|
PR TENDON SHEATH INCISION
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
CPT 26055
|
| Hospital Charge Code |
26055
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$1,062.00 |
| Rate for Payer: Aetna Commercial |
$1,003.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$767.00
|
| Rate for Payer: Cash Price |
$944.00
|
| Rate for Payer: Cofinity Commercial |
$1,014.80
|
| Rate for Payer: Cofinity Commercial |
$826.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$826.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.00
|
| Rate for Payer: Healthscope Commercial |
$1,062.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,003.00
|
| Rate for Payer: PHP Commercial |
$1,003.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$767.00
|
| Rate for Payer: Priority Health SBD |
$743.40
|
|
|
PR TENDON TRANSFER TRANSPLANT CARP/MTCRPL GRAFT
|
Professional
|
Both
|
$1,419.00
|
|
|
Service Code
|
HCPCS 26483
|
| Min. Negotiated Rate |
$567.60 |
| Max. Negotiated Rate |
$1,505.33 |
| Rate for Payer: Aetna Commercial |
$1,090.34
|
| Rate for Payer: Aetna Medicare |
$846.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,171.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,090.34
|
| Rate for Payer: BCBS Complete |
$567.60
|
| Rate for Payer: BCBS MAPPO |
$813.69
|
| Rate for Payer: BCN Medicare Advantage |
$813.69
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cofinity Commercial |
$1,171.71
|
| Rate for Payer: Cofinity Commercial |
$1,090.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$813.69
|
| Rate for Payer: Healthscope Commercial |
$1,301.90
|
| Rate for Payer: Healthscope Commercial |
$1,505.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$854.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$922.35
|
| Rate for Payer: Nomi Health Commercial |
$976.43
|
| Rate for Payer: PACE SWMI |
$813.69
|
| Rate for Payer: PHP Medicare Advantage |
$813.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$922.35
|
| Rate for Payer: Priority Health Medicare |
$813.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$813.69
|
| Rate for Payer: UHC Medicare Advantage |
$813.69
|
|
|
PR TENODESIS BICEPS TENDON ELBOW SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,092.00
|
|
|
Service Code
|
HCPCS 24340
|
| Min. Negotiated Rate |
$436.80 |
| Max. Negotiated Rate |
$1,084.75 |
| Rate for Payer: Aetna Commercial |
$785.71
|
| Rate for Payer: Aetna Medicare |
$609.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$844.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$785.71
|
| Rate for Payer: BCBS Complete |
$436.80
|
| Rate for Payer: BCBS MAPPO |
$586.35
|
| Rate for Payer: BCN Medicare Advantage |
$586.35
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cofinity Commercial |
$844.34
|
| Rate for Payer: Cofinity Commercial |
$785.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$586.35
|
| Rate for Payer: Healthscope Commercial |
$938.16
|
| Rate for Payer: Healthscope Commercial |
$1,084.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$615.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$709.80
|
| Rate for Payer: Nomi Health Commercial |
$703.62
|
| Rate for Payer: PACE SWMI |
$586.35
|
| Rate for Payer: PHP Medicare Advantage |
$586.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$709.80
|
| Rate for Payer: Priority Health Medicare |
$586.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$586.35
|
| Rate for Payer: UHC Medicare Advantage |
$586.35
|
|
|
PR TENODESIS DISTAL JOINT EACH
|
Professional
|
Both
|
$1,015.00
|
|
|
Service Code
|
HCPCS 26474
|
| Min. Negotiated Rate |
$406.00 |
| Max. Negotiated Rate |
$1,123.08 |
| Rate for Payer: Aetna Commercial |
$813.47
|
| Rate for Payer: Aetna Medicare |
$631.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$874.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$813.47
|
| Rate for Payer: BCBS Complete |
$406.00
