|
PR SUTR ESOPHGL WND/INJ CRV APPR
|
Professional
|
Both
|
$2,855.00
|
|
|
Service Code
|
HCPCS 43410
|
| Min. Negotiated Rate |
$989.66 |
| Max. Negotiated Rate |
$1,855.75 |
| Rate for Payer: Aetna Commercial |
$1,326.14
|
| Rate for Payer: Aetna Medicare |
$1,029.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,425.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,326.14
|
| Rate for Payer: BCBS Complete |
$1,142.00
|
| Rate for Payer: BCBS MAPPO |
$989.66
|
| Rate for Payer: BCN Medicare Advantage |
$989.66
|
| Rate for Payer: Cash Price |
$2,284.00
|
| Rate for Payer: Cash Price |
$2,284.00
|
| Rate for Payer: Cofinity Commercial |
$1,425.11
|
| Rate for Payer: Cofinity Commercial |
$1,326.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$989.66
|
| Rate for Payer: Healthscope Commercial |
$1,830.87
|
| Rate for Payer: Healthscope Commercial |
$1,583.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,039.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,855.75
|
| Rate for Payer: Nomi Health Commercial |
$1,187.59
|
| Rate for Payer: PACE SWMI |
$989.66
|
| Rate for Payer: PHP Medicare Advantage |
$989.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,855.75
|
| Rate for Payer: Priority Health Medicare |
$989.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$989.66
|
| Rate for Payer: UHC Medicare Advantage |
$989.66
|
|
|
PR SUTR ESOPHGL WND/INJ TTHRC/TABDL APPR
|
Professional
|
Both
|
$4,076.00
|
|
|
Service Code
|
HCPCS 43415
|
| Min. Negotiated Rate |
$1,630.40 |
| Max. Negotiated Rate |
$4,575.72 |
| Rate for Payer: Aetna Commercial |
$3,314.30
|
| Rate for Payer: Aetna Medicare |
$2,572.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,561.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,314.30
|
| Rate for Payer: BCBS Complete |
$1,630.40
|
| Rate for Payer: BCBS MAPPO |
$2,473.36
|
| Rate for Payer: BCN Medicare Advantage |
$2,473.36
|
| Rate for Payer: Cash Price |
$3,260.80
|
| Rate for Payer: Cash Price |
$3,260.80
|
| Rate for Payer: Cofinity Commercial |
$3,561.64
|
| Rate for Payer: Cofinity Commercial |
$3,314.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,473.36
|
| Rate for Payer: Healthscope Commercial |
$3,957.38
|
| Rate for Payer: Healthscope Commercial |
$4,575.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,597.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,649.40
|
| Rate for Payer: Nomi Health Commercial |
$2,968.03
|
| Rate for Payer: PACE SWMI |
$2,473.36
|
| Rate for Payer: PHP Medicare Advantage |
$2,473.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,649.40
|
| Rate for Payer: Priority Health Medicare |
$2,473.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,473.36
|
| Rate for Payer: UHC Medicare Advantage |
$2,473.36
|
|
|
PR SUTR INFRAPATELLAR TDN 2 RCNSTJ W/FSCAL/TDN GRF
|
Professional
|
Both
|
$1,586.00
|
|
|
Service Code
|
HCPCS 27381
|
| Min. Negotiated Rate |
$634.40 |
| Max. Negotiated Rate |
$1,456.86 |
| Rate for Payer: Aetna Commercial |
$1,055.24
|
| Rate for Payer: Aetna Medicare |
$818.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,133.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.24
|
| Rate for Payer: BCBS Complete |
$634.40
|
| Rate for Payer: BCBS MAPPO |
$787.49
|
| Rate for Payer: BCN Medicare Advantage |
$787.49
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cofinity Commercial |
$1,133.99
|
| Rate for Payer: Cofinity Commercial |
$1,055.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.49
|
| Rate for Payer: Healthscope Commercial |
$1,456.86
|
| Rate for Payer: Healthscope Commercial |
$1,259.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.90
|
| Rate for Payer: Nomi Health Commercial |
$944.99
|
| Rate for Payer: PACE SWMI |
$787.49
|
| Rate for Payer: PHP Medicare Advantage |
$787.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,030.90
|
| Rate for Payer: Priority Health Medicare |
$787.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$787.49
|
| Rate for Payer: UHC Medicare Advantage |
$787.49
|
|
|
PR SUTR LG INTESTINE 1/MULT PERFORAT W/COLOSTOMY
|
Professional
|
Both
|
