|
| Rate for Payer: BCN Medicare Advantage |
$773.13
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$1,113.31
|
| Rate for Payer: Cofinity Commercial |
$1,035.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$773.13
|
| Rate for Payer: Healthscope Commercial |
$1,430.29
|
| Rate for Payer: Healthscope Commercial |
$1,237.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$811.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$791.70
|
| Rate for Payer: Nomi Health Commercial |
$927.76
|
| Rate for Payer: PACE SWMI |
$773.13
|
| Rate for Payer: PHP Medicare Advantage |
$773.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health Medicare |
$773.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$773.13
|
| Rate for Payer: UHC Medicare Advantage |
$773.13
|
|
|
PR REVISION OF RECONSTRUCTED BREAST
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
CPT 19380
|
| Hospital Charge Code |
19380
|
| Min. Negotiated Rate |
$767.34 |
| Max. Negotiated Rate |
$1,096.20 |
| Rate for Payer: Aetna Commercial |
$1,035.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$791.70
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$1,047.48
|
| Rate for Payer: Cofinity Commercial |
$852.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$852.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$974.40
|
| Rate for Payer: Healthscope Commercial |
$1,096.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,035.30
|
| Rate for Payer: PHP Commercial |
$1,035.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health SBD |
$767.34
|
|
|
PR REVISION OF RECONSTRUCTED BREAST
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
CPT 19380
|
| Hospital Charge Code |
19380
|
| Min. Negotiated Rate |
$767.34 |
| Max. Negotiated Rate |
$17,903.47 |
| Rate for Payer: Aetna Commercial |
$1,035.30
|
| Rate for Payer: Aetna Medicare |
$6,614.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$791.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,950.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,950.31
|
| Rate for Payer: BCBS Complete |
$3,579.55
|
| Rate for Payer: BCBS MAPPO |
$6,360.25
|
| Rate for Payer: BCN Medicare Advantage |
$6,360.25
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$852.60
|
| Rate for Payer: Cofinity Commercial |
$1,047.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$852.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$974.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,360.25
|
| Rate for Payer: Healthscope Commercial |
$1,096.20
|
| Rate for Payer: Mclaren Medicaid |
$3,409.09
|
| Rate for Payer: Mclaren Medicare |
$6,360.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,678.26
|
| Rate for Payer: Meridian Medicaid |
$3,579.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,314.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,035.30
|
| Rate for Payer: PACE Medicare |
$6,042.24
|
| Rate for Payer: PACE SWMI |
$6,360.25
|
| Rate for Payer: PHP Commercial |
$1,035.30
|
| Rate for Payer: PHP Medicare Advantage |
$6,360.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,409.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health Medicare |
$6,360.25
|
| Rate for Payer: Priority Health SBD |
$767.34
|
| Rate for Payer: Railroad Medicare Medicare |
$6,360.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,903.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,360.25
|
| Rate for Payer: UHC Medicare Advantage |
$6,360.25
|
| Rate for Payer: UHCCP Medicaid |
$3,580.82
|
| Rate for Payer: VA VA |
$6,360.25
|
|
|
PR REVISION PERI-IMPLANT CAPSULE BREAST
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
HCPCS 19370
|
| Min. Negotiated Rate |
$497.60 |
| Max. Negotiated Rate |
$1,190.33 |
| Rate for Payer: Aetna Commercial |
$862.18
|
| Rate for Payer: Aetna Medicare |
$669.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$926.52
|
| Rate for Payer: BCBS Complete |
$497.60
|
| Rate for Payer: BCBS MAPPO |
$643.42
|
| Rate for Payer: BCN Medicare Advantage |
$643.42
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cofinity Commercial |
$862.18
|
| Rate for Payer: Cofinity Commercial |
$926.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$643.42
|
| Rate for Payer: Healthscope Commercial |
$1,029.47
|
| Rate for Payer: Healthscope Commercial |
$1,190.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$675.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$808.60
|
| Rate for Payer: Nomi Health Commercial |
$772.10
|
| Rate for Payer: PACE SWMI |
$643.42
|
| Rate for Payer: PHP Medicare Advantage |
$643.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$808.60
|
| Rate for Payer: Priority Health Medicare |
$643.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$643.42
|
| Rate for Payer: UHC Medicare Advantage |
$643.42
|
|
|
PR REVISION PROSTHETIC VAGINAL GRAFT LAPAROSCOPIC
|
Professional
|
Both
|
$1,612.00
|
|
|
Service Code
|
HCPCS 57426
|
| Min. Negotiated Rate |
$644.80 |
| Max. Negotiated Rate |
$1,544.49 |
| Rate for Payer: Aetna Commercial |
$1,118.71
|
| Rate for Payer: Aetna Medicare |