|
| Rate for Payer: BCBS MAPPO |
$607.07
|
| Rate for Payer: BCN Medicare Advantage |
$607.07
|
| Rate for Payer: Cash Price |
$812.00
|
| Rate for Payer: Cash Price |
$812.00
|
| Rate for Payer: Cofinity Commercial |
$874.18
|
| Rate for Payer: Cofinity Commercial |
$813.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.07
|
| Rate for Payer: Healthscope Commercial |
$1,123.08
|
| Rate for Payer: Healthscope Commercial |
$971.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$637.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$659.75
|
| Rate for Payer: Nomi Health Commercial |
$728.48
|
| Rate for Payer: PACE SWMI |
$607.07
|
| Rate for Payer: PHP Medicare Advantage |
$607.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$659.75
|
| Rate for Payer: Priority Health Medicare |
$607.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.07
|
| Rate for Payer: UHC Medicare Advantage |
$607.07
|
|
|
PR TENODESIS LONG TENDON BICEPS
|
Professional
|
Both
|
$2,357.00
|
|
|
Service Code
|
HCPCS 23430
|
| Min. Negotiated Rate |
$717.63 |
| Max. Negotiated Rate |
$1,532.05 |
| Rate for Payer: Aetna Commercial |
$961.62
|
| Rate for Payer: Aetna Medicare |
$746.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$961.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.39
|
| Rate for Payer: BCBS Complete |
$942.80
|
| Rate for Payer: BCBS MAPPO |
$717.63
|
| Rate for Payer: BCN Medicare Advantage |
$717.63
|
| Rate for Payer: Cash Price |
$1,885.60
|
| Rate for Payer: Cash Price |
$1,885.60
|
| Rate for Payer: Cofinity Commercial |
$961.62
|
| Rate for Payer: Cofinity Commercial |
$1,033.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$717.63
|
| Rate for Payer: Healthscope Commercial |
$1,327.62
|
| Rate for Payer: Healthscope Commercial |
$1,148.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$753.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,532.05
|
| Rate for Payer: Nomi Health Commercial |
$861.16
|
| Rate for Payer: PACE SWMI |
$717.63
|
| Rate for Payer: PHP Medicare Advantage |
$717.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,532.05
|
| Rate for Payer: Priority Health Medicare |
$717.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$717.63
|
| Rate for Payer: UHC Medicare Advantage |
$717.63
|
|
|
PR TENODESIS LONG TENDON BICEPS
|
Facility
|
IP
|
$2,357.00
|
|
|
Service Code
|
CPT 23430
|
| Hospital Charge Code |
23430
|
| Min. Negotiated Rate |
$1,484.91 |
| Max. Negotiated Rate |
$2,121.30 |
| Rate for Payer: Aetna Commercial |
$2,003.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,532.05
|
| Rate for Payer: Cash Price |
$1,885.60
|
| Rate for Payer: Cofinity Commercial |
$1,649.90
|
| Rate for Payer: Cofinity Commercial |
$2,027.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,649.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,885.60
|
| Rate for Payer: Healthscope Commercial |
$2,121.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,003.45
|
| Rate for Payer: PHP Commercial |
$2,003.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,532.05
|
| Rate for Payer: Priority Health SBD |
$1,484.91
|
|
|
PR TENODESIS LONG TENDON BICEPS
|
Facility
|
OP
|
$2,357.00
|
|
|
Service Code
|
CPT 23430
|
| Hospital Charge Code |
23430
|
| Min. Negotiated Rate |
$1,484.91 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Commercial |
$2,003.45
|
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,532.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Cash Price |
$1,885.60
|
| Rate for Payer: Cash Price |
$1,885.60
|
| Rate for Payer: Cofinity Commercial |
$1,649.90
|
| Rate for Payer: Cofinity Commercial |
$2,027.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,649.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,885.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Healthscope Commercial |
$2,121.30
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,003.45
