|
PR RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT
|
Professional
|
Both
|
$3,241.00
|
|
|
Service Code
|
HCPCS 25405
|
| Min. Negotiated Rate |
$1,000.77 |
| Max. Negotiated Rate |
$2,106.65 |
| Rate for Payer: Aetna Commercial |
$1,341.03
|
| Rate for Payer: Aetna Medicare |
$1,040.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,441.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,341.03
|
| Rate for Payer: BCBS Complete |
$1,296.40
|
| Rate for Payer: BCBS MAPPO |
$1,000.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,000.77
|
| Rate for Payer: Cash Price |
$2,592.80
|
| Rate for Payer: Cash Price |
$2,592.80
|
| Rate for Payer: Cofinity Commercial |
$1,441.11
|
| Rate for Payer: Cofinity Commercial |
$1,341.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,000.77
|
| Rate for Payer: Healthscope Commercial |
$1,601.23
|
| Rate for Payer: Healthscope Commercial |
$1,851.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,050.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,106.65
|
| Rate for Payer: Nomi Health Commercial |
$1,200.92
|
| Rate for Payer: PACE SWMI |
$1,000.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,000.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,106.65
|
| Rate for Payer: Priority Health Medicare |
$1,000.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,000.77
|
| Rate for Payer: UHC Medicare Advantage |
$1,000.77
|
|
|
PR RPR NONUNION/MALUNION RADIUS&ULNA W/O AUTOGRAF
|
Professional
|
Both
|
$3,275.00
|
|
|
Service Code
|
HCPCS 25415
|
| Min. Negotiated Rate |
$933.93 |
| Max. Negotiated Rate |
$2,128.75 |
| Rate for Payer: Aetna Commercial |
$1,251.47
|
| Rate for Payer: Aetna Medicare |
$971.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,344.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,251.47
|
| Rate for Payer: BCBS Complete |
$1,310.00
|
| Rate for Payer: BCBS MAPPO |
$933.93
|
| Rate for Payer: BCN Medicare Advantage |
$933.93
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cofinity Commercial |
$1,344.86
|
| Rate for Payer: Cofinity Commercial |
$1,251.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$933.93
|
| Rate for Payer: Healthscope Commercial |
$1,727.77
|
| Rate for Payer: Healthscope Commercial |
$1,494.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$980.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,128.75
|
| Rate for Payer: Nomi Health Commercial |
$1,120.72
|
| Rate for Payer: PACE SWMI |
$933.93
|
| Rate for Payer: PHP Medicare Advantage |
$933.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,128.75
|
| Rate for Payer: Priority Health Medicare |
$933.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$933.93
|
| Rate for Payer: UHC Medicare Advantage |
$933.93
|
|
|
PR RPR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT
|
Professional
|
Both
|
$2,633.00
|
|
|
Service Code
|
HCPCS 25400
|
| Min. Negotiated Rate |
$774.63 |
| Max. Negotiated Rate |
$1,711.45 |
| Rate for Payer: Aetna Commercial |
$1,038.00
|
| Rate for Payer: Aetna Medicare |
$805.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,115.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,038.00
|
| Rate for Payer: BCBS Complete |
$1,053.20
|
| Rate for Payer: BCBS MAPPO |
$774.63
|
| Rate for Payer: BCN Medicare Advantage |
$774.63
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cofinity Commercial |
$1,115.47
|
| Rate for Payer: Cofinity Commercial |
$1,038.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.63
|
| Rate for Payer: Healthscope Commercial |
$1,239.41
|
| Rate for Payer: Healthscope Commercial |
$1,433.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$813.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,711.45
|
| Rate for Payer: Nomi Health Commercial |
$929.56
|
| Rate for Payer: PACE SWMI |
$774.63
|
| Rate for Payer: PHP Medicare Advantage |
$774.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,711.45
