|
PR RPR AA HERNIA RECR 3-10 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$1,751.00
|
|
|
Service Code
|
HCPCS 49616
|
| Min. Negotiated Rate |
$549.97 |
| Max. Negotiated Rate |
$154,557.00 |
| Rate for Payer: Aetna Commercial |
$1,123.36
|
| Rate for Payer: Aetna Medicare |
$871.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,123.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,207.20
|
| Rate for Payer: BCBS Complete |
$577.47
|
| Rate for Payer: BCBS MAPPO |
$838.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,140.07
|
| Rate for Payer: BCN Commercial |
$1,251.51
|
| Rate for Payer: BCN Medicare Advantage |
$838.33
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cofinity Commercial |
$1,207.20
|
| Rate for Payer: Cofinity Commercial |
$1,123.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$838.33
|
| Rate for Payer: Healthscope Commercial |
$1,341.33
|
| Rate for Payer: Healthscope Commercial |
$1,550.91
|
| Rate for Payer: Mclaren Medicaid |
$549.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$880.25
|
| Rate for Payer: Meridian Medicaid |
$577.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154,557.00
|
| Rate for Payer: Nomi Health Commercial |
$1,006.00
|
| Rate for Payer: PACE SWMI |
$838.33
|
| Rate for Payer: PHP Medicare Advantage |
$838.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$549.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,138.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,532.66
|
| Rate for Payer: Priority Health Medicare |
$838.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,532.66
|
| Rate for Payer: Priority Health SBD |
$1,532.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$838.33
|
| Rate for Payer: UHC Medicare Advantage |
$838.33
|
| Rate for Payer: UHCCP Medicaid |
$549.97
|
|
|
PR RPR AA HERNIA RECR 3-10 CM REDUCIBLE
|
Facility
|
OP
|
$1,589.00
|
|
|
Service Code
|
CPT 49615
|
| Hospital Charge Code |
49615
|
| Min. Negotiated Rate |
$690.82 |
| Max. Negotiated Rate |
$19,214.90 |
| Rate for Payer: Aetna Commercial |
$1,350.65
|
| Rate for Payer: Aetna Medicare |
$6,358.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,032.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,641.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,641.98
|
| Rate for Payer: BCBS Complete |
$3,440.72
|
| Rate for Payer: BCBS MAPPO |
$6,113.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,501.36
|
| Rate for Payer: BCN Commercial |
$1,501.36
|
| Rate for Payer: BCN Medicare Advantage |
$6,113.58
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cofinity Commercial |
$1,366.54
|
| Rate for Payer: Cofinity Commercial |
$1,112.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,112.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,271.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,113.58
|
| Rate for Payer: Healthscope Commercial |
$1,430.10
|
| Rate for Payer: Mclaren Medicaid |
$3,276.88
|
| Rate for Payer: Mclaren Medicare |
$6,113.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,419.26
|
| Rate for Payer: Meridian Medicaid |
$3,440.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,030.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,350.65
|
| Rate for Payer: Nomi Health Commercial |
$12,838.52
|
| Rate for Payer: PACE Medicare |
$5,807.90
|
| Rate for Payer: PACE SWMI |
$6,113.58
|
| Rate for Payer: PHP Commercial |
$1,350.65
|
| Rate for Payer: PHP Medicare Advantage |
$6,113.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,276.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,032.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,214.90
|
| Rate for Payer: Priority Health Medicare |
$6,113.58
|
| Rate for Payer: Priority Health Narrow Network |
$15,371.92
|
| Rate for Payer: Priority Health SBD |
$1,001.07
|
| Rate for Payer: Railroad Medicare Medicare |
$6,113.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$690.82
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,113.58
|
| Rate for Payer: UHC Medicare Advantage |
$6,113.58
|
| Rate for Payer: UHCCP Medicaid |
$3,441.95
|
| Rate for Payer: VA VA |
$6,113.58
|
|
|
PR RPR AA HERNIA RECR 3-10 CM REDUCIBLE
|
Facility
|
IP
|
$1,589.00
|
|
|
Service Code
|
CPT 49615
|
| Hospital Charge Code |
49615
|
| Min. Negotiated Rate |
$1,001.07 |
| Max. Negotiated Rate |
$1,430.10 |
| Rate for Payer: Aetna Commercial |
$1,350.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,032.85
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cofinity Commercial |
$1,112.30
|
| Rate for Payer: Cofinity Commercial |
$1,366.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,112.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,271.20
|
| Rate for Payer: Healthscope Commercial |
$1,430.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,350.65
|
| Rate for Payer: PHP Commercial |
$1,350.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,032.85
|
| Rate for Payer: Priority Health SBD |
$1,001.07
|
|
|
PR RPR AA HERNIA RECR 3-10 CM REDUCIBLE
|
Professional
|
Both
|
$1,589.00
|
|
|
Service Code
|
HCPCS 49615
|
| Min. Negotiated Rate |
$409.60 |
| Max. Negotiated Rate |
$114,979.00 |
| Rate for Payer: Aetna Commercial |
$835.56
|
| Rate for Payer: Aetna Medicare |
$648.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$835.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.91
|
| Rate for Payer: BCBS Complete |
$430.08
|
| Rate for Payer: BCBS MAPPO |
$623.55
|
| Rate for Payer: BCBS Trust/PPO |
$941.43
|