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Commercial |
$2,003.45
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,532.05
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Priority Health SBD |
$1,484.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,922.50
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
PR TENODESIS LONG TENDON BICEPS
|
Professional
|
Both
|
$2,357.00
|
|
|
Service Code
|
HCPCS 23430
|
| Hospital Charge Code |
23430
|
| Min. Negotiated Rate |
$717.63 |
| Max. Negotiated Rate |
$1,532.05 |
| Rate for Payer: Aetna Commercial |
$961.62
|
| Rate for Payer: Aetna Medicare |
$746.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$961.62
|
| Rate for Payer: BCBS Complete |
$942.80
|
| Rate for Payer: BCBS MAPPO |
$717.63
|
| Rate for Payer: BCN Medicare Advantage |
$717.63
|
| Rate for Payer: Cash Price |
$1,885.60
|
| Rate for Payer: Cash Price |
$1,885.60
|
| Rate for Payer: Cofinity Commercial |
$961.62
|
| Rate for Payer: Cofinity Commercial |
$1,033.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$717.63
|
| Rate for Payer: Healthscope Commercial |
$1,148.21
|
| Rate for Payer: Healthscope Commercial |
$1,327.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$753.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,532.05
|
| Rate for Payer: Nomi Health Commercial |
$861.16
|
| Rate for Payer: PACE SWMI |
$717.63
|
| Rate for Payer: PHP Medicare Advantage |
$717.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,532.05
|
| Rate for Payer: Priority Health Medicare |
$717.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$717.63
|
| Rate for Payer: UHC Medicare Advantage |
$717.63
|
|
|
PR TENODESIS PROXIMAL INTERPHALANGEAL JOINT EACH
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 26471
|
| Min. Negotiated Rate |
$617.22 |
| Max. Negotiated Rate |
$1,288.95 |
| Rate for Payer: Aetna Commercial |
$827.07
|
| Rate for Payer: Aetna Medicare |
$641.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$827.07
|
| Rate for Payer: BCBS Complete |
$793.20
|
| Rate for Payer: BCBS MAPPO |
$617.22
|
| Rate for Payer: BCN Medicare Advantage |
$617.22
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Commercial |
$888.80
|
| Rate for Payer: Cofinity Commercial |
$827.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$617.22
|
| Rate for Payer: Healthscope Commercial |
$1,141.86
|
| Rate for Payer: Healthscope Commercial |
$987.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$648.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,288.95
|
| Rate for Payer: Nomi Health Commercial |
$740.66
|
| Rate for Payer: PACE SWMI |
$617.22
|
| Rate for Payer: PHP Medicare Advantage |
$617.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.95
|
| Rate for Payer: Priority Health Medicare |
$617.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$617.22
|
| Rate for Payer: UHC Medicare Advantage |
$617.22
|
|
|
PR TENODESIS WRIST EXTENSORS FINGERS
|
Professional
|
Both
|
$1,311.00
|
|
|
Service Code
|
HCPCS 25301
|
| Min. Negotiated Rate |
$524.40 |
| Max. Negotiated Rate |
$1,151.48 |
| Rate for Payer: Aetna Commercial |
$834.04
|
| Rate for Payer: Aetna Medicare |
$647.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$896.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$834.04
|
| Rate for Payer: BCBS Complete |
$524.40
|
| Rate for Payer: BCBS MAPPO |
$622.42
|
| Rate for Payer: BCN Medicare Advantage |
$622.42
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cofinity Commercial |
$896.28
|
| Rate for Payer: Cofinity Commercial |
$834.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$622.42
|
| Rate for Payer: Healthscope Commercial |
$995.87
|
| Rate for Payer: Healthscope Commercial |
$1,151.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$653.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$852.15
|
| Rate for Payer: Nomi Health Commercial |
$746.90
|