$2,938.00
|
|
|
Service Code
|
HCPCS 44605
|
| Min. Negotiated Rate |
$1,175.20 |
| Max. Negotiated Rate |
$2,308.30 |
| Rate for Payer: Aetna Commercial |
$1,671.96
|
| Rate for Payer: Aetna Medicare |
$1,297.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,796.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,671.96
|
| Rate for Payer: BCBS Complete |
$1,175.20
|
| Rate for Payer: BCBS MAPPO |
$1,247.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,247.73
|
| Rate for Payer: Cash Price |
$2,350.40
|
| Rate for Payer: Cash Price |
$2,350.40
|
| Rate for Payer: Cofinity Commercial |
$1,796.73
|
| Rate for Payer: Cofinity Commercial |
$1,671.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,247.73
|
| Rate for Payer: Healthscope Commercial |
$1,996.37
|
| Rate for Payer: Healthscope Commercial |
$2,308.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,310.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,909.70
|
| Rate for Payer: Nomi Health Commercial |
$1,497.28
|
| Rate for Payer: PACE SWMI |
$1,247.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,247.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,909.70
|
| Rate for Payer: Priority Health Medicare |
$1,247.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,247.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,247.73
|
|
|
PR SUTR LG INTESTINE 1/MULT PERFORAT W/O COLOSTOMY
|
Professional
|
Both
|
$3,081.00
|
|
|
Service Code
|
HCPCS 44604
|
| Min. Negotiated Rate |
$1,020.78 |
| Max. Negotiated Rate |
$2,002.65 |
| Rate for Payer: Aetna Commercial |
$1,367.85
|
| Rate for Payer: Aetna Medicare |
$1,061.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,469.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,367.85
|
| Rate for Payer: BCBS Complete |
$1,232.40
|
| Rate for Payer: BCBS MAPPO |
$1,020.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,020.78
|
| Rate for Payer: Cash Price |
$2,464.80
|
| Rate for Payer: Cash Price |
$2,464.80
|
| Rate for Payer: Cofinity Commercial |
$1,469.92
|
| Rate for Payer: Cofinity Commercial |
$1,367.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,020.78
|
| Rate for Payer: Healthscope Commercial |
$1,888.44
|
| Rate for Payer: Healthscope Commercial |
$1,633.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,071.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,002.65
|
| Rate for Payer: Nomi Health Commercial |
$1,224.94
|
| Rate for Payer: PACE SWMI |
$1,020.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,020.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,002.65
|
| Rate for Payer: Priority Health Medicare |
$1,020.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,020.78
|
| Rate for Payer: UHC Medicare Advantage |
$1,020.78
|
|
|
PR SUTR&/LIG THORACIC DUCT THORACIC APPROACH
|
Professional
|
Both
|
$5,927.00
|
|
|
Service Code
|
HCPCS 38381
|
| Min. Negotiated Rate |
$780.23 |
| Max. Negotiated Rate |
$3,852.55 |
| Rate for Payer: Aetna Commercial |
$1,045.51
|
| Rate for Payer: Aetna Medicare |
$811.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,123.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,045.51
|
| Rate for Payer: BCBS Complete |
$2,370.80
|
| Rate for Payer: BCBS MAPPO |
$780.23
|
| Rate for Payer: BCN Medicare Advantage |
$780.23
|
| Rate for Payer: Cash Price |
$4,741.60
|
| Rate for Payer: Cash Price |
$4,741.60
|
| Rate for Payer: Cofinity Commercial |
$1,123.53
|
| Rate for Payer: Cofinity Commercial |
$1,045.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$780.23
|
| Rate for Payer: Healthscope Commercial |
$1,248.37
|
| Rate for Payer: Healthscope Commercial |
$1,443.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$819.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,852.55
|
| Rate for Payer: Nomi Health Commercial |
$936.28
|
| Rate for Payer: PACE SWMI |
$780.23
|
| Rate for Payer: PHP Medicare Advantage |
$780.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,852.55
|
| Rate for Payer: Priority Health Medicare |
$780.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$780.23
|
| Rate for Payer: UHC Medicare Advantage |