|
| Rate for Payer: Priority Health Medicare |
$774.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.63
|
| Rate for Payer: UHC Medicare Advantage |
$774.63
|
|
|
PR RPR NON-UNION MTCRPL/PHALANX
|
Professional
|
Both
|
$2,109.00
|
|
|
Service Code
|
HCPCS 26546
|
| Min. Negotiated Rate |
$843.60 |
| Max. Negotiated Rate |
$1,819.44 |
| Rate for Payer: Aetna Commercial |
$1,317.86
|
| Rate for Payer: Aetna Medicare |
$1,022.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,416.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,317.86
|
| Rate for Payer: BCBS Complete |
$843.60
|
| Rate for Payer: BCBS MAPPO |
$983.48
|
| Rate for Payer: BCN Medicare Advantage |
$983.48
|
| Rate for Payer: Cash Price |
$1,687.20
|
| Rate for Payer: Cash Price |
$1,687.20
|
| Rate for Payer: Cofinity Commercial |
$1,416.21
|
| Rate for Payer: Cofinity Commercial |
$1,317.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$983.48
|
| Rate for Payer: Healthscope Commercial |
$1,819.44
|
| Rate for Payer: Healthscope Commercial |
$1,573.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,032.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,370.85
|
| Rate for Payer: Nomi Health Commercial |
$1,180.18
|
| Rate for Payer: PACE SWMI |
$983.48
|
| Rate for Payer: PHP Medicare Advantage |
$983.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,370.85
|
| Rate for Payer: Priority Health Medicare |
$983.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$983.48
|
| Rate for Payer: UHC Medicare Advantage |
$983.48
|
|
|
PR RPR NONUNION SCAPHOID CARPAL B1 W/WO RDL STYLODC
|
Professional
|
Both
|
$1,376.00
|
|
|
Service Code
|
HCPCS 25440
|
| Min. Negotiated Rate |
$550.40 |
| Max. Negotiated Rate |
$1,375.11 |
| Rate for Payer: Aetna Commercial |
$996.02
|
| Rate for Payer: Aetna Medicare |
$773.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$996.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.35
|
| Rate for Payer: BCBS Complete |
$550.40
|
| Rate for Payer: BCBS MAPPO |
$743.30
|
| Rate for Payer: BCN Medicare Advantage |
$743.30
|
| Rate for Payer: Cash Price |
$1,100.80
|
| Rate for Payer: Cash Price |
$1,100.80
|
| Rate for Payer: Cofinity Commercial |
$996.02
|
| Rate for Payer: Cofinity Commercial |
$1,070.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$743.30
|
| Rate for Payer: Healthscope Commercial |
$1,189.28
|
| Rate for Payer: Healthscope Commercial |
$1,375.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$780.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$894.40
|
| Rate for Payer: Nomi Health Commercial |
$891.96
|
| Rate for Payer: PACE SWMI |
$743.30
|
| Rate for Payer: PHP Medicare Advantage |
$743.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$894.40
|
| Rate for Payer: Priority Health Medicare |
$743.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$743.30
|
| Rate for Payer: UHC Medicare Advantage |
$743.30
|
|
|
PR RPR NSL VLV COLLAPSE SUBQ/SBMCSL LAT WALL IMPLT
|
Professional
|
Both
|
$419.00
|
|
|
Service Code
|
HCPCS 30468
|
| Min. Negotiated Rate |
$161.44 |
| Max. Negotiated Rate |
$298.66 |
| Rate for Payer: Aetna Commercial |
$216.33
|
| Rate for Payer: Aetna Medicare |
$167.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.33
|
| Rate for Payer: BCBS Complete |
$167.60
|
| Rate for Payer: BCBS MAPPO |
$161.44
|
| Rate for Payer: BCN Medicare Advantage |
$161.44
|
| Rate for Payer: Cash Price |
$335.20
|
| Rate for Payer: Cash Price |
$335.20
|
| Rate for Payer: Cofinity Commercial |
$232.47
|
| Rate for Payer: Cofinity Commercial |
$216.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.44
|
| Rate for Payer: Healthscope Commercial |
$298.66
|
| Rate for Payer: Healthscope Commercial |
$258.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.35
|
| Rate for Payer: Nomi Health Commercial |
$193.73
|
| Rate for Payer: PACE SWMI |
$161.44
|
| Rate for Payer: PHP Medicare Advantage |