| Rate for Payer: PACE SWMI |
$622.42
|
| Rate for Payer: PHP Medicare Advantage |
$622.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$852.15
|
| Rate for Payer: Priority Health Medicare |
$622.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$622.42
|
| Rate for Payer: UHC Medicare Advantage |
$622.42
|
|
|
PR TENOLYSIS CPLX XTNSR TENDON FINGER W/FOREARM EA
|
Professional
|
Both
|
$1,844.00
|
|
|
Service Code
|
HCPCS 26449
|
| Min. Negotiated Rate |
$675.67 |
| Max. Negotiated Rate |
$1,249.99 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Medicare |
$702.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$972.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$905.40
|
| Rate for Payer: BCBS Complete |
$737.60
|
| Rate for Payer: BCBS MAPPO |
$675.67
|
| Rate for Payer: BCN Medicare Advantage |
$675.67
|
| Rate for Payer: Cash Price |
$1,475.20
|
| Rate for Payer: Cash Price |
$1,475.20
|
| Rate for Payer: Cofinity Commercial |
$972.96
|
| Rate for Payer: Cofinity Commercial |
$905.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$675.67
|
| Rate for Payer: Healthscope Commercial |
$1,081.07
|
| Rate for Payer: Healthscope Commercial |
$1,249.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,198.60
|
| Rate for Payer: Nomi Health Commercial |
$810.80
|
| Rate for Payer: PACE SWMI |
$675.67
|
| Rate for Payer: PHP Medicare Advantage |
$675.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,198.60
|
| Rate for Payer: Priority Health Medicare |
$675.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.67
|
| Rate for Payer: UHC Medicare Advantage |
$675.67
|
|
|
PR TENOLYSIS EXTENSOR FOOT MULTIPLE TENDON
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
HCPCS 28226
|
| Min. Negotiated Rate |
$318.40 |
| Max. Negotiated Rate |
$712.49 |
| Rate for Payer: Aetna Commercial |
$516.07
|
| Rate for Payer: Aetna Medicare |
$400.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$554.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$516.07
|
| Rate for Payer: BCBS Complete |
$318.40
|
| Rate for Payer: BCBS MAPPO |
$385.13
|
| Rate for Payer: BCN Medicare Advantage |
$385.13
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cofinity Commercial |
$554.59
|
| Rate for Payer: Cofinity Commercial |
$516.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$385.13
|
| Rate for Payer: Healthscope Commercial |
$712.49
|
| Rate for Payer: Healthscope Commercial |
$616.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$404.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$517.40
|
| Rate for Payer: Nomi Health Commercial |
$462.16
|
| Rate for Payer: PACE SWMI |
$385.13
|
| Rate for Payer: PHP Medicare Advantage |
$385.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.40
|
| Rate for Payer: Priority Health Medicare |
$385.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$385.13
|
| Rate for Payer: UHC Medicare Advantage |
$385.13
|
|
|
PR TENOLYSIS EXTENSOR FOOT SINGLE TENDON
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 28225
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$469.46 |
| Rate for Payer: Aetna Commercial |
$340.04
|
| Rate for Payer: Aetna Medicare |
$263.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.04
|
| Rate for Payer: BCBS Complete |
$260.00
|
| Rate for Payer: BCBS MAPPO |
$253.76
|
| Rate for Payer: BCN Medicare Advantage |
$253.76
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$365.41
|
| Rate for Payer: Cofinity Commercial |
$340.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$253.76
|
| Rate for Payer: Healthscope Commercial |
$406.02
|
| Rate for Payer: Healthscope Commercial |
$469.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$266.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$422.50
|
| Rate for Payer: Nomi Health Commercial |
$304.51
|
| Rate for Payer: PACE SWMI |
$253.76
|
| Rate for Payer: PHP Medicare Advantage |