$780.23
|
|
|
PR SUTR NRV ITPRL W/WO GRF/DCMPRN LAT GENICULATE
|
Professional
|
Both
|
$2,055.00
|
|
|
Service Code
|
HCPCS 69740
|
| Min. Negotiated Rate |
$822.00 |
| Max. Negotiated Rate |
$2,019.37 |
| Rate for Payer: Aetna Commercial |
$1,462.68
|
| Rate for Payer: Aetna Medicare |
$1,135.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,571.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,462.68
|
| Rate for Payer: BCBS Complete |
$822.00
|
| Rate for Payer: BCBS MAPPO |
$1,091.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,091.55
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Cofinity Commercial |
$1,571.83
|
| Rate for Payer: Cofinity Commercial |
$1,462.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,091.55
|
| Rate for Payer: Healthscope Commercial |
$2,019.37
|
| Rate for Payer: Healthscope Commercial |
$1,746.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,146.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,335.75
|
| Rate for Payer: Nomi Health Commercial |
$1,309.86
|
| Rate for Payer: PACE SWMI |
$1,091.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,091.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,335.75
|
| Rate for Payer: Priority Health Medicare |
$1,091.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,091.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,091.55
|
|
|
PR SUTR PRPH NRV ARM/LEG XCP SCIATIC W/O TRPOS
|
Professional
|
Both
|
$3,175.00
|
|
|
Service Code
|
HCPCS 64857
|
| Min. Negotiated Rate |
$1,008.34 |
| Max. Negotiated Rate |
$2,063.75 |
| Rate for Payer: Aetna Commercial |
$1,351.18
|
| Rate for Payer: Aetna Medicare |
$1,048.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,452.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,351.18
|
| Rate for Payer: BCBS Complete |
$1,270.00
|
| Rate for Payer: BCBS MAPPO |
$1,008.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,008.34
|
| Rate for Payer: Cash Price |
$2,540.00
|
| Rate for Payer: Cash Price |
$2,540.00
|
| Rate for Payer: Cofinity Commercial |
$1,452.01
|
| Rate for Payer: Cofinity Commercial |
$1,351.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,008.34
|
| Rate for Payer: Healthscope Commercial |
$1,613.34
|
| Rate for Payer: Healthscope Commercial |
$1,865.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,058.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,063.75
|
| Rate for Payer: Nomi Health Commercial |
$1,210.01
|
| Rate for Payer: PACE SWMI |
$1,008.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,008.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,063.75
|
| Rate for Payer: Priority Health Medicare |
$1,008.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,008.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,008.34
|
|
|
PR SUTR PRPH NRV ARM/LEG XCP SCIATIC W/TRPOS
|
Professional
|
Both
|
$3,953.00
|
|
|
Service Code
|
HCPCS 64856
|
| Min. Negotiated Rate |
$974.79 |
| Max. Negotiated Rate |
$2,569.45 |
| Rate for Payer: Aetna Commercial |
$1,306.22
|
| Rate for Payer: Aetna Medicare |
$1,013.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,403.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,306.22
|
| Rate for Payer: BCBS Complete |
$1,581.20
|
| Rate for Payer: BCBS MAPPO |
$974.79
|
| Rate for Payer: BCN Medicare Advantage |
$974.79
|
| Rate for Payer: Cash Price |
$3,162.40
|
| Rate for Payer: Cash Price |
$3,162.40
|
| Rate for Payer: Cofinity Commercial |
$1,403.70
|
| Rate for Payer: Cofinity Commercial |
$1,306.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$974.79
|
| Rate for Payer: Healthscope Commercial |
$1,803.36
|
| Rate for Payer: Healthscope Commercial |
$1,559.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,023.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,569.45
|
| Rate for Payer: Nomi Health Commercial |
$1,169.75
|
| Rate for Payer: PACE SWMI |
$974.79
|
| Rate for Payer: PHP Medicare Advantage |
$974.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,569.45
|
| Rate for Payer: Priority Health Medicare |
$974.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$974.79