$161.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.35
|
| Rate for Payer: Priority Health Medicare |
$161.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.44
|
| Rate for Payer: UHC Medicare Advantage |
$161.44
|
|
|
PR RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/O MESH
|
Professional
|
Both
|
$2,725.00
|
|
|
Service Code
|
HCPCS 43336
|
| Min. Negotiated Rate |
$1,090.00 |
| Max. Negotiated Rate |
$2,577.81 |
| Rate for Payer: Aetna Commercial |
$1,867.17
|
| Rate for Payer: Aetna Medicare |
$1,449.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,006.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,867.17
|
| Rate for Payer: BCBS Complete |
$1,090.00
|
| Rate for Payer: BCBS MAPPO |
$1,393.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,393.41
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cofinity Commercial |
$2,006.51
|
| Rate for Payer: Cofinity Commercial |
$1,867.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,393.41
|
| Rate for Payer: Healthscope Commercial |
$2,229.46
|
| Rate for Payer: Healthscope Commercial |
$2,577.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,463.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,771.25
|
| Rate for Payer: Nomi Health Commercial |
$1,672.09
|
| Rate for Payer: PACE SWMI |
$1,393.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,393.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,771.25
|
| Rate for Payer: Priority Health Medicare |
$1,393.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,393.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,393.41
|
|
|
PR RPR PARAESOPH HIATAL HERNIA W/LAPT W/O MESH
|
Professional
|
Both
|
$2,118.00
|
|
|
Service Code
|
HCPCS 43332
|
| Min. Negotiated Rate |
$847.20 |
| Max. Negotiated Rate |
$2,058.66 |
| Rate for Payer: Aetna Commercial |
$1,491.14
|
| Rate for Payer: Aetna Medicare |
$1,157.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,602.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,491.14
|
| Rate for Payer: BCBS Complete |
$847.20
|
| Rate for Payer: BCBS MAPPO |
$1,112.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,112.79
|
| Rate for Payer: Cash Price |
$1,694.40
|
| Rate for Payer: Cash Price |
$1,694.40
|
| Rate for Payer: Cofinity Commercial |
$1,602.42
|
| Rate for Payer: Cofinity Commercial |
$1,491.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,112.79
|
| Rate for Payer: Healthscope Commercial |
$2,058.66
|
| Rate for Payer: Healthscope Commercial |
$1,780.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,168.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,376.70
|
| Rate for Payer: Nomi Health Commercial |
$1,335.35
|
| Rate for Payer: PACE SWMI |
$1,112.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,112.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,376.70
|
| Rate for Payer: Priority Health Medicare |
$1,112.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,112.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,112.79
|
|
|
PR RPR PARAESOPH HIATAL HERNIA W/THORCOM W/MESH
|
Professional
|
Both
|
$2,801.00
|
|
|
Service Code
|
HCPCS 43335
|
| Min. Negotiated Rate |
$1,120.40 |
| Max. Negotiated Rate |
$2,373.98 |
| Rate for Payer: Aetna Commercial |
$1,719.53
|
| Rate for Payer: Aetna Medicare |
$1,334.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,847.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,719.53
|
| Rate for Payer: BCBS Complete |
$1,120.40
|
| Rate for Payer: BCBS MAPPO |
$1,283.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,283.23
|
| Rate for Payer: Cash Price |
$2,240.80
|
| Rate for Payer: Cash Price |
$2,240.80
|
| Rate for Payer: Cofinity Commercial |
$1,847.85
|
| Rate for Payer: Cofinity Commercial |
$1,719.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,283.23
|
| Rate for Payer: Healthscope Commercial |
$2,053.17
|
| Rate for Payer: Healthscope Commercial |
