|
PR DIR RPR RUPTD ANEURYSM & GRAFT ILIAC ARTERY
|
Professional
|
Both
|
$3,452.00
|
|
|
Service Code
|
HCPCS 35132
|
| Min. Negotiated Rate |
$1,380.80 |
| Max. Negotiated Rate |
$2,913.75 |
| Rate for Payer: Aetna Commercial |
$2,110.50
|
| Rate for Payer: Aetna Medicare |
$1,638.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,268.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,110.50
|
| Rate for Payer: BCBS Complete |
$1,380.80
|
| Rate for Payer: BCBS MAPPO |
$1,575.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,575.00
|
| Rate for Payer: Cash Price |
$2,761.60
|
| Rate for Payer: Cash Price |
$2,761.60
|
| Rate for Payer: Cofinity Commercial |
$2,268.00
|
| Rate for Payer: Cofinity Commercial |
$2,110.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,575.00
|
| Rate for Payer: Healthscope Commercial |
$2,520.00
|
| Rate for Payer: Healthscope Commercial |
$2,913.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,653.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,243.80
|
| Rate for Payer: Nomi Health Commercial |
$1,890.00
|
| Rate for Payer: PACE SWMI |
$1,575.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,575.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,243.80
|
| Rate for Payer: Priority Health Medicare |
$1,575.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,575.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,575.00
|
|
|
PR DIR RPR RUPTD ANEURYSM & GRF COMMON FEMORAL ART
|
Professional
|
Both
|
$2,610.00
|
|
|
Service Code
|
HCPCS 35142
|
| Min. Negotiated Rate |
$1,044.00 |
| Max. Negotiated Rate |
$2,340.47 |
| Rate for Payer: Aetna Commercial |
$1,695.26
|
| Rate for Payer: Aetna Medicare |
$1,315.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,821.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,695.26
|
| Rate for Payer: BCBS Complete |
$1,044.00
|
| Rate for Payer: BCBS MAPPO |
$1,265.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,265.12
|
| Rate for Payer: Cash Price |
$2,088.00
|
| Rate for Payer: Cash Price |
$2,088.00
|
| Rate for Payer: Cofinity Commercial |
$1,821.77
|
| Rate for Payer: Cofinity Commercial |
$1,695.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,265.12
|
| Rate for Payer: Healthscope Commercial |
$2,340.47
|
| Rate for Payer: Healthscope Commercial |
$2,024.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,328.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,696.50
|
| Rate for Payer: Nomi Health Commercial |
$1,518.14
|
| Rate for Payer: PACE SWMI |
$1,265.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,265.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,696.50
|
| Rate for Payer: Priority Health Medicare |
$1,265.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,265.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,265.12
|
|
|
PR DIR RPR RUPTD ANEURYSM & GRF POPLITEAL ARTERY
|
Professional
|
Both
|
$2,737.00
|
|
|
Service Code
|
HCPCS 35152
|
| Min. Negotiated Rate |
$1,094.80 |
| Max. Negotiated Rate |
$2,492.63 |
| Rate for Payer: Aetna Commercial |
$1,805.48
|
| Rate for Payer: Aetna Medicare |
$1,401.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,940.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,805.48
|
| Rate for Payer: BCBS Complete |
$1,094.80
|
| Rate for Payer: BCBS MAPPO |
$1,347.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,347.37
|
| Rate for Payer: Cash Price |
$2,189.60
|
| Rate for Payer: Cash Price |
$2,189.60
|
| Rate for Payer: Cofinity Commercial |
$1,940.21
|
| Rate for Payer: Cofinity Commercial |
$1,805.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,347.37
|
| Rate for Payer: Healthscope Commercial |
$2,155.79
|
| Rate for Payer: Healthscope Commercial |
$2,492.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,414.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,779.05
|
| Rate for Payer: Nomi Health Commercial |
$1,616.84
|
| Rate for Payer: PACE SWMI |
$1,347.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,347.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,779.05
|
| Rate for Payer: Priority Health Medicare |
$1,347.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,347.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,347.37
|
|
|
PR DIR RPR RUPTD ANEURYSM INNOMINATE/SUBCLAVIAN
|
Professional
|
Both
|
$2,934.00
|
|
|
Service Code
|
HCPCS 35022
|
| Min. Negotiated Rate |
$1,173.60 |
| Max. Negotiated Rate |
$2,549.78 |
| Rate for Payer: Aetna Commercial |
$1,846.87
|
| Rate for Payer: Aetna Medicare |
$1,433.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,984.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,846.87
|
| Rate for Payer: BCBS Complete |
$1,173.60
|
| Rate for Payer: BCBS MAPPO |
$1,378.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,378.26
|
| Rate for Payer: Cash Price |
$2,347.20
|
| Rate for Payer: Cash Price |
$2,347.20