|
| Rate for Payer: UHC Medicare Advantage |
$974.79
|
|
|
PR SUTR QUADRICEPS/HAMSTRING MUSC RPT RCNSTJ
|
Professional
|
Both
|
$2,342.00
|
|
|
Service Code
|
HCPCS 27386
|
| Min. Negotiated Rate |
$821.35 |
| Max. Negotiated Rate |
$1,522.30 |
| Rate for Payer: Aetna Commercial |
$1,100.61
|
| Rate for Payer: Aetna Medicare |
$854.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,182.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,100.61
|
| Rate for Payer: BCBS Complete |
$936.80
|
| Rate for Payer: BCBS MAPPO |
$821.35
|
| Rate for Payer: BCN Medicare Advantage |
$821.35
|
| Rate for Payer: Cash Price |
$1,873.60
|
| Rate for Payer: Cash Price |
$1,873.60
|
| Rate for Payer: Cofinity Commercial |
$1,182.74
|
| Rate for Payer: Cofinity Commercial |
$1,100.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$821.35
|
| Rate for Payer: Healthscope Commercial |
$1,314.16
|
| Rate for Payer: Healthscope Commercial |
$1,519.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$862.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,522.30
|
| Rate for Payer: Nomi Health Commercial |
$985.62
|
| Rate for Payer: PACE SWMI |
$821.35
|
| Rate for Payer: PHP Medicare Advantage |
$821.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,522.30
|
| Rate for Payer: Priority Health Medicare |
$821.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$821.35
|
| Rate for Payer: UHC Medicare Advantage |
$821.35
|
|
|
PR SUTR RPR AORTA/GRT VSL W/O SHUNT/CARD BYP
|
Professional
|
Both
|
$2,203.00
|
|
|
Service Code
|
HCPCS 33320
|
| Min. Negotiated Rate |
$881.20 |
| Max. Negotiated Rate |
$1,900.47 |
| Rate for Payer: Aetna Commercial |
$1,376.56
|
| Rate for Payer: Aetna Medicare |
$1,068.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,479.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,376.56
|
| Rate for Payer: BCBS Complete |
$881.20
|
| Rate for Payer: BCBS MAPPO |
$1,027.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,027.28
|
| Rate for Payer: Cash Price |
$1,762.40
|
| Rate for Payer: Cash Price |
$1,762.40
|
| Rate for Payer: Cofinity Commercial |
$1,479.28
|
| Rate for Payer: Cofinity Commercial |
$1,376.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,027.28
|
| Rate for Payer: Healthscope Commercial |
$1,900.47
|
| Rate for Payer: Healthscope Commercial |
$1,643.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,078.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,431.95
|
| Rate for Payer: Nomi Health Commercial |
$1,232.74
|
| Rate for Payer: PACE SWMI |
$1,027.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,027.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,431.95
|
| Rate for Payer: Priority Health Medicare |
$1,027.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,027.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,027.28
|
|
|
PR SUTR WND EYELID/MARGIN/TARSUS/CONJUNC FULL THICK
|
Professional
|
Both
|
$1,151.00
|
|
|
Service Code
|
HCPCS 67935
|
| Min. Negotiated Rate |
$406.98 |
| Max. Negotiated Rate |
$752.91 |
| Rate for Payer: Aetna Commercial |
$545.35
|
| Rate for Payer: Aetna Medicare |
$423.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.35
|
| Rate for Payer: BCBS Complete |
$460.40
|
| Rate for Payer: BCBS MAPPO |
$406.98
|
| Rate for Payer: BCN Medicare Advantage |
$406.98
|
| Rate for Payer: Cash Price |
$920.80
|
| Rate for Payer: Cash Price |
$920.80
|
| Rate for Payer: Cofinity Commercial |
$586.05
|
| Rate for Payer: Cofinity Commercial |
$545.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$406.98
|
| Rate for Payer: Healthscope Commercial |
$651.17
|
| Rate for Payer: Healthscope Commercial |
$752.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$748.15
|
| Rate for Payer: Nomi Health Commercial |
$488.38
|
| Rate for Payer: PACE SWMI |
$406.98
|
| Rate for Payer: PHP Medicare Advantage |
$406.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$748.15
|
| Rate for Payer: Priority Health Medicare |
$406.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$406.98
|
| Rate for Payer: UHC Medicare Advantage |
$406.98
|
|
|