$868.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,202.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,118.71
|
| Rate for Payer: BCBS Complete |
$644.80
|
| Rate for Payer: BCBS MAPPO |
$834.86
|
| Rate for Payer: BCN Medicare Advantage |
$834.86
|
| Rate for Payer: Cash Price |
$1,289.60
|
| Rate for Payer: Cash Price |
$1,289.60
|
| Rate for Payer: Cofinity Commercial |
$1,202.20
|
| Rate for Payer: Cofinity Commercial |
$1,118.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$834.86
|
| Rate for Payer: Healthscope Commercial |
$1,544.49
|
| Rate for Payer: Healthscope Commercial |
$1,335.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$876.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,047.80
|
| Rate for Payer: Nomi Health Commercial |
$1,001.83
|
| Rate for Payer: PACE SWMI |
$834.86
|
| Rate for Payer: PHP Medicare Advantage |
$834.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,047.80
|
| Rate for Payer: Priority Health Medicare |
$834.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$834.86
|
| Rate for Payer: UHC Medicare Advantage |
$834.86
|
|
|
PR REVISION/REPLMT NEUROSTIMLATOR ELTRD CRANIAL NRV
|
Professional
|
Both
|
$2,230.00
|
|
|
Service Code
|
HCPCS 64569
|
| Min. Negotiated Rate |
$760.86 |
| Max. Negotiated Rate |
$1,449.50 |
| Rate for Payer: Aetna Commercial |
$1,019.55
|
| Rate for Payer: Aetna Medicare |
$791.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,095.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,019.55
|
| Rate for Payer: BCBS Complete |
$892.00
|
| Rate for Payer: BCBS MAPPO |
$760.86
|
| Rate for Payer: BCN Medicare Advantage |
$760.86
|
| Rate for Payer: Cash Price |
$1,784.00
|
| Rate for Payer: Cash Price |
$1,784.00
|
| Rate for Payer: Cofinity Commercial |
$1,095.64
|
| Rate for Payer: Cofinity Commercial |
$1,019.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$760.86
|
| Rate for Payer: Healthscope Commercial |
$1,217.38
|
| Rate for Payer: Healthscope Commercial |
$1,407.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$798.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,449.50
|
| Rate for Payer: Nomi Health Commercial |
$913.03
|
| Rate for Payer: PACE SWMI |
$760.86
|
| Rate for Payer: PHP Medicare Advantage |
$760.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,449.50
|
| Rate for Payer: Priority Health Medicare |
$760.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$760.86
|
| Rate for Payer: UHC Medicare Advantage |
$760.86
|
|
|
PR REVISION STAPEDECTOMY/STAPEDOTOMY
|
Professional
|
Both
|
$3,917.00
|
|
|
Service Code
|
HCPCS 69662
|
| Min. Negotiated Rate |
$1,080.82 |
| Max. Negotiated Rate |
$2,546.05 |
| Rate for Payer: Aetna Commercial |
$1,448.30
|
| Rate for Payer: Aetna Medicare |
$1,124.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,556.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,448.30
|
| Rate for Payer: BCBS Complete |
$1,566.80
|
| Rate for Payer: BCBS MAPPO |
$1,080.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,080.82
|
| Rate for Payer: Cash Price |
$3,133.60
|
| Rate for Payer: Cash Price |
$3,133.60
|
| Rate for Payer: Cofinity Commercial |
$1,556.38
|
| Rate for Payer: Cofinity Commercial |
$1,448.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,080.82
|
| Rate for Payer: Healthscope Commercial |
$1,999.52
|
| Rate for Payer: Healthscope Commercial |
$1,729.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,134.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,546.05
|
| Rate for Payer: Nomi Health Commercial |
$1,296.98
|
| Rate for Payer: PACE SWMI |
$1,080.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,080.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,546.05
|
| Rate for Payer: Priority Health Medicare |
$1,080.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,080.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.82
|
|
|
PR REVISION TRACHEOSTOMY SCAR
|
Professional
|
Both
|
$697.00
|
|
|
Service Code
|
HCPCS 31830
|
| Min. Negotiated Rate |
$278.80 |
| Max. Negotiated Rate |
$641.71 |
| Rate for Payer: Aetna Commercial |
$464.81
|
| Rate for Payer: Aetna Medicare |
$360.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.81
|
| Rate for Payer: BCBS Complete |
$278.80
|
| Rate for Payer: BCBS MAPPO |
$346.87
|
| Rate for Payer: BCN Medicare Advantage |
$346.87
|
| Rate for Payer: Cash Price |
$557.60
|
| Rate for Payer: Cash Price |
$557.60
|
| Rate for Payer: Cofinity Commercial |
$499.49
|
| Rate for Payer: Cofinity Commercial |
$464.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.87
|
| Rate for Payer: Healthscope Commercial |
$554.99
|
| Rate for Payer: Healthscope Commercial |
$641.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$364.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$453.05
|
| Rate for Payer: Nomi Health Commercial |
$416.24
|
| Rate for Payer: PACE SWMI |
$346.87
|
| Rate for Payer: PHP Medicare Advantage |
$346.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$453.05
|
| Rate for Payer: Priority Health Medicare |
$346.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$346.87
|
| Rate for Payer: UHC Medicare Advantage |
$346.87
|
|