| Rate for Payer: BCN Commercial |
$931.91
|
| Rate for Payer: BCN Medicare Advantage |
$623.55
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cofinity Commercial |
$897.91
|
| Rate for Payer: Cofinity Commercial |
$835.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$623.55
|
| Rate for Payer: Healthscope Commercial |
$1,153.57
|
| Rate for Payer: Healthscope Commercial |
$997.68
|
| Rate for Payer: Mclaren Medicaid |
$409.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$654.73
|
| Rate for Payer: Meridian Medicaid |
$430.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114,979.00
|
| Rate for Payer: Nomi Health Commercial |
$748.26
|
| Rate for Payer: PACE SWMI |
$623.55
|
| Rate for Payer: PHP Medicare Advantage |
$623.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$409.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,032.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,140.69
|
| Rate for Payer: Priority Health Medicare |
$623.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,140.69
|
| Rate for Payer: Priority Health SBD |
$1,140.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$623.55
|
| Rate for Payer: UHC Medicare Advantage |
$623.55
|
| Rate for Payer: UHCCP Medicaid |
$409.60
|
|
|
PR RPR AA HERNIA RECR 3-10 CM REDUCIBLE
|
Professional
|
Both
|
$1,589.00
|
|
|
Service Code
|
HCPCS 49615
|
| Hospital Charge Code |
49615
|
| Min. Negotiated Rate |
$409.60 |
| Max. Negotiated Rate |
$114,979.00 |
| Rate for Payer: Aetna Commercial |
$835.56
|
| Rate for Payer: Aetna Medicare |
$648.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$835.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.91
|
| Rate for Payer: BCBS Complete |
$430.08
|
| Rate for Payer: BCBS MAPPO |
$623.55
|
| Rate for Payer: BCBS Trust/PPO |
$941.43
|
| Rate for Payer: BCN Commercial |
$931.91
|
| Rate for Payer: BCN Medicare Advantage |
$623.55
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cofinity Commercial |
$897.91
|
| Rate for Payer: Cofinity Commercial |
$835.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$623.55
|
| Rate for Payer: Healthscope Commercial |
$1,153.57
|
| Rate for Payer: Healthscope Commercial |
$997.68
|
| Rate for Payer: Mclaren Medicaid |
$409.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$654.73
|
| Rate for Payer: Meridian Medicaid |
$430.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114,979.00
|
| Rate for Payer: Nomi Health Commercial |
$748.26
|
| Rate for Payer: PACE SWMI |
$623.55
|
| Rate for Payer: PHP Medicare Advantage |
$623.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$409.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,032.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,140.69
|
| Rate for Payer: Priority Health Medicare |
$623.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,140.69
|
| Rate for Payer: Priority Health SBD |
$1,140.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$623.55
|
| Rate for Payer: UHC Medicare Advantage |
$623.55
|
| Rate for Payer: UHCCP Medicaid |
$409.60
|
|
|
PR RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 49614
|
| Min. Negotiated Rate |
$366.36 |
| Max. Negotiated Rate |
$102,803.00 |
| Rate for Payer: Aetna Commercial |
$747.44
|
| Rate for Payer: Aetna Medicare |
$580.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.22
|
| Rate for Payer: BCBS Complete |
$384.68
|
| Rate for Payer: BCBS MAPPO |
$557.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,425.95
|
| Rate for Payer: BCN Commercial |
$833.19
|
| Rate for Payer: BCN Medicare Advantage |
$557.79
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cofinity Commercial |
$803.22
|
| Rate for Payer: Cofinity Commercial |
$747.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.79
|
| Rate for Payer: Healthscope Commercial |
$1,031.91
|
| Rate for Payer: Healthscope Commercial |
$892.46
|
| Rate for Payer: Mclaren Medicaid |
$366.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$585.68
|
| Rate for Payer: Meridian Medicaid |
$384.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102,803.00
|
| Rate for Payer: Nomi Health Commercial |
$669.35
|
| Rate for Payer: PACE SWMI |
$557.79
|
| Rate for Payer: PHP Medicare Advantage |
$557.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$366.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,020.18
|
| Rate for Payer: Priority Health Medicare |
$557.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,020.18
|
| Rate for Payer: Priority Health SBD |
$1,020.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.79
|
| Rate for Payer: UHC Medicare Advantage |
$557.79
|
| Rate for Payer: UHCCP Medicaid |
$366.36
|
|
|
PR RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED
|
Facility
|
IP
|
$1,165.00
|
|
|
Service Code
|
CPT 49614
|
| Hospital Charge Code |
49614
|
| Min. Negotiated Rate |
$733.95 |
| Max. Negotiated Rate |
$1,048.50 |
| Rate for Payer: Aetna Commercial |
$990.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$757.25
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cofinity Commercial |
$1,001.90
|
| Rate for Payer: Cofinity Commercial |
$815.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$815.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$932.00
|
| Rate for Payer: Healthscope Commercial |
$1,048.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$990.25
|
| Rate for Payer: PHP Commercial |
$990.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.25
|
| Rate for Payer: Priority Health SBD |
$733.95
|
|
|