PR SUTR WND EYELID/MARGIN/TARSUS/CONJUNC PRTL THICK
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 67930
|
| Min. Negotiated Rate |
$219.58 |
| Max. Negotiated Rate |
$497.25 |
| Rate for Payer: Aetna Commercial |
$294.24
|
| Rate for Payer: Aetna Medicare |
$228.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.24
|
| Rate for Payer: BCBS Complete |
$306.00
|
| Rate for Payer: BCBS MAPPO |
$219.58
|
| Rate for Payer: BCN Medicare Advantage |
$219.58
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$316.20
|
| Rate for Payer: Cofinity Commercial |
$294.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.58
|
| Rate for Payer: Healthscope Commercial |
$406.22
|
| Rate for Payer: Healthscope Commercial |
$351.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$497.25
|
| Rate for Payer: Nomi Health Commercial |
$263.50
|
| Rate for Payer: PACE SWMI |
$219.58
|
| Rate for Payer: PHP Medicare Advantage |
$219.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health Medicare |
$219.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.58
|
| Rate for Payer: UHC Medicare Advantage |
$219.58
|
|
|
PR SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 64834
|
| Min. Negotiated Rate |
$717.69 |
| Max. Negotiated Rate |
$1,397.50 |
| Rate for Payer: Aetna Commercial |
$961.70
|
| Rate for Payer: Aetna Medicare |
$746.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$961.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.47
|
| Rate for Payer: BCBS Complete |
$860.00
|
| Rate for Payer: BCBS MAPPO |
$717.69
|
| Rate for Payer: BCN Medicare Advantage |
$717.69
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Cofinity Commercial |
$961.70
|
| Rate for Payer: Cofinity Commercial |
$1,033.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$717.69
|
| Rate for Payer: Healthscope Commercial |
$1,148.30
|
| Rate for Payer: Healthscope Commercial |
$1,327.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$753.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,397.50
|
| Rate for Payer: Nomi Health Commercial |
$861.23
|
| Rate for Payer: PACE SWMI |
$717.69
|
| Rate for Payer: PHP Medicare Advantage |
$717.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,397.50
|
| Rate for Payer: Priority Health Medicare |
$717.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$717.69
|
| Rate for Payer: UHC Medicare Advantage |
$717.69
|
|
|
PR SUTURE 1 NERVE MEDIAN MOTOR THENAR
|
Professional
|
Both
|
$2,287.00
|
|
|
Service Code
|
HCPCS 64835
|
| Min. Negotiated Rate |
$787.47 |
| Max. Negotiated Rate |
$1,486.55 |
| Rate for Payer: Aetna Commercial |
$1,055.21
|
| Rate for Payer: Aetna Medicare |
$818.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,133.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.21
|
| Rate for Payer: BCBS Complete |
$914.80
|
| Rate for Payer: BCBS MAPPO |
$787.47
|
| Rate for Payer: BCN Medicare Advantage |
$787.47
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cofinity Commercial |
$1,133.96
|
| Rate for Payer: Cofinity Commercial |
$1,055.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.47
|
| Rate for Payer: Healthscope Commercial |
$1,456.82
|
| Rate for Payer: Healthscope Commercial |
$1,259.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,486.55
|
| Rate for Payer: Nomi Health Commercial |
$944.96
|
| Rate for Payer: PACE SWMI |
$787.47
|
| Rate for Payer: PHP Medicare Advantage |
$787.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,486.55
|
| Rate for Payer: Priority Health Medicare |
$787.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$787.47
|
| Rate for Payer: UHC Medicare Advantage |
$787.47
|
|
|
PR SUTURE 1 NERVE ULNAR MOTOR
|
Professional
|
Both
|
$1,805.00
|
|
|
Service Code
|
HCPCS 64836
|
| Min. Negotiated Rate |
$722.00 |
| Max. Negotiated Rate |
$1,456.82 |
| Rate for Payer: Aetna Commercial |
$1,055.21
|
| Rate for Payer: Aetna Medicare |
$818.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,133.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.21
|
| Rate for Payer: BCBS Complete |
$722.00
|
| Rate for Payer: BCBS MAPPO |
$787.47