$2,373.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,347.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,820.65
|
| Rate for Payer: Nomi Health Commercial |
$1,539.88
|
| Rate for Payer: PACE SWMI |
$1,283.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,283.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,820.65
|
| Rate for Payer: Priority Health Medicare |
$1,283.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,283.23
|
| Rate for Payer: UHC Medicare Advantage |
$1,283.23
|
|
|
PR RPR PARAESOPH HIATAL HERNIA W/THORCOM W/O MESH
|
Professional
|
Both
|
$3,439.00
|
|
|
Service Code
|
HCPCS 43334
|
| Min. Negotiated Rate |
$1,194.57 |
| Max. Negotiated Rate |
$2,235.35 |
| Rate for Payer: Aetna Commercial |
$1,600.72
|
| Rate for Payer: Aetna Medicare |
$1,242.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,720.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,600.72
|
| Rate for Payer: BCBS Complete |
$1,375.60
|
| Rate for Payer: BCBS MAPPO |
$1,194.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,194.57
|
| Rate for Payer: Cash Price |
$2,751.20
|
| Rate for Payer: Cash Price |
$2,751.20
|
| Rate for Payer: Cofinity Commercial |
$1,720.18
|
| Rate for Payer: Cofinity Commercial |
$1,600.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,194.57
|
| Rate for Payer: Healthscope Commercial |
$2,209.95
|
| Rate for Payer: Healthscope Commercial |
$1,911.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,254.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,235.35
|
| Rate for Payer: Nomi Health Commercial |
$1,433.48
|
| Rate for Payer: PACE SWMI |
$1,194.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,194.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,235.35
|
| Rate for Payer: Priority Health Medicare |
$1,194.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,194.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,194.57
|
|
|
PR RPR PARASTOMAL HERNIA 1ST/RECR REDUCIBLE
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 49621
|
| Min. Negotiated Rate |
$620.00 |
| Max. Negotiated Rate |
$1,356.73 |
| Rate for Payer: Aetna Commercial |
$982.72
|
| Rate for Payer: Aetna Medicare |
$762.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$982.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,056.05
|
| Rate for Payer: BCBS Complete |
$620.00
|
| Rate for Payer: BCBS MAPPO |
$733.37
|
| Rate for Payer: BCN Medicare Advantage |
$733.37
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cofinity Commercial |
$982.72
|
| Rate for Payer: Cofinity Commercial |
$1,056.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$733.37
|
| Rate for Payer: Healthscope Commercial |
$1,173.39
|
| Rate for Payer: Healthscope Commercial |
$1,356.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$770.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.50
|
| Rate for Payer: Nomi Health Commercial |
$880.04
|
| Rate for Payer: PACE SWMI |
$733.37
|
| Rate for Payer: PHP Medicare Advantage |
$733.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,007.50
|
| Rate for Payer: Priority Health Medicare |
$733.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$733.37
|
| Rate for Payer: UHC Medicare Advantage |
$733.37
|
|
|
PR RPR PARASTOMAL HRNA 1ST/RECR NCRC8/STRANGULATED
|
Professional
|
Both
|
$1,911.00
|
|
|
Service Code
|
HCPCS 49622
|
| Min. Negotiated Rate |
$764.40 |
| Max. Negotiated Rate |
$1,690.12 |
| Rate for Payer: Aetna Commercial |
$1,224.20
|
| Rate for Payer: Aetna Medicare |
$950.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,315.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,224.20
|
| Rate for Payer: BCBS Complete |
$764.40
|
| Rate for Payer: BCBS MAPPO |
$913.58
|
| Rate for Payer: BCN Medicare Advantage |
$913.58
|
| Rate for Payer: Cash Price |
$1,528.80
|
| Rate for Payer: Cash Price |
$1,528.80
|
| Rate for Payer: Cofinity Commercial |
$1,315.56
|
| Rate for Payer: Cofinity Commercial |