PR RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 49614
|
| Hospital Charge Code |
49614
|
| Min. Negotiated Rate |
$366.36 |
| Max. Negotiated Rate |
$102,803.00 |
| Rate for Payer: Aetna Commercial |
$747.44
|
| Rate for Payer: Aetna Medicare |
$580.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.22
|
| Rate for Payer: BCBS Complete |
$384.68
|
| Rate for Payer: BCBS MAPPO |
$557.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,425.95
|
| Rate for Payer: BCN Commercial |
$833.19
|
| Rate for Payer: BCN Medicare Advantage |
$557.79
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cofinity Commercial |
$803.22
|
| Rate for Payer: Cofinity Commercial |
$747.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.79
|
| Rate for Payer: Healthscope Commercial |
$1,031.91
|
| Rate for Payer: Healthscope Commercial |
$892.46
|
| Rate for Payer: Mclaren Medicaid |
$366.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$585.68
|
| Rate for Payer: Meridian Medicaid |
$384.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102,803.00
|
| Rate for Payer: Nomi Health Commercial |
$669.35
|
| Rate for Payer: PACE SWMI |
$557.79
|
| Rate for Payer: PHP Medicare Advantage |
$557.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$366.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,020.18
|
| Rate for Payer: Priority Health Medicare |
$557.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,020.18
|
| Rate for Payer: Priority Health SBD |
$1,020.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.79
|
| Rate for Payer: UHC Medicare Advantage |
$557.79
|
| Rate for Payer: UHCCP Medicaid |
$366.36
|
|
|
PR RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED
|
Facility
|
OP
|
$1,165.00
|
|
|
Service Code
|
CPT 49614
|
| Hospital Charge Code |
49614
|
| Min. Negotiated Rate |
$617.92 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Commercial |
$990.25
|
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$757.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,251.78
|
| Rate for Payer: BCN Commercial |
$2,251.78
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cofinity Commercial |
$815.50
|
| Rate for Payer: Cofinity Commercial |
$1,001.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$815.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$932.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Healthscope Commercial |
$1,048.50
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$990.25
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Commercial |
$990.25
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Priority Health SBD |
$733.95
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.92
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,218.33
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
PR RPR AA HERNIA RECR < 3 CM REDUCIBLE
|
Professional
|
Both
|
$857.00
|
|
|
Service Code
|
HCPCS 49613
|
| Min. Negotiated Rate |
$270.08 |
| Max. Negotiated Rate |
$75,659.00 |
| Rate for Payer: Aetna Commercial |
$549.76
|
| Rate for Payer: Aetna Medicare |
$426.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.79
|
| Rate for Payer: BCBS Complete |
$283.58
|
| Rate for Payer: BCBS MAPPO |
$410.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,199.84
|
| Rate for Payer: BCN Commercial |
$614.26
|
| Rate for Payer: BCN Medicare Advantage |
$410.27
|
| Rate for Payer: Cash Price |
$685.60
|
| Rate for Payer: Cash Price |
$685.60
|
| Rate for Payer: Cofinity Commercial |
$590.79
|
| Rate for Payer: Cofinity Commercial |
$549.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$410.27
|
| Rate for Payer: Healthscope Commercial |
$656.43
|
| Rate for Payer: Healthscope Commercial |
$759.00
|
| Rate for Payer: Mclaren Medicaid |
$270.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$430.78
|
| Rate for Payer: Meridian Medicaid |
$283.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75,659.00
|
| Rate for Payer: Nomi Health Commercial |
$492.32
|
| Rate for Payer: PACE SWMI |
$410.27
|
| Rate for Payer: PHP Medicare Advantage |
$410.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$557.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$753.50
|
| Rate for Payer: Priority Health Medicare |
$410.27
|
| Rate for Payer: Priority Health Narrow Network |
$753.50
|
| Rate for Payer: Priority Health SBD |
$753.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$410.27
|
| Rate for Payer: UHC Medicare Advantage |
$410.27
|
| Rate for Payer: UHCCP Medicaid |
$270.08
|
|
|
PR RPR ACQUIRED/TRAUMATIC AV FISTULA EXTREMITIES
|
Professional
|
Both
|
$1,541.00
|
|
|
Service Code
|
HCPCS 35190
|
| Min. Negotiated Rate |
$474.14 |
| Max. Negotiated Rate |
$135,085.00 |
| Rate for Payer: Aetna Commercial |
$968.34
|
| Rate for Payer: Aetna Medicare |
$751.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,040.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$968.34
|
| Rate for Payer: BCBS Complete |
$497.85
|
| Rate for Payer: BCBS MAPPO |
$722.64
|
| Rate for Payer: BCBS Trust/PPO |
$706.87
|
| Rate for Payer: BCN Commercial |
$1,095.13
|
| Rate for Payer: BCN Medicare Advantage |
$722.64
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cofinity Commercial |
$968.34
|
| Rate for Payer: Cofinity Commercial |
$1,040.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.64
|
| Rate for Payer: Healthscope Commercial |
$1,336.88
|
| Rate for Payer: Healthscope Commercial |
$1,156.22
|
| Rate for Payer: Mclaren Medicaid |
$474.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$758.77