|
| Rate for Payer: BCN Medicare Advantage |
$787.47
|
| Rate for Payer: Cash Price |
$1,444.00
|
| Rate for Payer: Cash Price |
$1,444.00
|
| Rate for Payer: Cofinity Commercial |
$1,133.96
|
| Rate for Payer: Cofinity Commercial |
$1,055.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.47
|
| Rate for Payer: Healthscope Commercial |
$1,259.95
|
| Rate for Payer: Healthscope Commercial |
$1,456.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.25
|
| Rate for Payer: Nomi Health Commercial |
$944.96
|
| Rate for Payer: PACE SWMI |
$787.47
|
| Rate for Payer: PHP Medicare Advantage |
$787.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,173.25
|
| Rate for Payer: Priority Health Medicare |
$787.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$787.47
|
| Rate for Payer: UHC Medicare Advantage |
$787.47
|
|
|
PR SUTURE BRACHIAL PLEXUS
|
Professional
|
Both
|
$3,705.00
|
|
|
Service Code
|
HCPCS 64861
|
| Min. Negotiated Rate |
$1,482.00 |
| Max. Negotiated Rate |
$2,794.13 |
| Rate for Payer: Aetna Commercial |
$2,023.86
|
| Rate for Payer: Aetna Medicare |
$1,570.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,174.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,023.86
|
| Rate for Payer: BCBS Complete |
$1,482.00
|
| Rate for Payer: BCBS MAPPO |
$1,510.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,510.34
|
| Rate for Payer: Cash Price |
$2,964.00
|
| Rate for Payer: Cash Price |
$2,964.00
|
| Rate for Payer: Cofinity Commercial |
$2,174.89
|
| Rate for Payer: Cofinity Commercial |
$2,023.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,510.34
|
| Rate for Payer: Healthscope Commercial |
$2,794.13
|
| Rate for Payer: Healthscope Commercial |
$2,416.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,585.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,408.25
|
| Rate for Payer: Nomi Health Commercial |
$1,812.41
|
| Rate for Payer: PACE SWMI |
$1,510.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,510.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,408.25
|
| Rate for Payer: Priority Health Medicare |
$1,510.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,510.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,510.34
|
|
|
PR SUTURE DIGITAL NERVE HAND/FOOT 1 NERVE
|
Professional
|
Both
|
$1,985.00
|
|
|
Service Code
|
HCPCS 64831
|
| Min. Negotiated Rate |
$668.23 |
| Max. Negotiated Rate |
$1,290.25 |
| Rate for Payer: Aetna Commercial |
$895.43
|
| Rate for Payer: Aetna Medicare |
$694.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$962.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$895.43
|
| Rate for Payer: BCBS Complete |
$794.00
|
| Rate for Payer: BCBS MAPPO |
$668.23
|
| Rate for Payer: BCN Medicare Advantage |
$668.23
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cofinity Commercial |
$962.25
|
| Rate for Payer: Cofinity Commercial |
$895.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$668.23
|
| Rate for Payer: Healthscope Commercial |
$1,069.17
|
| Rate for Payer: Healthscope Commercial |
$1,236.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$701.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.25
|
| Rate for Payer: Nomi Health Commercial |
$801.88
|
| Rate for Payer: PACE SWMI |
$668.23
|
| Rate for Payer: PHP Medicare Advantage |
$668.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.25
|
| Rate for Payer: Priority Health Medicare |
$668.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$668.23
|
| Rate for Payer: UHC Medicare Advantage |
$668.23
|
|
|
PR SUTURE EACH ADDITIONAL NERVE HAND/FOOT
|
Professional
|
Both
|
$1,311.00
|
|
|
Service Code
|
HCPCS 64837
|
| Min. Negotiated Rate |
$348.27 |
| Max. Negotiated Rate |
$852.15 |
| Rate for Payer: Aetna Commercial |
$466.68
|
| Rate for Payer: Aetna Medicare |
$362.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.68
|
| Rate for Payer: BCBS Complete |
$524.40
|
| Rate for Payer: BCBS MAPPO |
$348.27
|
| Rate for Payer: BCN Medicare Advantage |
$348.27
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cofinity Commercial |
$501.51
|
| Rate for Payer: Cofinity Commercial |