$1,224.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$913.58
|
| Rate for Payer: Healthscope Commercial |
$1,690.12
|
| Rate for Payer: Healthscope Commercial |
$1,461.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$959.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,242.15
|
| Rate for Payer: Nomi Health Commercial |
$1,096.30
|
| Rate for Payer: PACE SWMI |
$913.58
|
| Rate for Payer: PHP Medicare Advantage |
$913.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,242.15
|
| Rate for Payer: Priority Health Medicare |
$913.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$913.58
|
| Rate for Payer: UHC Medicare Advantage |
$913.58
|
|
|
PR RPR P-ART ARBORIZJ ANOMAL UNIFCLIZJ W/O BYPASS
|
Professional
|
Both
|
$7,564.00
|
|
|
Service Code
|
HCPCS 33925
|
| Min. Negotiated Rate |
$1,647.56 |
| Max. Negotiated Rate |
$4,916.60 |
| Rate for Payer: Aetna Commercial |
$2,207.73
|
| Rate for Payer: Aetna Medicare |
$1,713.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,372.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,207.73
|
| Rate for Payer: BCBS Complete |
$3,025.60
|
| Rate for Payer: BCBS MAPPO |
$1,647.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,647.56
|
| Rate for Payer: Cash Price |
$6,051.20
|
| Rate for Payer: Cash Price |
$6,051.20
|
| Rate for Payer: Cofinity Commercial |
$2,372.49
|
| Rate for Payer: Cofinity Commercial |
$2,207.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,647.56
|
| Rate for Payer: Healthscope Commercial |
$2,636.10
|
| Rate for Payer: Healthscope Commercial |
$3,047.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,729.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,916.60
|
| Rate for Payer: Nomi Health Commercial |
$1,977.07
|
| Rate for Payer: PACE SWMI |
$1,647.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,647.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,916.60
|
| Rate for Payer: Priority Health Medicare |
$1,647.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,647.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,647.56
|
|
|
PR RPR POSTINFRCJ VENTRICULAR SEPTAL DEFECT
|
Professional
|
Both
|
$5,876.00
|
|
|
Service Code
|
HCPCS 33545
|
| Min. Negotiated Rate |
$2,350.40 |
| Max. Negotiated Rate |
$5,417.04 |
| Rate for Payer: Aetna Commercial |
$3,923.69
|
| Rate for Payer: Aetna Medicare |
$3,045.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,216.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,923.69
|
| Rate for Payer: BCBS Complete |
$2,350.40
|
| Rate for Payer: BCBS MAPPO |
$2,928.13
|
| Rate for Payer: BCN Medicare Advantage |
$2,928.13
|
| Rate for Payer: Cash Price |
$4,700.80
|
| Rate for Payer: Cash Price |
$4,700.80
|
| Rate for Payer: Cofinity Commercial |
$4,216.51
|
| Rate for Payer: Cofinity Commercial |
$3,923.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,928.13
|
| Rate for Payer: Healthscope Commercial |
$5,417.04
|
| Rate for Payer: Healthscope Commercial |
$4,685.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,074.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,819.40
|
| Rate for Payer: Nomi Health Commercial |
$3,513.76
|
| Rate for Payer: PACE SWMI |
$2,928.13
|
| Rate for Payer: PHP Medicare Advantage |
$2,928.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,819.40
|
| Rate for Payer: Priority Health Medicare |
$2,928.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,928.13
|
| Rate for Payer: UHC Medicare Advantage |
$2,928.13
|
|
|
PR RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL
|
Professional
|
Both
|
$1,951.00
|
|
|
Service Code
|
HCPCS 27695
|
| Min. Negotiated Rate |
$467.38 |
| Max. Negotiated Rate |
$1,268.15 |
| Rate for Payer: Aetna Commercial |
$626.29
|
| Rate for Payer: Aetna Medicare |
$486.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$626.29
|
| Rate for Payer: BCBS Complete |
$780.40
|
| Rate for Payer: BCBS MAPPO |
$467.38
|