|
| Rate for Payer: Cofinity Commercial |
$1,984.69
|
| Rate for Payer: Cofinity Commercial |
$1,846.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,378.26
|
| Rate for Payer: Healthscope Commercial |
$2,549.78
|
| Rate for Payer: Healthscope Commercial |
$2,205.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,447.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,907.10
|
| Rate for Payer: Nomi Health Commercial |
$1,653.91
|
| Rate for Payer: PACE SWMI |
$1,378.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,378.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,907.10
|
| Rate for Payer: Priority Health Medicare |
$1,378.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,378.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,378.26
|
|
|
PR DIR RPR RUPTD ANEURYSM RADIAL/ULNAR ARTERY
|
Professional
|
Both
|
$3,424.00
|
|
|
Service Code
|
HCPCS 35045
|
| Min. Negotiated Rate |
$928.16 |
| Max. Negotiated Rate |
$2,225.60 |
| Rate for Payer: Aetna Commercial |
$1,243.73
|
| Rate for Payer: Aetna Medicare |
$965.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,336.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,243.73
|
| Rate for Payer: BCBS Complete |
$1,369.60
|
| Rate for Payer: BCBS MAPPO |
$928.16
|
| Rate for Payer: BCN Medicare Advantage |
$928.16
|
| Rate for Payer: Cash Price |
$2,739.20
|
| Rate for Payer: Cash Price |
$2,739.20
|
| Rate for Payer: Cofinity Commercial |
$1,336.55
|
| Rate for Payer: Cofinity Commercial |
$1,243.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$928.16
|
| Rate for Payer: Healthscope Commercial |
$1,485.06
|
| Rate for Payer: Healthscope Commercial |
$1,717.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$974.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,225.60
|
| Rate for Payer: Nomi Health Commercial |
$1,113.79
|
| Rate for Payer: PACE SWMI |
$928.16
|
| Rate for Payer: PHP Medicare Advantage |
$928.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,225.60
|
| Rate for Payer: Priority Health Medicare |
$928.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$928.16
|
| Rate for Payer: UHC Medicare Advantage |
$928.16
|
|
|
PR DISARTICULATION HIP
|
Professional
|
Both
|
$5,432.00
|
|
|
Service Code
|
HCPCS 27295
|
| Min. Negotiated Rate |
$1,211.33 |
| Max. Negotiated Rate |
$3,530.80 |
| Rate for Payer: Aetna Commercial |
$1,623.18
|
| Rate for Payer: Aetna Medicare |
$1,259.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,744.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,623.18
|
| Rate for Payer: BCBS Complete |
$2,172.80
|
| Rate for Payer: BCBS MAPPO |
$1,211.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,211.33
|
| Rate for Payer: Cash Price |
$4,345.60
|
| Rate for Payer: Cash Price |
$4,345.60
|
| Rate for Payer: Cofinity Commercial |
$1,744.32
|
| Rate for Payer: Cofinity Commercial |
$1,623.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,211.33
|
| Rate for Payer: Healthscope Commercial |
$2,240.96
|
| Rate for Payer: Healthscope Commercial |
$1,938.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,271.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,530.80
|
| Rate for Payer: Nomi Health Commercial |
$1,453.60
|
| Rate for Payer: PACE SWMI |
$1,211.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,211.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,530.80
|
| Rate for Payer: Priority Health Medicare |
$1,211.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,211.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,211.33
|
|
|
PR DISARTICULATION KNEE
|
Professional
|
Both
|
$2,933.00
|
|
|
Service Code
|
HCPCS 27598
|
| Min. Negotiated Rate |
$672.65 |
| Max. Negotiated Rate |
$1,906.45 |
| Rate for Payer: Aetna Commercial |
$901.35
|
| Rate for Payer: Aetna Medicare |
$699.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$968.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$901.35
|
| Rate for Payer: BCBS Complete |
$1,173.20
|
| Rate for Payer: BCBS MAPPO |
$672.65
|
| Rate for Payer: BCN Medicare Advantage |
$672.65
|
| Rate for Payer: Cash Price |
$2,346.40
|
| Rate for Payer: Cash Price |
$2,346.40
|
| Rate for Payer: Cofinity Commercial |
$968.62
|
| Rate for Payer: Cofinity Commercial |
$901.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$672.65
|
| Rate for Payer: Healthscope Commercial |
$1,076.24
|
| Rate for Payer: Healthscope Commercial |
$1,244.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$706.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,906.45
|
| Rate for Payer: Nomi Health Commercial |
$807.18
|
| Rate for Payer: PACE SWMI |
$672.65
|
| Rate for Payer: PHP Medicare Advantage |
$672.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,906.45
|
| Rate for Payer: Priority Health Medicare |
$672.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$672.65
|