$466.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.27
|
| Rate for Payer: Healthscope Commercial |
$644.30
|
| Rate for Payer: Healthscope Commercial |
$557.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$852.15
|
| Rate for Payer: Nomi Health Commercial |
$417.92
|
| Rate for Payer: PACE SWMI |
$348.27
|
| Rate for Payer: PHP Medicare Advantage |
$348.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$852.15
|
| Rate for Payer: Priority Health Medicare |
$348.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.27
|
| Rate for Payer: UHC Medicare Advantage |
$348.27
|
|
|
PR SUTURE EACH ADDITIONAL PERIPHERAL NERVE
|
Professional
|
Both
|
$1,633.00
|
|
|
Service Code
|
HCPCS 64859
|
| Min. Negotiated Rate |
$236.41 |
| Max. Negotiated Rate |
$1,061.45 |
| Rate for Payer: Aetna Commercial |
$316.79
|
| Rate for Payer: Aetna Medicare |
$245.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.79
|
| Rate for Payer: BCBS Complete |
$653.20
|
| Rate for Payer: BCBS MAPPO |
$236.41
|
| Rate for Payer: BCN Medicare Advantage |
$236.41
|
| Rate for Payer: Cash Price |
$1,306.40
|
| Rate for Payer: Cash Price |
$1,306.40
|
| Rate for Payer: Cofinity Commercial |
$340.43
|
| Rate for Payer: Cofinity Commercial |
$316.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.41
|
| Rate for Payer: Healthscope Commercial |
$378.26
|
| Rate for Payer: Healthscope Commercial |
$437.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,061.45
|
| Rate for Payer: Nomi Health Commercial |
$283.69
|
| Rate for Payer: PACE SWMI |
$236.41
|
| Rate for Payer: PHP Medicare Advantage |
$236.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,061.45
|
| Rate for Payer: Priority Health Medicare |
$236.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.41
|
| Rate for Payer: UHC Medicare Advantage |
$236.41
|
|
|
PR SUTURE EXTRAHEPATIC BILE DUCT PRE-EXIST INJURY
|
Professional
|
Both
|
$3,048.00
|
|
|
Service Code
|
HCPCS 47900
|
| Min. Negotiated Rate |
$1,219.20 |
| Max. Negotiated Rate |
$2,477.19 |
| Rate for Payer: Aetna Commercial |
$1,794.29
|
| Rate for Payer: Aetna Medicare |
$1,392.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,928.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,794.29
|
| Rate for Payer: BCBS Complete |
$1,219.20
|
| Rate for Payer: BCBS MAPPO |
$1,339.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,339.02
|
| Rate for Payer: Cash Price |
$2,438.40
|
| Rate for Payer: Cash Price |
$2,438.40
|
| Rate for Payer: Cofinity Commercial |
$1,928.19
|
| Rate for Payer: Cofinity Commercial |
$1,794.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,339.02
|
| Rate for Payer: Healthscope Commercial |
$2,477.19
|
| Rate for Payer: Healthscope Commercial |
$2,142.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,405.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,981.20
|
| Rate for Payer: Nomi Health Commercial |
$1,606.82
|
| Rate for Payer: PACE SWMI |
$1,339.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,339.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,981.20
|
| Rate for Payer: Priority Health Medicare |
$1,339.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,339.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,339.02
|
|
|
PR SUTURE FACIAL NERVE EXTRACRANIAL
|
Professional
|
Both
|
$2,429.00
|
|
|
Service Code
|
HCPCS 64864
|
| Min. Negotiated Rate |
$823.37 |
| Max. Negotiated Rate |
$1,578.85 |
| Rate for Payer: Aetna Commercial |
$1,103.32
|
| Rate for Payer: Aetna Medicare |
$856.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,185.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,103.32
|
| Rate for Payer: BCBS Complete |
$971.60
|
| Rate for Payer: BCBS MAPPO |
$823.37
|
| Rate for Payer: BCN Medicare Advantage |
$823.37
|
| Rate for Payer: Cash Price |
$1,943.20
|
| Rate for Payer: Cash Price |
$1,943.20
|
| Rate for Payer: Cofinity Commercial |
$1,185.65
|
| Rate for Payer: Cofinity Commercial |
$1,103.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$823.37
|
| Rate for Payer: Healthscope Commercial |
$1,317.39
|