| Rate for Payer: BCN Medicare Advantage |
$467.38
|
| Rate for Payer: Cash Price |
$1,560.80
|
| Rate for Payer: Cash Price |
$1,560.80
|
| Rate for Payer: Cofinity Commercial |
$673.03
|
| Rate for Payer: Cofinity Commercial |
$626.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$467.38
|
| Rate for Payer: Healthscope Commercial |
$747.81
|
| Rate for Payer: Healthscope Commercial |
$864.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$490.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,268.15
|
| Rate for Payer: Nomi Health Commercial |
$560.86
|
| Rate for Payer: PACE SWMI |
$467.38
|
| Rate for Payer: PHP Medicare Advantage |
$467.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,268.15
|
| Rate for Payer: Priority Health Medicare |
$467.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$467.38
|
| Rate for Payer: UHC Medicare Advantage |
$467.38
|
|
|
PR RPR PRIMARY OPEN/PRQ RUPTURED ACHILLES W/GRAFT
|
Professional
|
Both
|
$1,046.00
|
|
|
Service Code
|
HCPCS 27652
|
| Min. Negotiated Rate |
$418.40 |
| Max. Negotiated Rate |
$1,186.48 |
| Rate for Payer: Aetna Commercial |
$859.40
|
| Rate for Payer: Aetna Medicare |
$666.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$859.40
|
| Rate for Payer: BCBS Complete |
$418.40
|
| Rate for Payer: BCBS MAPPO |
$641.34
|
| Rate for Payer: BCN Medicare Advantage |
$641.34
|
| Rate for Payer: Cash Price |
$836.80
|
| Rate for Payer: Cash Price |
$836.80
|
| Rate for Payer: Cofinity Commercial |
$923.53
|
| Rate for Payer: Cofinity Commercial |
$859.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.34
|
| Rate for Payer: Healthscope Commercial |
$1,186.48
|
| Rate for Payer: Healthscope Commercial |
$1,026.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$673.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$679.90
|
| Rate for Payer: Nomi Health Commercial |
$769.61
|
| Rate for Payer: PACE SWMI |
$641.34
|
| Rate for Payer: PHP Medicare Advantage |
$641.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$679.90
|
| Rate for Payer: Priority Health Medicare |
$641.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.34
|
| Rate for Payer: UHC Medicare Advantage |
$641.34
|
|
|
PR RPR PRIMARY TORN LIGM&/CAPSULE KNEE COLLATERAL
|
Professional
|
Both
|
$1,903.00
|
|
|
Service Code
|
HCPCS 27405
|
| Min. Negotiated Rate |
$653.14 |
| Max. Negotiated Rate |
$1,236.95 |
| Rate for Payer: Aetna Commercial |
$875.21
|
| Rate for Payer: Aetna Medicare |
$679.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$875.21
|
| Rate for Payer: BCBS Complete |
$761.20
|
| Rate for Payer: BCBS MAPPO |
$653.14
|
| Rate for Payer: BCN Medicare Advantage |
$653.14
|
| Rate for Payer: Cash Price |
$1,522.40
|
| Rate for Payer: Cash Price |
$1,522.40
|
| Rate for Payer: Cofinity Commercial |
$940.52
|
| Rate for Payer: Cofinity Commercial |
$875.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.14
|
| Rate for Payer: Healthscope Commercial |
$1,045.02
|
| Rate for Payer: Healthscope Commercial |
$1,208.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$685.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,236.95
|
| Rate for Payer: Nomi Health Commercial |
$783.77
|
| Rate for Payer: PACE SWMI |
$653.14
|
| Rate for Payer: PHP Medicare Advantage |
$653.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.95
|
| Rate for Payer: Priority Health Medicare |
$653.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$653.14
|
| Rate for Payer: UHC Medicare Advantage |
$653.14
|
|
|
PR RPR PRIM DISRUPTED LIGM ANKLE BTH COLTRL LIGMS
|
Professional
|
Both
|
$2,906.00
|
|
|
Service Code
|
HCPCS 27696
|
| Min. Negotiated Rate |
$527.31 |
| Max. Negotiated Rate |
$1,888.90 |
| Rate for Payer: Aetna Commercial |
$706.60
|
| Rate for Payer: Aetna Medicare |
$548.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$759.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$706.60
|