|
| Rate for Payer: Meridian Medicaid |
$497.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135,085.00
|
| Rate for Payer: Nomi Health Commercial |
$867.17
|
| Rate for Payer: PACE SWMI |
$722.64
|
| Rate for Payer: PHP Medicare Advantage |
$722.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$474.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,185.44
|
| Rate for Payer: Priority Health Medicare |
$722.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,185.44
|
| Rate for Payer: Priority Health SBD |
$1,185.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,083.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$722.64
|
| Rate for Payer: UHC Exchange |
$1,083.67
|
| Rate for Payer: UHC Medicare Advantage |
$722.64
|
| Rate for Payer: UHCCP Medicaid |
$474.14
|
|
|
PR RPR ACQUIRED/TRAUMATIC AV FISTULA HEAD & NECK
|
Professional
|
Both
|
$4,240.00
|
|
|
Service Code
|
HCPCS 35188
|
| Min. Negotiated Rate |
$836.88 |
| Max. Negotiated Rate |
$232,369.00 |
| Rate for Payer: Aetna Commercial |
$1,704.68
|
| Rate for Payer: Aetna Medicare |
$1,323.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,704.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,831.90
|
| Rate for Payer: BCBS Complete |
$878.72
|
| Rate for Payer: BCBS MAPPO |
$1,272.15
|
| Rate for Payer: BCBS Trust/PPO |
$933.51
|
| Rate for Payer: BCN Commercial |
$1,893.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,272.15
|
| Rate for Payer: Cash Price |
$3,392.00
|
| Rate for Payer: Cash Price |
$3,392.00
|
| Rate for Payer: Cofinity Commercial |
$1,831.90
|
| Rate for Payer: Cofinity Commercial |
$1,704.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,272.15
|
| Rate for Payer: Healthscope Commercial |
$2,353.48
|
| Rate for Payer: Healthscope Commercial |
$2,035.44
|
| Rate for Payer: Mclaren Medicaid |
$836.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,335.76
|
| Rate for Payer: Meridian Medicaid |
$878.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232,369.00
|
| Rate for Payer: Nomi Health Commercial |
$1,526.58
|
| Rate for Payer: PACE SWMI |
$1,272.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,272.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,756.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,080.50
|
| Rate for Payer: Priority Health Medicare |
$1,272.15
|
| Rate for Payer: Priority Health Narrow Network |
$2,080.50
|
| Rate for Payer: Priority Health SBD |
$2,080.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,174.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,272.15
|
| Rate for Payer: UHC Exchange |
$1,174.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,272.15
|
| Rate for Payer: UHCCP Medicaid |
$836.88
|
|
|
PR RPR/ADVMNT FLXR TDN N/Z/2 W/O FR GRAFT EA TENDON
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 26350
|
| Min. Negotiated Rate |
$329.13 |
| Max. Negotiated Rate |
$130,891.00 |
| Rate for Payer: Aetna Commercial |
$929.13
|
| Rate for Payer: Aetna Medicare |
$721.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$929.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$998.47
|
| Rate for Payer: BCBS Complete |
$505.23
|
| Rate for Payer: BCBS MAPPO |
$693.38
|
| Rate for Payer: BCBS Trust/PPO |
$329.13
|
| Rate for Payer: BCN Commercial |
$1,111.25
|
| Rate for Payer: BCN Medicare Advantage |
$693.38
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Commercial |
$998.47
|
| Rate for Payer: Cofinity Commercial |
$929.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$693.38
|
| Rate for Payer: Healthscope Commercial |
$1,282.75
|
| Rate for Payer: Healthscope Commercial |
$1,109.41
|
| Rate for Payer: Mclaren Medicaid |
$481.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$728.05
|
| Rate for Payer: Meridian Medicaid |
$505.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130,891.00
|
| Rate for Payer: Nomi Health Commercial |
$832.06
|
| Rate for Payer: PACE SWMI |
$693.38
|
| Rate for Payer: PHP Medicare Advantage |
$693.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$481.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,156.13
|
| Rate for Payer: Priority Health Medicare |
$693.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,156.13
|
| Rate for Payer: Priority Health SBD |
$1,156.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,010.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$693.38
|
| Rate for Payer: UHC Exchange |
$1,010.18
|
| Rate for Payer: UHC Medicare Advantage |
$693.38
|
| Rate for Payer: UHCCP Medicaid |
$481.17
|
|
|
PR RPR/ADVMNT FLXR TDN ZONE 2 W/FR GRAFT EA TENDON
|
Professional
|
Both
|
$2,709.00
|
|
|
Service Code
|
HCPCS 26358
|
| Min. Negotiated Rate |
$641.34 |
| Max. Negotiated Rate |
$174,202.00 |
| Rate for Payer: Aetna Commercial |
$1,266.73
|
| Rate for Payer: Aetna Medicare |
$983.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,266.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,361.26
|
| Rate for Payer: BCBS Complete |
$673.41
|
| Rate for Payer: BCBS MAPPO |
$945.32
|
| Rate for Payer: BCBS Trust/PPO |
$662.49
|
| Rate for Payer: BCN Commercial |
$1,449.42
|
| Rate for Payer: BCN Medicare Advantage |
$945.32
|
| Rate for Payer: Cash Price |
$2,167.20
|
| Rate for Payer: Cash Price |
$2,167.20
|
| Rate for Payer: Cofinity Commercial |
$1,361.26
|
| Rate for Payer: Cofinity Commercial |
$1,266.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$945.32
|
| Rate for Payer: Healthscope Commercial |
$1,748.84
|
| Rate for Payer: Healthscope Commercial |