| Rate for Payer: UHC Medicare Advantage |
$672.65
|
|
|
PR DISARTICULATION SHOULDER
|
Professional
|
Both
|
$1,996.00
|
|
|
Service Code
|
HCPCS 23920
|
| Min. Negotiated Rate |
$798.40 |
| Max. Negotiated Rate |
$2,003.85 |
| Rate for Payer: Aetna Commercial |
$1,451.43
|
| Rate for Payer: Aetna Medicare |
$1,126.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,559.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,451.43
|
| Rate for Payer: BCBS Complete |
$798.40
|
| Rate for Payer: BCBS MAPPO |
$1,083.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,083.16
|
| Rate for Payer: Cash Price |
$1,596.80
|
| Rate for Payer: Cash Price |
$1,596.80
|
| Rate for Payer: Cofinity Commercial |
$1,559.75
|
| Rate for Payer: Cofinity Commercial |
$1,451.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,083.16
|
| Rate for Payer: Healthscope Commercial |
$2,003.85
|
| Rate for Payer: Healthscope Commercial |
$1,733.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,137.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,297.40
|
| Rate for Payer: Nomi Health Commercial |
$1,299.79
|
| Rate for Payer: PACE SWMI |
$1,083.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,083.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,297.40
|
| Rate for Payer: Priority Health Medicare |
$1,083.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,083.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,083.16
|
|
|
PR DISARTICULATION THROUGH WRIST
|
Professional
|
Both
|
$1,432.00
|
|
|
Service Code
|
HCPCS 25920
|
| Min. Negotiated Rate |
$572.80 |
| Max. Negotiated Rate |
$1,295.28 |
| Rate for Payer: Aetna Commercial |
$938.20
|
| Rate for Payer: Aetna Medicare |
$728.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$938.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,008.22
|
| Rate for Payer: BCBS Complete |
$572.80
|
| Rate for Payer: BCBS MAPPO |
$700.15
|
| Rate for Payer: BCN Medicare Advantage |
$700.15
|
| Rate for Payer: Cash Price |
$1,145.60
|
| Rate for Payer: Cash Price |
$1,145.60
|
| Rate for Payer: Cofinity Commercial |
$938.20
|
| Rate for Payer: Cofinity Commercial |
$1,008.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$700.15
|
| Rate for Payer: Healthscope Commercial |
$1,120.24
|
| Rate for Payer: Healthscope Commercial |
$1,295.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$735.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$930.80
|
| Rate for Payer: Nomi Health Commercial |
$840.18
|
| Rate for Payer: PACE SWMI |
$700.15
|
| Rate for Payer: PHP Medicare Advantage |
$700.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$930.80
|
| Rate for Payer: Priority Health Medicare |
$700.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$700.15
|
| Rate for Payer: UHC Medicare Advantage |
$700.15
|
|
|
PR DISARTICULATION THRU WRIST RE-AMPUTATION
|
Professional
|
Both
|
$2,359.00
|
|
|
Service Code
|
HCPCS 25924
|
| Min. Negotiated Rate |
$683.01 |
| Max. Negotiated Rate |
$1,533.35 |
| Rate for Payer: Aetna Commercial |
$915.23
|
| Rate for Payer: Aetna Medicare |
$710.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$983.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$915.23
|
| Rate for Payer: BCBS Complete |
$943.60
|
| Rate for Payer: BCBS MAPPO |
$683.01
|
| Rate for Payer: BCN Medicare Advantage |
$683.01
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Cofinity Commercial |
$983.53
|
| Rate for Payer: Cofinity Commercial |
$915.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.01
|
| Rate for Payer: Healthscope Commercial |
$1,263.57
|
| Rate for Payer: Healthscope Commercial |
$1,092.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$717.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,533.35
|
| Rate for Payer: Nomi Health Commercial |
$819.61
|
| Rate for Payer: PACE SWMI |
$683.01
|
| Rate for Payer: PHP Medicare Advantage |
$683.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,533.35
|
| Rate for Payer: Priority Health Medicare |
$683.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$683.01
|
| Rate for Payer: UHC Medicare Advantage |
$683.01
|
|
|
PR DISCECTOMY ANT DCMPRN CORD CERVICAL 1 NTRSPC
|
Professional
|
Both
|
$5,746.00
|
|
|
Service Code
|
HCPCS 63075
|
| Min. Negotiated Rate |
$1,328.31 |
| Max. Negotiated Rate |
$3,734.90 |
| Rate for Payer: Aetna Commercial |
$1,779.94
|
| Rate for Payer: Aetna Medicare |
$1,381.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,912.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,779.94
|
| Rate for Payer: BCBS Complete |
$2,298.40
|
| Rate for Payer: BCBS MAPPO |
$1,328.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,328.31
|
| Rate for Payer: Cash Price |
$4,596.80
|
| Rate for Payer: Cash Price |
$4,596.80
|
| Rate for Payer: Cofinity Commercial |
$1,912.77
|
| Rate for Payer: Cofinity Commercial |