$253.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.50
|
| Rate for Payer: Priority Health Medicare |
$253.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$253.76
|
| Rate for Payer: UHC Medicare Advantage |
$253.76
|
|
|
PR TENOLYSIS EXTENSOR TENDON HAND/FINGER EACH
|
Professional
|
Both
|
$1,229.00
|
|
|
Service Code
|
HCPCS 26445
|
| Min. Negotiated Rate |
$491.60 |
| Max. Negotiated Rate |
$1,032.15 |
| Rate for Payer: Aetna Commercial |
$747.61
|
| Rate for Payer: Aetna Medicare |
$580.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.61
|
| Rate for Payer: BCBS Complete |
$491.60
|
| Rate for Payer: BCBS MAPPO |
$557.92
|
| Rate for Payer: BCN Medicare Advantage |
$557.92
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cofinity Commercial |
$803.40
|
| Rate for Payer: Cofinity Commercial |
$747.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.92
|
| Rate for Payer: Healthscope Commercial |
$892.67
|
| Rate for Payer: Healthscope Commercial |
$1,032.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$585.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$798.85
|
| Rate for Payer: Nomi Health Commercial |
$669.50
|
| Rate for Payer: PACE SWMI |
$557.92
|
| Rate for Payer: PHP Medicare Advantage |
$557.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$798.85
|
| Rate for Payer: Priority Health Medicare |
$557.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.92
|
| Rate for Payer: UHC Medicare Advantage |
$557.92
|
|
|
PR TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS
|
Professional
|
Both
|
$837.00
|
|
|
Service Code
|
HCPCS 28222
|
| Min. Negotiated Rate |
$334.80 |
| Max. Negotiated Rate |
$655.49 |
| Rate for Payer: Aetna Commercial |
$474.79
|
| Rate for Payer: Aetna Medicare |
$368.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.79
|
| Rate for Payer: BCBS Complete |
$334.80
|
| Rate for Payer: BCBS MAPPO |
$354.32
|
| Rate for Payer: BCN Medicare Advantage |
$354.32
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cofinity Commercial |
$510.22
|
| Rate for Payer: Cofinity Commercial |
$474.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.32
|
| Rate for Payer: Healthscope Commercial |
$566.91
|
| Rate for Payer: Healthscope Commercial |
$655.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$372.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.05
|
| Rate for Payer: Nomi Health Commercial |
$425.18
|
| Rate for Payer: PACE SWMI |
$354.32
|
| Rate for Payer: PHP Medicare Advantage |
$354.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.05
|
| Rate for Payer: Priority Health Medicare |
$354.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.32
|
| Rate for Payer: UHC Medicare Advantage |
$354.32
|
|
|
PR TENOLYSIS FLEXOR FOOT SINGLE TENDON
|
Professional
|
Both
|
$988.00
|
|
|
Service Code
|
HCPCS 28220
|
| Min. Negotiated Rate |
$291.77 |
| Max. Negotiated Rate |
$642.20 |
| Rate for Payer: Aetna Commercial |
$390.97
|
| Rate for Payer: Aetna Medicare |
$303.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.97
|
| Rate for Payer: BCBS Complete |
$395.20
|
| Rate for Payer: BCBS MAPPO |
$291.77
|
| Rate for Payer: BCN Medicare Advantage |
$291.77
|
| Rate for Payer: Cash Price |
$790.40
|
| Rate for Payer: Cash Price |
$790.40
|
| Rate for Payer: Cofinity Commercial |
$420.15
|
| Rate for Payer: Cofinity Commercial |
$390.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$291.77
|
| Rate for Payer: Healthscope Commercial |
$539.77
|
| Rate for Payer: Healthscope Commercial |
$466.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$306.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.20
|
| Rate for Payer: Nomi Health Commercial |
$350.12
|
| Rate for Payer: PACE SWMI |
$291.77
|
| Rate for Payer: PHP Medicare Advantage |
$291.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$642.20
|
| Rate for Payer: Priority Health Medicare |