$1,512.51
|
| Rate for Payer: Mclaren Medicaid |
$641.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$992.59
|
| Rate for Payer: Meridian Medicaid |
$673.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174,202.00
|
| Rate for Payer: Nomi Health Commercial |
$1,134.38
|
| Rate for Payer: PACE SWMI |
$945.32
|
| Rate for Payer: PHP Medicare Advantage |
$945.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$641.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,760.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,522.00
|
| Rate for Payer: Priority Health Medicare |
$945.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,522.00
|
| Rate for Payer: Priority Health SBD |
$1,522.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,216.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$945.32
|
| Rate for Payer: UHC Exchange |
$1,216.01
|
| Rate for Payer: UHC Medicare Advantage |
$945.32
|
| Rate for Payer: UHCCP Medicaid |
$641.34
|
|
|
PR RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON
|
Professional
|
Both
|
$2,657.00
|
|
|
Service Code
|
HCPCS 26356
|
| Min. Negotiated Rate |
$521.21 |
| Max. Negotiated Rate |
$140,704.00 |
| Rate for Payer: Aetna Commercial |
$1,023.56
|
| Rate for Payer: Aetna Medicare |
$794.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,023.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,099.94
|
| Rate for Payer: BCBS Complete |
$547.27
|
| Rate for Payer: BCBS MAPPO |
$763.85
|
| Rate for Payer: BCBS Trust/PPO |
$559.47
|
| Rate for Payer: BCN Commercial |
$1,176.25
|
| Rate for Payer: BCN Medicare Advantage |
$763.85
|
| Rate for Payer: Cash Price |
$2,125.60
|
| Rate for Payer: Cash Price |
$2,125.60
|
| Rate for Payer: Cofinity Commercial |
$1,099.94
|
| Rate for Payer: Cofinity Commercial |
$1,023.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$763.85
|
| Rate for Payer: Healthscope Commercial |
$1,413.12
|
| Rate for Payer: Healthscope Commercial |
$1,222.16
|
| Rate for Payer: Mclaren Medicaid |
$521.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$802.04
|
| Rate for Payer: Meridian Medicaid |
$547.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140,704.00
|
| Rate for Payer: Nomi Health Commercial |
$916.62
|
| Rate for Payer: PACE SWMI |
$763.85
|
| Rate for Payer: PHP Medicare Advantage |
$763.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$521.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,727.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,233.98
|
| Rate for Payer: Priority Health Medicare |
$763.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,233.98
|
| Rate for Payer: Priority Health SBD |
$1,233.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,160.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$763.85
|
| Rate for Payer: UHC Exchange |
$1,160.37
|
| Rate for Payer: UHC Medicare Advantage |
$763.85
|
| Rate for Payer: UHCCP Medicaid |
$521.21
|
|
|
PR RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON
|
Professional
|
Both
|
$2,775.00
|
|
|
Service Code
|
HCPCS 26357
|
| Min. Negotiated Rate |
$511.92 |
| Max. Negotiated Rate |
$157,918.00 |
| Rate for Payer: Aetna Commercial |
$1,147.04
|
| Rate for Payer: Aetna Medicare |
$890.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,147.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,232.64
|
| Rate for Payer: BCBS Complete |
$611.24
|
| Rate for Payer: BCBS MAPPO |
$856.00
|
| Rate for Payer: BCBS Trust/PPO |
$511.92
|
| Rate for Payer: BCN Commercial |
$1,316.50
|
| Rate for Payer: BCN Medicare Advantage |
$856.00
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cofinity Commercial |
$1,232.64
|
| Rate for Payer: Cofinity Commercial |
$1,147.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$856.00
|
| Rate for Payer: Healthscope Commercial |
$1,583.60
|
| Rate for Payer: Healthscope Commercial |
$1,369.60
|
| Rate for Payer: Mclaren Medicaid |
$582.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$898.80
|
| Rate for Payer: Meridian Medicaid |
$611.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157,918.00
|
| Rate for Payer: Nomi Health Commercial |
$1,027.20
|
| Rate for Payer: PACE SWMI |
$856.00
|
| Rate for Payer: PHP Medicare Advantage |
$856.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$582.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,381.56
|
| Rate for Payer: Priority Health Medicare |
$856.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,381.56
|
| Rate for Payer: Priority Health SBD |
$1,381.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,171.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$856.00
|
| Rate for Payer: UHC Exchange |
$1,171.07
|
| Rate for Payer: UHC Medicare Advantage |
$856.00
|
| Rate for Payer: UHCCP Medicaid |
$582.13
|
|
|
PR RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN
|
Professional
|
Both
|
$2,340.00
|
|
|
Service Code
|
HCPCS 26370
|
| Min. Negotiated Rate |
$505.24 |
| Max. Negotiated Rate |
$137,988.00 |
| Rate for Payer: Aetna Commercial |
$980.26
|
| Rate for Payer: Aetna Medicare |
$760.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,053.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$980.26
|
| Rate for Payer: BCBS Complete |
$530.50
|
| Rate for Payer: BCBS MAPPO |
$731.54
|
| Rate for Payer: BCBS Trust/PPO |
$732.75
|
| Rate for Payer: BCN Commercial |
$1,166.96
|
| Rate for Payer: BCN Medicare Advantage |
$731.54
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Cofinity Commercial |
$980.26
