|
PR DIR RPR RUPTD ANEURYSM RADIAL/ULNAR ARTERY
|
Professional
|
Both
|
$3,424.00
|
|
|
Service Code
|
HCPCS 35045
|
| Min. Negotiated Rate |
$606.84 |
| Max. Negotiated Rate |
$172,055.00 |
| Rate for Payer: Aetna Commercial |
$1,243.73
|
| Rate for Payer: Aetna Medicare |
$965.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,243.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,336.55
|
| Rate for Payer: BCBS Complete |
$637.18
|
| Rate for Payer: BCBS MAPPO |
$928.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,582.22
|
| Rate for Payer: BCN Commercial |
$1,389.31
|
| 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 |
$1,717.10
|
| Rate for Payer: Healthscope Commercial |
$1,485.06
|
| Rate for Payer: Mclaren Medicaid |
$606.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$974.57
|
| Rate for Payer: Meridian Medicaid |
$637.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172,055.00
|
| 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 Choice Medicaid |
$606.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,225.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,515.17
|
| Rate for Payer: Priority Health Medicare |
$928.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,515.17
|
| Rate for Payer: Priority Health SBD |
$1,515.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,267.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$928.16
|
| Rate for Payer: UHC Exchange |
$1,267.14
|
| Rate for Payer: UHC Medicare Advantage |
$928.16
|
| Rate for Payer: UHCCP Medicaid |
$606.84
|
|
|
PR DISARTICULATION HIP
|
Professional
|
Both
|
$5,432.00
|
|
|
Service Code
|
HCPCS 27295
|
| Min. Negotiated Rate |
$809.19 |
| Max. Negotiated Rate |
$223,681.00 |
| Rate for Payer: Aetna Commercial |
$1,623.18
|
| Rate for Payer: Aetna Medicare |
$1,259.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,623.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,744.32
|
| Rate for Payer: BCBS Complete |
$849.65
|
| Rate for Payer: BCBS MAPPO |
$1,211.33
|
| Rate for Payer: BCBS Trust/PPO |
$3,334.10
|
| Rate for Payer: BCN Commercial |
$1,837.92
|
| 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: Mclaren Medicaid |
$809.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,271.90
|
| Rate for Payer: Meridian Medicaid |
$849.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223,681.00
|
| 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 Choice Medicaid |
$809.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,530.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,930.62
|
| Rate for Payer: Priority Health Medicare |
$1,211.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,930.62
|
| Rate for Payer: Priority Health SBD |
$1,930.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,781.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,211.33
|
| Rate for Payer: UHC Exchange |
$1,781.54
|
| Rate for Payer: UHC Medicare Advantage |
$1,211.33
|
| Rate for Payer: UHCCP Medicaid |
$809.19
|
|
|
PR DISARTICULATION KNEE
|
Professional
|
Both
|
$2,933.00
|
|
|
Service Code
|
HCPCS 27598
|
| Min. Negotiated Rate |
$446.87 |
| Max. Negotiated Rate |
$123,971.00 |
| Rate for Payer: Aetna Commercial |
$901.35
|
| Rate for Payer: Aetna Medicare |
$699.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$901.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$968.62
|
| Rate for Payer: BCBS Complete |
$469.21
|
| Rate for Payer: BCBS MAPPO |
$672.65
|
| Rate for Payer: BCBS Trust/PPO |
$797.73
|
| Rate for Payer: BCN Commercial |
$1,014.00
|
| 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 |
$1,244.40
|
| Rate for Payer: Healthscope Commercial |
$1,076.24
|
| Rate for Payer: Mclaren Medicaid |
$446.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$706.28
|
| Rate for Payer: Meridian Medicaid |
$469.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123,971.00
|
| 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 Choice Medicaid |
$446.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,906.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,057.93
|
| Rate for Payer: Priority Health Medicare |
$672.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,057.93
|
| Rate for Payer: Priority Health SBD |
$1,057.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,035.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$672.65
|
| Rate for Payer: UHC Exchange |
$1,035.35
|
| Rate for Payer: UHC Medicare Advantage |
$672.65
|
| Rate for Payer: UHCCP Medicaid |
$446.87
|
|
|
PR DISARTICULATION SHOULDER
|
Professional
|
Both
|
$1,996.00
|
|
|
Service Code
|
HCPCS 23920
|
| Min. Negotiated Rate |
$491.15 |
| Max. Negotiated Rate |
$199,145.00 |
| Rate for Payer: Aetna Commercial |
$1,451.43
|
| Rate for Payer: Aetna Medicare |
$1,126.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,451.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,559.75
|
| Rate for Payer: BCBS Complete |
$765.33
|
| Rate for Payer: BCBS MAPPO |
$1,083.16
|
| Rate for Payer: BCBS Trust/PPO |
$491.15
|
| Rate for Payer: BCN Commercial |
$1,644.89
|
| 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: Mclaren Medicaid |
$728.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,137.32
|
| Rate for Payer: Meridian Medicaid |
$765.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199,145.00
|
| 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 Choice Medicaid |
$728.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,297.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,727.08