$291.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$291.77
|
| Rate for Payer: UHC Medicare Advantage |
$291.77
|
|
|
PR TENOLYSIS FLEXOR TENDON PALM&FINGER EACH TENDO
|
Professional
|
Both
|
$1,785.00
|
|
|
Service Code
|
HCPCS 26442
|
| Min. Negotiated Rate |
$714.00 |
| Max. Negotiated Rate |
$1,720.04 |
| Rate for Payer: Aetna Commercial |
$1,245.87
|
| Rate for Payer: Aetna Medicare |
$966.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,338.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,245.87
|
| Rate for Payer: BCBS Complete |
$714.00
|
| Rate for Payer: BCBS MAPPO |
$929.75
|
| Rate for Payer: BCN Medicare Advantage |
$929.75
|
| Rate for Payer: Cash Price |
$1,428.00
|
| Rate for Payer: Cash Price |
$1,428.00
|
| Rate for Payer: Cofinity Commercial |
$1,338.84
|
| Rate for Payer: Cofinity Commercial |
$1,245.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$929.75
|
| Rate for Payer: Healthscope Commercial |
$1,487.60
|
| Rate for Payer: Healthscope Commercial |
$1,720.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$976.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,160.25
|
| Rate for Payer: Nomi Health Commercial |
$1,115.70
|
| Rate for Payer: PACE SWMI |
$929.75
|
| Rate for Payer: PHP Medicare Advantage |
$929.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,160.25
|
| Rate for Payer: Priority Health Medicare |
$929.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$929.75
|
| Rate for Payer: UHC Medicare Advantage |
$929.75
|
|
|
PR TENOLYSIS FLEXOR TENDON PALM/FINGER EACH TENDON
|
Professional
|
Both
|
$1,189.00
|
|
|
Service Code
|
HCPCS 26440
|
| Min. Negotiated Rate |
$475.60 |
| Max. Negotiated Rate |
$1,113.37 |
| Rate for Payer: Aetna Commercial |
$806.44
|
| Rate for Payer: Aetna Medicare |
$625.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$806.44
|
| Rate for Payer: BCBS Complete |
$475.60
|
| Rate for Payer: BCBS MAPPO |
$601.82
|
| Rate for Payer: BCN Medicare Advantage |
$601.82
|
| Rate for Payer: Cash Price |
$951.20
|
| Rate for Payer: Cash Price |
$951.20
|
| Rate for Payer: Cofinity Commercial |
$866.62
|
| Rate for Payer: Cofinity Commercial |
$806.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$601.82
|
| Rate for Payer: Healthscope Commercial |
$962.91
|
| Rate for Payer: Healthscope Commercial |
$1,113.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$631.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$772.85
|
| Rate for Payer: Nomi Health Commercial |
$722.18
|
| Rate for Payer: PACE SWMI |
$601.82
|
| Rate for Payer: PHP Medicare Advantage |
$601.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$772.85
|
| Rate for Payer: Priority Health Medicare |
$601.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$601.82
|
| Rate for Payer: UHC Medicare Advantage |
$601.82
|
|
|
PR TENOLYSIS FLXR/XTNSR TENDON LEG&/ANKLE 1 EACH
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 27680
|
| Min. Negotiated Rate |
$407.46 |
| Max. Negotiated Rate |
$845.65 |
| Rate for Payer: Aetna Commercial |
$546.00
|
| Rate for Payer: Aetna Medicare |
$423.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.00
|
| Rate for Payer: BCBS Complete |
$520.40
|
| Rate for Payer: BCBS MAPPO |
$407.46
|
| Rate for Payer: BCN Medicare Advantage |
$407.46
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$586.74
|
| Rate for Payer: Cofinity Commercial |
$546.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.46
|
| Rate for Payer: Healthscope Commercial |
$651.94
|
| Rate for Payer: Healthscope Commercial |
$753.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.65
|
| Rate for Payer: Nomi Health Commercial |
$488.95
|
| Rate for Payer: PACE SWMI |
$407.46
|
| Rate for Payer: PHP Medicare Advantage |
$407.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health Medicare |
$407.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$407.46
|
| Rate for Payer: UHC Medicare Advantage |