| Rate for Payer: Healthscope Commercial |
$1,523.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$864.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,578.85
|
| Rate for Payer: Nomi Health Commercial |
$988.04
|
| Rate for Payer: PACE SWMI |
$823.37
|
| Rate for Payer: PHP Medicare Advantage |
$823.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,578.85
|
| Rate for Payer: Priority Health Medicare |
$823.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$823.37
|
| Rate for Payer: UHC Medicare Advantage |
$823.37
|
|
|
PR SUTURE FACIAL NERVE INFRATEMPORAL W/WO GRAFT
|
Professional
|
Both
|
$3,037.00
|
|
|
Service Code
|
HCPCS 64865
|
| Min. Negotiated Rate |
$1,023.60 |
| Max. Negotiated Rate |
$1,974.05 |
| Rate for Payer: Aetna Commercial |
$1,371.62
|
| Rate for Payer: Aetna Medicare |
$1,064.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,473.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,371.62
|
| Rate for Payer: BCBS Complete |
$1,214.80
|
| Rate for Payer: BCBS MAPPO |
$1,023.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,023.60
|
| Rate for Payer: Cash Price |
$2,429.60
|
| Rate for Payer: Cash Price |
$2,429.60
|
| Rate for Payer: Cofinity Commercial |
$1,473.98
|
| Rate for Payer: Cofinity Commercial |
$1,371.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,023.60
|
| Rate for Payer: Healthscope Commercial |
$1,893.66
|
| Rate for Payer: Healthscope Commercial |
$1,637.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,074.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,974.05
|
| Rate for Payer: Nomi Health Commercial |
$1,228.32
|
| Rate for Payer: PACE SWMI |
$1,023.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,023.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,974.05
|
| Rate for Payer: Priority Health Medicare |
$1,023.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,023.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,023.60
|
|
|
PR SUTURE INFRAPATELLAR TENDON PRIMARY
|
Facility
|
IP
|
$1,551.00
|
|
|
Service Code
|
CPT 27380
|
| Hospital Charge Code |
27380
|
| Min. Negotiated Rate |
$977.13 |
| Max. Negotiated Rate |
$1,395.90 |
| Rate for Payer: Aetna Commercial |
$1,318.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,008.15
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cofinity Commercial |
$1,085.70
|
| Rate for Payer: Cofinity Commercial |
$1,333.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,085.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,240.80
|
| Rate for Payer: Healthscope Commercial |
$1,395.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,318.35
|
| Rate for Payer: PHP Commercial |
$1,318.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.15
|
| Rate for Payer: Priority Health SBD |
$977.13
|
|
|
PR SUTURE INFRAPATELLAR TENDON PRIMARY
|
Professional
|
Both
|
$1,551.00
|
|
|
Service Code
|
HCPCS 27380
|
| Hospital Charge Code |
27380
|
| Min. Negotiated Rate |
$595.26 |
| Max. Negotiated Rate |
$1,101.23 |
| Rate for Payer: Aetna Commercial |
$797.65
|
| Rate for Payer: Aetna Medicare |
$619.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$797.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.17
|
| Rate for Payer: BCBS Complete |
$620.40
|
| Rate for Payer: BCBS MAPPO |
$595.26
|
| Rate for Payer: BCN Medicare Advantage |
$595.26
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cofinity Commercial |
$857.17
|
| Rate for Payer: Cofinity Commercial |
$797.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$595.26
|
| Rate for Payer: Healthscope Commercial |
$1,101.23
|
| Rate for Payer: Healthscope Commercial |
$952.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$625.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,008.15
|
| Rate for Payer: Nomi Health Commercial |
$714.31
|
| Rate for Payer: PACE SWMI |
$595.26
|
| Rate for Payer: PHP Medicare Advantage |
$595.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.15
|
| Rate for Payer: Priority Health Medicare |
$595.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$595.26
|
| Rate for Payer: UHC Medicare Advantage |
$595.26
|
|