| Rate for Payer: BCBS Complete |
$1,162.40
|
| Rate for Payer: BCBS MAPPO |
$527.31
|
| Rate for Payer: BCN Medicare Advantage |
$527.31
|
| Rate for Payer: Cash Price |
$2,324.80
|
| Rate for Payer: Cash Price |
$2,324.80
|
| Rate for Payer: Cofinity Commercial |
$759.33
|
| Rate for Payer: Cofinity Commercial |
$706.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$527.31
|
| Rate for Payer: Healthscope Commercial |
$975.52
|
| Rate for Payer: Healthscope Commercial |
$843.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,888.90
|
| Rate for Payer: Nomi Health Commercial |
$632.77
|
| Rate for Payer: PACE SWMI |
$527.31
|
| Rate for Payer: PHP Medicare Advantage |
$527.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,888.90
|
| Rate for Payer: Priority Health Medicare |
$527.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$527.31
|
| Rate for Payer: UHC Medicare Advantage |
$527.31
|
|
|
PR RPR & RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL
|
Professional
|
Both
|
$2,181.00
|
|
|
Service Code
|
HCPCS 26548
|
| Min. Negotiated Rate |
$752.57 |
| Max. Negotiated Rate |
$1,417.65 |
| Rate for Payer: Aetna Commercial |
$1,008.44
|
| Rate for Payer: Aetna Medicare |
$782.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,083.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,008.44
|
| Rate for Payer: BCBS Complete |
$872.40
|
| Rate for Payer: BCBS MAPPO |
$752.57
|
| Rate for Payer: BCN Medicare Advantage |
$752.57
|
| Rate for Payer: Cash Price |
$1,744.80
|
| Rate for Payer: Cash Price |
$1,744.80
|
| Rate for Payer: Cofinity Commercial |
$1,083.70
|
| Rate for Payer: Cofinity Commercial |
$1,008.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$752.57
|
| Rate for Payer: Healthscope Commercial |
$1,204.11
|
| Rate for Payer: Healthscope Commercial |
$1,392.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$790.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,417.65
|
| Rate for Payer: Nomi Health Commercial |
$903.08
|
| Rate for Payer: PACE SWMI |
$752.57
|
| Rate for Payer: PHP Medicare Advantage |
$752.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,417.65
|
| Rate for Payer: Priority Health Medicare |
$752.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$752.57
|
| Rate for Payer: UHC Medicare Advantage |
$752.57
|
|
|
PR RPR RECRT FEM HERNIA REDUCIBLE
|
Professional
|
Both
|
$1,071.00
|
|
|
Service Code
|
HCPCS 49555
|
| Min. Negotiated Rate |
$428.40 |
| Max. Negotiated Rate |
$1,091.11 |
| Rate for Payer: Aetna Commercial |
$790.32
|
| Rate for Payer: Aetna Medicare |
$613.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$849.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$790.32
|
| Rate for Payer: BCBS Complete |
$428.40
|
| Rate for Payer: BCBS MAPPO |
$589.79
|
| Rate for Payer: BCN Medicare Advantage |
$589.79
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$849.30
|
| Rate for Payer: Cofinity Commercial |
$790.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$589.79
|
| Rate for Payer: Healthscope Commercial |
$943.66
|
| Rate for Payer: Healthscope Commercial |
$1,091.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$619.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.15
|
| Rate for Payer: Nomi Health Commercial |
$707.75
|
| Rate for Payer: PACE SWMI |
$589.79
|
| Rate for Payer: PHP Medicare Advantage |
$589.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.15
|
| Rate for Payer: Priority Health Medicare |
$589.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$589.79
|
| Rate for Payer: UHC Medicare Advantage |
$589.79
|
|
|
PR RPR RECRT FEM HERNIA REDUCIBLE
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
CPT 49555
|
| Hospital Charge Code |
49555
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$674.73 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.15
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$749.70