|
| Rate for Payer: Cofinity Commercial |
$1,053.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$731.54
|
| Rate for Payer: Healthscope Commercial |
$1,353.35
|
| Rate for Payer: Healthscope Commercial |
$1,170.46
|
| Rate for Payer: Mclaren Medicaid |
$505.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$768.12
|
| Rate for Payer: Meridian Medicaid |
$530.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137,988.00
|
| Rate for Payer: Nomi Health Commercial |
$877.85
|
| Rate for Payer: PACE SWMI |
$731.54
|
| Rate for Payer: PHP Medicare Advantage |
$731.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$505.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,521.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,210.58
|
| Rate for Payer: Priority Health Medicare |
$731.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,210.58
|
| Rate for Payer: Priority Health SBD |
$1,210.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,087.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$731.54
|
| Rate for Payer: UHC Exchange |
$1,087.55
|
| Rate for Payer: UHC Medicare Advantage |
$731.54
|
| Rate for Payer: UHCCP Medicaid |
$505.24
|
|
|
PR RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/FREE GRAFT EA
|
Professional
|
Both
|
$3,106.00
|
|
|
Service Code
|
HCPCS 26372
|
| Min. Negotiated Rate |
$588.73 |
| Max. Negotiated Rate |
$161,294.00 |
| Rate for Payer: Aetna Commercial |
$1,147.07
|
| Rate for Payer: Aetna Medicare |
$890.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,147.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,232.67
|
| Rate for Payer: BCBS Complete |
$618.17
|
| Rate for Payer: BCBS MAPPO |
$856.02
|
| Rate for Payer: BCN Commercial |
$1,359.50
|
| Rate for Payer: BCN Medicare Advantage |
$856.02
|
| Rate for Payer: Cash Price |
$2,484.80
|
| Rate for Payer: Cash Price |
$2,484.80
|
| Rate for Payer: Cofinity Commercial |
$1,232.67
|
| Rate for Payer: Cofinity Commercial |
$1,147.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$856.02
|
| Rate for Payer: Healthscope Commercial |
$1,583.64
|
| Rate for Payer: Healthscope Commercial |
$1,369.63
|
| Rate for Payer: Mclaren Medicaid |
$588.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$898.82
|
| Rate for Payer: Meridian Medicaid |
$618.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161,294.00
|
| Rate for Payer: Nomi Health Commercial |
$1,027.22
|
| Rate for Payer: PACE SWMI |
$856.02
|
| Rate for Payer: PHP Medicare Advantage |
$856.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$588.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,018.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,413.10
|
| Rate for Payer: Priority Health Medicare |
$856.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,413.10
|
| Rate for Payer: Priority Health SBD |
$1,413.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,210.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$856.02
|
| Rate for Payer: UHC Exchange |
$1,210.14
|
| Rate for Payer: UHC Medicare Advantage |
$856.02
|
| Rate for Payer: UHCCP Medicaid |
$588.73
|
|
|
PR RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/O FREE GRF EA
|
Professional
|
Both
|
$2,854.00
|
|
|
Service Code
|
HCPCS 26373
|
| Min. Negotiated Rate |
$250.94 |
| Max. Negotiated Rate |
$155,189.00 |
| Rate for Payer: Aetna Commercial |
$1,102.32
|
| Rate for Payer: Aetna Medicare |
$855.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,102.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,184.59
|
| Rate for Payer: BCBS Complete |
$594.91
|
| Rate for Payer: BCBS MAPPO |
$822.63
|
| Rate for Payer: BCBS Trust/PPO |
$250.94
|
| Rate for Payer: BCN Commercial |
$1,309.65
|
| Rate for Payer: BCN Medicare Advantage |
$822.63
|
| Rate for Payer: Cash Price |
$2,283.20
|
| Rate for Payer: Cash Price |
$2,283.20
|
| Rate for Payer: Cofinity Commercial |
$1,184.59
|
| Rate for Payer: Cofinity Commercial |
$1,102.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$822.63
|
| Rate for Payer: Healthscope Commercial |
$1,521.87
|
| Rate for Payer: Healthscope Commercial |
$1,316.21
|
| Rate for Payer: Mclaren Medicaid |
$566.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$863.76
|
| Rate for Payer: Meridian Medicaid |
$594.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155,189.00
|
| Rate for Payer: Nomi Health Commercial |
$987.16
|
| Rate for Payer: PACE SWMI |
$822.63
|
| Rate for Payer: PHP Medicare Advantage |
$822.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$566.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,855.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,360.18
|
| Rate for Payer: Priority Health Medicare |
$822.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,360.18
|
| Rate for Payer: Priority Health SBD |
$1,360.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,165.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$822.63
|
| Rate for Payer: UHC Exchange |
$1,165.82
|
| Rate for Payer: UHC Medicare Advantage |
$822.63
|
| Rate for Payer: UHCCP Medicaid |
$566.58
|
|
|
PR RPR ANOM AORTIC ORIGIN CORONARY ART UNROOF/TLCJ
|
Professional
|
Both
|
$3,602.00
|
|
|
Service Code
|
HCPCS 33507
|
| Min. Negotiated Rate |
$724.30 |
| Max. Negotiated Rate |
$305,163.00 |
| Rate for Payer: Aetna Commercial |
$2,214.78
|
| Rate for Payer: Aetna Medicare |
$1,718.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,214.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,380.06
|
| Rate for Payer: BCBS Complete |