$407.46
|
|
|
PR TENOLYSIS TRICEPS
|
Professional
|
Both
|
$1,419.00
|
|
|
Service Code
|
HCPCS 24332
|
| Min. Negotiated Rate |
$567.60 |
| Max. Negotiated Rate |
$1,105.12 |
| Rate for Payer: Aetna Commercial |
$800.46
|
| Rate for Payer: Aetna Medicare |
$621.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$860.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$800.46
|
| Rate for Payer: BCBS Complete |
$567.60
|
| Rate for Payer: BCBS MAPPO |
$597.36
|
| Rate for Payer: BCN Medicare Advantage |
$597.36
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cofinity Commercial |
$860.20
|
| Rate for Payer: Cofinity Commercial |
$800.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.36
|
| Rate for Payer: Healthscope Commercial |
$955.78
|
| Rate for Payer: Healthscope Commercial |
$1,105.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$627.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$922.35
|
| Rate for Payer: Nomi Health Commercial |
$716.83
|
| Rate for Payer: PACE SWMI |
$597.36
|
| Rate for Payer: PHP Medicare Advantage |
$597.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$922.35
|
| Rate for Payer: Priority Health Medicare |
$597.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.36
|
| Rate for Payer: UHC Medicare Advantage |
$597.36
|
|
|
PR TENOTOMY ABDUCTORS&/EXTENSOR HIP OPEN SPX
|
Professional
|
Both
|
$2,879.00
|
|
|
Service Code
|
HCPCS 27006
|
| Min. Negotiated Rate |
$685.56 |
| Max. Negotiated Rate |
$1,871.35 |
| Rate for Payer: Aetna Commercial |
$918.65
|
| Rate for Payer: Aetna Medicare |
$712.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$987.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$918.65
|
| Rate for Payer: BCBS Complete |
$1,151.60
|
| Rate for Payer: BCBS MAPPO |
$685.56
|
| Rate for Payer: BCN Medicare Advantage |
$685.56
|
| Rate for Payer: Cash Price |
$2,303.20
|
| Rate for Payer: Cash Price |
$2,303.20
|
| Rate for Payer: Cofinity Commercial |
$987.21
|
| Rate for Payer: Cofinity Commercial |
$918.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$685.56
|
| Rate for Payer: Healthscope Commercial |
$1,096.90
|
| Rate for Payer: Healthscope Commercial |
$1,268.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,871.35
|
| Rate for Payer: Nomi Health Commercial |
$822.67
|
| Rate for Payer: PACE SWMI |
$685.56
|
| Rate for Payer: PHP Medicare Advantage |
$685.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,871.35
|
| Rate for Payer: Priority Health Medicare |
$685.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$685.56
|
| Rate for Payer: UHC Medicare Advantage |
$685.56
|
|
|
PR TENOTOMY ADDUCTOR HIP OPEN
|
Professional
|
Both
|
$1,058.00
|
|
|
Service Code
|
HCPCS 27001
|
| Min. Negotiated Rate |
$423.20 |
| Max. Negotiated Rate |
$964.24 |
| Rate for Payer: Aetna Commercial |
$698.42
|
| Rate for Payer: Aetna Medicare |
$542.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$698.42
|
| Rate for Payer: BCBS Complete |
$423.20
|
| Rate for Payer: BCBS MAPPO |
$521.21
|
| Rate for Payer: BCN Medicare Advantage |
$521.21
|
| Rate for Payer: Cash Price |
$846.40
|
| Rate for Payer: Cash Price |
$846.40
|
| Rate for Payer: Cofinity Commercial |
$750.54
|
| Rate for Payer: Cofinity Commercial |
$698.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$521.21
|
| Rate for Payer: Healthscope Commercial |
$964.24
|
| Rate for Payer: Healthscope Commercial |
$833.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$547.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$687.70
|
| Rate for Payer: Nomi Health Commercial |
$625.45
|
| Rate for Payer: PACE SWMI |
$521.21
|
| Rate for Payer: PHP Medicare Advantage |
$521.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$687.70
|
| Rate for Payer: Priority Health Medicare |
$521.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$521.21
|
| Rate for Payer: UHC Medicare Advantage |