$1,779.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,328.31
|
| Rate for Payer: Healthscope Commercial |
$2,125.30
|
| Rate for Payer: Healthscope Commercial |
$2,457.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,394.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,734.90
|
| Rate for Payer: Nomi Health Commercial |
$1,593.97
|
| Rate for Payer: PACE SWMI |
$1,328.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,328.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,734.90
|
| Rate for Payer: Priority Health Medicare |
$1,328.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,328.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,328.31
|
|
|
PR DISCECTOMY ANT DCMPRN CORD CERVICAL EA NTRSPC
|
Professional
|
Both
|
$1,928.00
|
|
|
Service Code
|
HCPCS 63076
|
| Min. Negotiated Rate |
$238.31 |
| Max. Negotiated Rate |
$1,253.20 |
| Rate for Payer: Aetna Commercial |
$319.34
|
| Rate for Payer: Aetna Medicare |
$247.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.34
|
| Rate for Payer: BCBS Complete |
$771.20
|
| Rate for Payer: BCBS MAPPO |
$238.31
|
| Rate for Payer: BCN Medicare Advantage |
$238.31
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cofinity Commercial |
$343.17
|
| Rate for Payer: Cofinity Commercial |
$319.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.31
|
| Rate for Payer: Healthscope Commercial |
$440.87
|
| Rate for Payer: Healthscope Commercial |
$381.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,253.20
|
| Rate for Payer: Nomi Health Commercial |
$285.97
|
| Rate for Payer: PACE SWMI |
$238.31
|
| Rate for Payer: PHP Medicare Advantage |
$238.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.20
|
| Rate for Payer: Priority Health Medicare |
$238.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.31
|
| Rate for Payer: UHC Medicare Advantage |
$238.31
|
|
|
PR DISCECTOMY ANT DCMPRN CORD THORACIC 1 NTRSPC
|
Professional
|
Both
|
$5,692.00
|
|
|
Service Code
|
HCPCS 63077
|
| Min. Negotiated Rate |
$1,409.39 |
| Max. Negotiated Rate |
$3,699.80 |
| Rate for Payer: Aetna Commercial |
$1,888.58
|
| Rate for Payer: Aetna Medicare |
$1,465.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,029.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,888.58
|
| Rate for Payer: BCBS Complete |
$2,276.80
|
| Rate for Payer: BCBS MAPPO |
$1,409.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,409.39
|
| Rate for Payer: Cash Price |
$4,553.60
|
| Rate for Payer: Cash Price |
$4,553.60
|
| Rate for Payer: Cofinity Commercial |
$2,029.52
|
| Rate for Payer: Cofinity Commercial |
$1,888.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,409.39
|
| Rate for Payer: Healthscope Commercial |
$2,255.02
|
| Rate for Payer: Healthscope Commercial |
$2,607.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,479.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,699.80
|
| Rate for Payer: Nomi Health Commercial |
$1,691.27
|
| Rate for Payer: PACE SWMI |
$1,409.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,409.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,699.80
|
| Rate for Payer: Priority Health Medicare |
$1,409.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,409.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,409.39
|
|
|
PR DISEASE MANAGEMENT PROGRAM
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS S0315
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
|
|
PR DISEASE MGMT PER DIEM
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS S0317
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
|
PR DISE DYN EVAL SLEEP DISORDERED BREATHING FLX DX
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 42975
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$171.05 |
| Rate for Payer: Aetna Commercial |
$123.90
|
| Rate for Payer: Aetna Medicare |
$96.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.14
|
| Rate for Payer: BCBS Complete |
$90.80
|
| Rate for Payer: BCBS MAPPO |
$92.46
|
| Rate for Payer: BCN Medicare Advantage |
$92.46
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cofinity Commercial |
$123.90
|
| Rate for Payer: Cofinity Commercial |
$133.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.46
|
| Rate for Payer: Healthscope Commercial |
$171.05
|
| Rate for Payer: Healthscope Commercial |
$147.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.55
|
| Rate for Payer: Nomi Health Commercial |
$110.95
|
| Rate for Payer: PACE SWMI |
$92.46
|
| Rate for Payer: PHP Medicare Advantage |
$92.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.55
|
| Rate for Payer: Priority Health Medicare |
$92.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.46
|
| Rate for Payer: UHC Medicare Advantage |
$92.46
|
|
|
PR DISPENSING FEE BINAURAL
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS V5160
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$315.25 |