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$749.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.35
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.15
|
| Rate for Payer: Priority Health SBD |
$674.73
|
|
|
PR RPR RECRT FEM HERNIA REDUCIBLE
|
Professional
|
Both
|
$1,071.00
|
|
|
Service Code
|
HCPCS 49555
|
| Hospital Charge Code |
49555
|
| Min. Negotiated Rate |
$428.40 |
| Max. Negotiated Rate |
$1,091.11 |
| Rate for Payer: Aetna Commercial |
$790.32
|
| Rate for Payer: Aetna Medicare |
$613.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$790.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$849.30
|
| Rate for Payer: BCBS Complete |
$428.40
|
| Rate for Payer: BCBS MAPPO |
$589.79
|
| Rate for Payer: BCN Medicare Advantage |
$589.79
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$849.30
|
| Rate for Payer: Cofinity Commercial |
$790.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$589.79
|
| Rate for Payer: Healthscope Commercial |
$1,091.11
|
| Rate for Payer: Healthscope Commercial |
$943.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$619.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.15
|
| Rate for Payer: Nomi Health Commercial |
$707.75
|
| Rate for Payer: PACE SWMI |
$589.79
|
| Rate for Payer: PHP Medicare Advantage |
$589.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.15
|
| Rate for Payer: Priority Health Medicare |
$589.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$589.79
|
| Rate for Payer: UHC Medicare Advantage |
$589.79
|
|
|
PR RPR RECRT FEM HERNIA REDUCIBLE
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
CPT 49555
|
| Hospital Charge Code |
49555
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$674.73 |
| Max. Negotiated Rate |
$9,688.38 |
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: Aetna Medicare |
$3,579.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$749.70
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$749.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.35
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.15
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Priority Health SBD |
$674.73
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,937.74
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
PR RPR RECRT FEM HRNA INCARCERATED
|
Professional
|
Both
|
$1,481.00
|
|
|
Service Code
|
HCPCS 49557
|
| Min. Negotiated Rate |
$592.40 |
| Max. Negotiated Rate |
$1,299.75 |
| Rate for Payer: Aetna Commercial |
$941.44
|
| Rate for Payer: Aetna Medicare |
$730.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,011.70
|
| Rate for Payer: BCBS Complete |
$592.40
|
| Rate for Payer: BCBS MAPPO |
$702.57
|
| Rate for Payer: BCN Medicare Advantage |
$702.57
|
| Rate for Payer: Cash Price |
$1,184.80
|
| Rate for Payer: Cash Price |
$1,184.80
|
| Rate for Payer: Cofinity Commercial |
$941.44
|
| Rate for Payer: Cofinity Commercial |
$1,011.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$702.57
|
| Rate for Payer: Healthscope Commercial |
$1,124.11
|
| Rate for Payer: Healthscope Commercial |
$1,299.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$737.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$962.65
|
| Rate for Payer: Nomi Health Commercial |
$843.08
|
| Rate for Payer: PACE SWMI |
$702.57
|
| Rate for Payer: PHP Medicare Advantage |
$702.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$962.65
|
| Rate for Payer: Priority Health Medicare |
$702.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$702.57
|
| Rate for Payer: UHC Medicare Advantage |
$702.57
|
|
|
PR RPR RECRT INCAL/VNT HERNIA INCARCERATED
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 49566
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$1,723.80 |
| Rate for Payer: Aetna Medicare |
$1,326.00
|
| Rate for Payer: BCBS Complete |
$1,060.80
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,723.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
|