$521.21
|
|
|
PR TENOTOMY ADDUCTOR HIP PERCUTANEOUS SPX
|
Professional
|
Both
|
$835.00
|
|
|
Service Code
|
HCPCS 27000
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$689.64 |
| Rate for Payer: Aetna Commercial |
$499.53
|
| Rate for Payer: Aetna Medicare |
$387.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.53
|
| Rate for Payer: BCBS Complete |
$334.00
|
| Rate for Payer: BCBS MAPPO |
$372.78
|
| Rate for Payer: BCN Medicare Advantage |
$372.78
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Cofinity Commercial |
$536.80
|
| Rate for Payer: Cofinity Commercial |
$499.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$372.78
|
| Rate for Payer: Healthscope Commercial |
$596.45
|
| Rate for Payer: Healthscope Commercial |
$689.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$542.75
|
| Rate for Payer: Nomi Health Commercial |
$447.34
|
| Rate for Payer: PACE SWMI |
$372.78
|
| Rate for Payer: PHP Medicare Advantage |
$372.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.75
|
| Rate for Payer: Priority Health Medicare |
$372.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$372.78
|
| Rate for Payer: UHC Medicare Advantage |
$372.78
|
|
|
PR TENOTOMY ELBOW LATERAL/MEDIAL PERCUTANEOUS
|
Professional
|
Both
|
$1,273.00
|
|
|
Service Code
|
HCPCS 24357
|
| Min. Negotiated Rate |
$396.76 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Aetna Commercial |
$531.66
|
| Rate for Payer: Aetna Medicare |
$412.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$571.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$531.66
|
| Rate for Payer: BCBS Complete |
$509.20
|
| Rate for Payer: BCBS MAPPO |
$396.76
|
| Rate for Payer: BCN Medicare Advantage |
$396.76
|
| Rate for Payer: Cash Price |
$1,018.40
|
| Rate for Payer: Cash Price |
$1,018.40
|
| Rate for Payer: Cofinity Commercial |
$571.33
|
| Rate for Payer: Cofinity Commercial |
$531.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$396.76
|
| Rate for Payer: Healthscope Commercial |
$734.01
|
| Rate for Payer: Healthscope Commercial |
$634.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$416.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$827.45
|
| Rate for Payer: Nomi Health Commercial |
$476.11
|
| Rate for Payer: PACE SWMI |
$396.76
|
| Rate for Payer: PHP Medicare Advantage |
$396.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$827.45
|
| Rate for Payer: Priority Health Medicare |
$396.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$396.76
|
| Rate for Payer: UHC Medicare Advantage |
$396.76
|
|
|
PR TENOTOMY EXTENSOR HAND/FINGER OPEN EACH TENDON
|
Professional
|
Both
|
$991.00
|
|
|
Service Code
|
HCPCS 26460
|
| Min. Negotiated Rate |
$396.40 |
| Max. Negotiated Rate |
$777.76 |
| Rate for Payer: Aetna Commercial |
$563.35
|
| Rate for Payer: Aetna Medicare |
$437.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$605.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.35
|
| Rate for Payer: BCBS Complete |
$396.40
|
| Rate for Payer: BCBS MAPPO |
$420.41
|
| Rate for Payer: BCN Medicare Advantage |
$420.41
|
| Rate for Payer: Cash Price |
$792.80
|
| Rate for Payer: Cash Price |
$792.80
|
| Rate for Payer: Cofinity Commercial |
$605.39
|
| Rate for Payer: Cofinity Commercial |
$563.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.41
|
| Rate for Payer: Healthscope Commercial |
$672.66
|
| Rate for Payer: Healthscope Commercial |
$777.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$441.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.15
|
| Rate for Payer: Nomi Health Commercial |
$504.49
|
| Rate for Payer: PACE SWMI |
$420.41
|
| Rate for Payer: PHP Medicare Advantage |
$420.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.15
|
| Rate for Payer: Priority Health Medicare |
$420.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$420.41
|
| Rate for Payer: UHC Medicare Advantage |
$420.41
|
|