| Rate for Payer: Aetna Medicare |
$242.50
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
|
|
PR DISPENSING FEE, MONAURAL
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS V5241
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
|
|
PR DISP FEE CONTRALATERAL BINAU
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS V5240
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$315.25 |
| Rate for Payer: Aetna Medicare |
$242.50
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
|
|
PR DISP FEE CONTRALATERAL MONAU
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS V5200
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Facility
|
OP
|
$938.00
|
|
|
Service Code
|
CPT 38542
|
| Hospital Charge Code |
38542
|
| Min. Negotiated Rate |
$590.94 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Commercial |
$797.30
|
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cofinity Commercial |
$656.60
|
| Rate for Payer: Cofinity Commercial |
$806.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$656.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Healthscope Commercial |
$844.20
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.30
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Commercial |
$797.30
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Priority Health SBD |
$590.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,203.54
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Facility
|
IP
|
$938.00
|
|
|
Service Code
|
CPT 38542
|
| Hospital Charge Code |
38542
|
| Min. Negotiated Rate |
$590.94 |
| Max. Negotiated Rate |
$844.20 |
| Rate for Payer: Aetna Commercial |
$797.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.70
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cofinity Commercial |
$656.60
|
| Rate for Payer: Cofinity Commercial |
$806.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$656.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.40
|
| Rate for Payer: Healthscope Commercial |
$844.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.30
|
| Rate for Payer: PHP Commercial |
$797.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health SBD |
$590.94
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
HCPCS 38542
|
| Min. Negotiated Rate |
$375.20 |
| Max. Negotiated Rate |
$928.42 |
| Rate for Payer: Aetna Commercial |
$672.48
|
| Rate for Payer: Aetna Medicare |
$521.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$672.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$722.66
|
| Rate for Payer: BCBS Complete |
$375.20
|
| Rate for Payer: BCBS MAPPO |
$501.85
|
| Rate for Payer: BCN Medicare Advantage |
$501.85
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cofinity Commercial |
$722.66
|
| Rate for Payer: Cofinity Commercial |
$672.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$501.85
|
| Rate for Payer: Healthscope Commercial |
$802.96
|
| Rate for Payer: Healthscope Commercial |
$928.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$526.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$609.70
|
| Rate for Payer: Nomi Health Commercial |
$602.22
|
| Rate for Payer: PACE SWMI |
$501.85
|
| Rate for Payer: PHP Medicare Advantage |
$501.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health Medicare |
$501.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$501.85
|
| Rate for Payer: UHC Medicare Advantage |
$501.85
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
HCPCS 38542
|
| Hospital Charge Code |
38542
|
| Min. Negotiated Rate |
$375.20 |
| Max. Negotiated Rate |
$928.42 |
| Rate for Payer: Aetna Commercial |
$672.48
|
| Rate for Payer: Aetna Medicare |
$521.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$722.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$672.48
|
| Rate for Payer: BCBS Complete |
$375.20
|
| Rate for Payer: BCBS MAPPO |
$501.85
|
| Rate for Payer: BCN Medicare Advantage |
$501.85
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cofinity Commercial |
$722.66
|
| Rate for Payer: Cofinity Commercial |
$672.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$501.85
|
| Rate for Payer: Healthscope Commercial |
$928.42
|
| Rate for Payer: Healthscope Commercial |
$802.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$526.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$609.70
|
| Rate for Payer: Nomi Health Commercial |
$602.22
|
| Rate for Payer: PACE SWMI |
$501.85
|
| Rate for Payer: PHP Medicare Advantage |
$501.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health Medicare |
$501.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$501.85
|
| Rate for Payer: UHC Medicare Advantage |
$501.85
|
|
|
PR DIS SITE TELE SVCS RHC/FQHC
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS G2025
|
| Min. Negotiated Rate |
$75.20 |
| Max. Negotiated Rate |
$122.20 |
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
|