$1,136.36
|
| Rate for Payer: BCBS MAPPO |
$1,652.82
|
| Rate for Payer: BCBS Trust/PPO |
$724.30
|
| Rate for Payer: BCN Commercial |
$2,466.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,652.82
|
| Rate for Payer: Cash Price |
$2,881.60
|
| Rate for Payer: Cash Price |
$2,881.60
|
| Rate for Payer: Cofinity Commercial |
$2,380.06
|
| Rate for Payer: Cofinity Commercial |
$2,214.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,652.82
|
| Rate for Payer: Healthscope Commercial |
$3,057.72
|
| Rate for Payer: Healthscope Commercial |
$2,644.51
|
| Rate for Payer: Mclaren Medicaid |
$1,082.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,735.46
|
| Rate for Payer: Meridian Medicaid |
$1,136.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305,163.00
|
| Rate for Payer: Nomi Health Commercial |
$1,983.38
|
| Rate for Payer: PACE SWMI |
$1,652.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,652.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,082.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,341.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,694.22
|
| Rate for Payer: Priority Health Medicare |
$1,652.82
|
| Rate for Payer: Priority Health Narrow Network |
$2,694.22
|
| Rate for Payer: Priority Health SBD |
$2,694.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,958.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,652.82
|
| Rate for Payer: UHC Exchange |
$1,958.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,652.82
|
| Rate for Payer: UHCCP Medicaid |
$1,082.25
|
|
|
PR RPR ANOM CORONARY ART PULM ART ORIGIN GRF W/BYP
|
Professional
|
Both
|
$5,041.00
|
|
|
Service Code
|
HCPCS 33504
|
| Min. Negotiated Rate |
$576.38 |
| Max. Negotiated Rate |
$259,870.00 |
| Rate for Payer: Aetna Commercial |
$1,891.09
|
| Rate for Payer: Aetna Medicare |
$1,467.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,891.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,032.21
|
| Rate for Payer: BCBS Complete |
$975.33
|
| Rate for Payer: BCBS MAPPO |
$1,411.26
|
| Rate for Payer: BCBS Trust/PPO |
$576.38
|
| Rate for Payer: BCN Commercial |
$2,109.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,411.26
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Cofinity Commercial |
$2,032.21
|
| Rate for Payer: Cofinity Commercial |
$1,891.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,411.26
|
| Rate for Payer: Healthscope Commercial |
$2,610.83
|
| Rate for Payer: Healthscope Commercial |
$2,258.02
|
| Rate for Payer: Mclaren Medicaid |
$928.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,481.82
|
| Rate for Payer: Meridian Medicaid |
$975.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259,870.00
|
| Rate for Payer: Nomi Health Commercial |
$1,693.51
|
| Rate for Payer: PACE SWMI |
$1,411.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,411.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$928.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,276.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,309.18
|
| Rate for Payer: Priority Health Medicare |
$1,411.26
|
| Rate for Payer: Priority Health Narrow Network |
$2,309.18
|
| Rate for Payer: Priority Health SBD |
$2,309.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,807.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,411.26
|
| Rate for Payer: UHC Exchange |
$2,807.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,411.26
|
| Rate for Payer: UHCCP Medicaid |
$928.89
|
|
|
PR RPR ATRIAL SEPTAL DFCT SECUNDUM W/BYP W/WO PATCH
|
Professional
|
Both
|
$5,071.00
|
|
|
Service Code
|
HCPCS 33641
|
| Min. Negotiated Rate |
$957.28 |
| Max. Negotiated Rate |
$290,331.00 |
| Rate for Payer: Aetna Commercial |
$2,109.17
|
| Rate for Payer: Aetna Medicare |
$1,636.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,109.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,266.57
|
| Rate for Payer: BCBS Complete |
$1,083.36
|
| Rate for Payer: BCBS MAPPO |
$1,574.01
|
| Rate for Payer: BCBS Trust/PPO |
$957.28
|
| Rate for Payer: BCN Commercial |
$2,349.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,574.01
|
| Rate for Payer: Cash Price |
$4,056.80
|
| Rate for Payer: Cash Price |
$4,056.80
|
| Rate for Payer: Cofinity Commercial |
$2,266.57
|
| Rate for Payer: Cofinity Commercial |
$2,109.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,574.01
|
| Rate for Payer: Healthscope Commercial |
$2,911.92
|
| Rate for Payer: Healthscope Commercial |
$2,518.42
|
| Rate for Payer: Mclaren Medicaid |
$1,031.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,652.71
|
| Rate for Payer: Meridian Medicaid |
$1,083.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290,331.00
|
| Rate for Payer: Nomi Health Commercial |
$1,888.81
|
| Rate for Payer: PACE SWMI |
$1,574.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,574.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,031.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,296.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,568.72
|
| Rate for Payer: Priority Health Medicare |
$1,574.01
|
| Rate for Payer: Priority Health Narrow Network |
$2,568.72
|
| Rate for Payer: Priority Health SBD |
$2,568.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,448.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,574.01
|
| Rate for Payer: UHC Exchange |
$2,448.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,574.01
|
| Rate for Payer: UHCCP Medicaid |
$1,031.77
|
|
|
PR RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL
|
Professional
|
Both
|
$1,139.00
|
|
|
Service Code
|
HCPCS 67903
|
| Min. Negotiated Rate |
$304.38 |
| Max. Negotiated Rate |
$82,454.00 |
| Rate for Payer: Aetna Commercial |
$595.28
|
| Rate for Payer: Aetna Medicare |
$462.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.71
|
| Rate for Payer: BCBS Complete |
$319.60
|
| Rate for Payer: BCBS MAPPO |
$444.24
|
| Rate for Payer: BCBS Trust/PPO |
$714.79
|
| Rate for Payer: BCN Commercial |
$875.71
|
| Rate for Payer: BCN Medicare Advantage |
$444.24
|
| Rate for Payer: Cash Price |
$911.20
|
| Rate for Payer: Cash Price |
$911.20
|
| Rate for Payer: Cofinity Commercial |
$639.71
|
| Rate for Payer: Cofinity Commercial |
$595.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.24
|
| Rate for Payer: Healthscope Commercial |
$821.84
|
| Rate for Payer: Healthscope Commercial |
$710.78
|
| Rate for Payer: Mclaren Medicaid |
$304.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$466.45
|
| Rate for Payer: Meridian Medicaid |
$319.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82,454.00
|
| Rate for Payer: Nomi Health Commercial |
$533.09
|
| Rate for Payer: PACE SWMI |
$444.24
|
| Rate for Payer: PHP Medicare Advantage |
$444.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$740.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$834.08
|
| Rate for Payer: Priority Health Medicare |
$444.24
|
| Rate for Payer: Priority Health Narrow Network |
$834.08
|
| Rate for Payer: Priority Health SBD |
$834.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$781.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$444.24
|
| Rate for Payer: UHC Exchange |
$781.85
|
| Rate for Payer: UHC Medicare Advantage |
$444.24
|
| Rate for Payer: UHCCP Medicaid |
$304.38
|
|
|
PR RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 67904
|
| Min. Negotiated Rate |
$377.01 |
| Max. Negotiated Rate |
$102,235.00 |
| Rate for Payer: Aetna Commercial |
$737.16
|
| Rate for Payer: Aetna Medicare |
$572.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$737.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$792.17
|
| Rate for Payer: BCBS Complete |
$395.86
|
| Rate for Payer: BCBS MAPPO |
$550.12
|
| Rate for Payer: BCBS Trust/PPO |
$581.13
|
| Rate for Payer: BCN Commercial |
$1,075.09
|
| Rate for Payer: BCN Medicare Advantage |
$550.12
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$792.17
|
| Rate for Payer: Cofinity Commercial |
$737.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.12
|
| Rate for Payer: Healthscope Commercial |
$880.19
|
| Rate for Payer: Healthscope Commercial |
$1,017.72
|
| Rate for Payer: Mclaren Medicaid |
$377.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$577.63
|
| Rate for Payer: Meridian Medicaid |
$395.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102,235.00
|
| Rate for Payer: Nomi Health Commercial |
$660.14
|
| Rate for Payer: PACE SWMI |
$550.12
|
| Rate for Payer: PHP Medicare Advantage |
$550.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$377.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,034.70
|
| Rate for Payer: Priority Health Medicare |
$550.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,034.70
|
| Rate for Payer: Priority Health SBD |
$1,034.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$851.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$550.12
|
| Rate for Payer: UHC Exchange |
$851.91
|
| Rate for Payer: UHC Medicare Advantage |
$550.12
|
| Rate for Payer: UHCCP Medicaid |
$377.01
|
|
|
PR RPR BLOOD VESSEL DIRECT INTRATHORACIC W/BYPASS
|
Professional
|
Both
|
$2,893.00
|
|
|
Service Code
|
HCPCS 35211
|
| Min. Negotiated Rate |
$877.35 |
| Max. Negotiated Rate |
$245,662.00 |
| Rate for Payer: Aetna Commercial |
$1,786.80
|
| Rate for Payer: Aetna Medicare |
$1,386.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,786.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,920.14
|
| Rate for Payer: BCBS Complete |
$921.22
|
| Rate for Payer: BCBS MAPPO |
$1,333.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,289.05
|
| Rate for Payer: BCN Commercial |
$1,992.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,333.43
|
| Rate for Payer: Cash Price |
$2,314.40
|
| Rate for Payer: Cash Price |
$2,314.40
|
| Rate for Payer: Cofinity Commercial |
$1,920.14
|
| Rate for Payer: Cofinity Commercial |
$1,786.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,333.43
|
| Rate for Payer: Healthscope Commercial |
$2,466.85
|
| Rate for Payer: Healthscope Commercial |
$2,133.49
|
| Rate for Payer: Mclaren Medicaid |
$877.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,400.10
|
| Rate for Payer: Meridian Medicaid |
$921.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245,662.00
|
| Rate for Payer: Nomi Health Commercial |
$1,600.12
|
| Rate for Payer: PACE SWMI |
$1,333.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,333.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$877.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,880.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,185.26
|
| Rate for Payer: Priority Health Medicare |
$1,333.43
|
| Rate for Payer: Priority Health Narrow Network |
$2,185.26
|
| Rate for Payer: Priority Health SBD |
$2,185.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,747.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,333.43
|
| Rate for Payer: UHC Exchange |
$1,747.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,333.43
|
| Rate for Payer: UHCCP Medicaid |
$877.35
|
|