|
| Rate for Payer: Priority Health Medicare |
$1,083.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,727.08
|
| Rate for Payer: Priority Health SBD |
$1,727.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,453.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,083.16
|
| Rate for Payer: UHC Exchange |
$1,453.91
|
| Rate for Payer: UHC Medicare Advantage |
$1,083.16
|
| Rate for Payer: UHCCP Medicaid |
$728.89
|
|
|
PR DISARTICULATION THROUGH WRIST
|
Professional
|
Both
|
$1,432.00
|
|
|
Service Code
|
HCPCS 25920
|
| Min. Negotiated Rate |
$129.43 |
| Max. Negotiated Rate |
$129,474.00 |
| Rate for Payer: Aetna Commercial |
$938.20
|
| Rate for Payer: Aetna Medicare |
$728.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,008.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$938.20
|
| Rate for Payer: BCBS Complete |
$499.63
|
| Rate for Payer: BCBS MAPPO |
$700.15
|
| Rate for Payer: BCBS Trust/PPO |
$129.43
|
| Rate for Payer: BCN Commercial |
$1,079.48
|
| 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 |
$1,295.28
|
| Rate for Payer: Healthscope Commercial |
$1,120.24
|
| Rate for Payer: Mclaren Medicaid |
$475.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$735.16
|
| Rate for Payer: Meridian Medicaid |
$499.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129,474.00
|
| 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 Choice Medicaid |
$475.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$930.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,130.19
|
| Rate for Payer: Priority Health Medicare |
$700.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,130.19
|
| Rate for Payer: Priority Health SBD |
$1,130.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$764.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$700.15
|
| Rate for Payer: UHC Exchange |
$764.83
|
| Rate for Payer: UHC Medicare Advantage |
$700.15
|
| Rate for Payer: UHCCP Medicaid |
$475.84
|
|
|
PR DISARTICULATION THRU WRIST RE-AMPUTATION
|
Professional
|
Both
|
$2,359.00
|
|
|
Service Code
|
HCPCS 25924
|
| Min. Negotiated Rate |
$69.19 |
| Max. Negotiated Rate |
$126,470.00 |
| Rate for Payer: Aetna Commercial |
$915.23
|
| Rate for Payer: Aetna Medicare |
$710.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$915.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$983.53
|
| Rate for Payer: BCBS Complete |
$487.56
|
| Rate for Payer: BCBS MAPPO |
$683.01
|
| Rate for Payer: BCBS Trust/PPO |
$69.19
|
| Rate for Payer: BCN Commercial |
$1,054.56
|
| 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: Mclaren Medicaid |
$464.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$717.16
|
| Rate for Payer: Meridian Medicaid |
$487.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126,470.00
|
| 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 Choice Medicaid |
$464.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,533.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,104.23
|
| Rate for Payer: Priority Health Medicare |
$683.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,104.23
|
| Rate for Payer: Priority Health SBD |
$1,104.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$769.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$683.01
|
| Rate for Payer: UHC Exchange |
$769.33
|
| Rate for Payer: UHC Medicare Advantage |
$683.01
|
| Rate for Payer: UHCCP Medicaid |
$464.34
|
|
|
PR DISCECTOMY ANT DCMPRN CORD CERVICAL 1 NTRSPC
|
Professional
|
Both
|
$5,746.00
|
|
|
Service Code
|
HCPCS 63075
|
| Min. Negotiated Rate |
$170.11 |
| Max. Negotiated Rate |
$243,860.00 |
| Rate for Payer: Aetna Commercial |
$1,779.94
|
| Rate for Payer: Aetna Medicare |
$1,381.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,779.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,912.77
|
| Rate for Payer: BCBS Complete |
$923.90
|
| Rate for Payer: BCBS MAPPO |
$1,328.31
|
| Rate for Payer: BCBS Trust/PPO |
$170.11
|
| Rate for Payer: BCN Commercial |
$2,197.49
|
| 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 |
$2,457.37
|
| Rate for Payer: Healthscope Commercial |
$2,125.30
|
| Rate for Payer: Mclaren Medicaid |
$879.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,394.73
|
| Rate for Payer: Meridian Medicaid |
$923.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243,860.00
|
| 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 Choice Medicaid |
$879.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,734.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,334.01
|
| Rate for Payer: Priority Health Medicare |
$1,328.31
|
| Rate for Payer: Priority Health Narrow Network |
$2,334.01
|
| Rate for Payer: Priority Health SBD |
$2,334.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,494.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,328.31
|
| Rate for Payer: UHC Exchange |
$2,494.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,328.31
|
| Rate for Payer: UHCCP Medicaid |
$879.90
|
|
|
PR DISCECTOMY ANT DCMPRN CORD CERVICAL EA NTRSPC
|
Professional
|
Both
|
$1,928.00
|
|
|
Service Code
|
HCPCS 63076
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$43,547.00 |
| Rate for Payer: Aetna Commercial |
$319.34
|
| Rate for Payer: Aetna Medicare |
$247.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.17
|
| Rate for Payer: BCBS Complete |
$163.94
|
| Rate for Payer: BCBS MAPPO |
$238.31
|
| Rate for Payer: BCBS Trust/PPO |
$174.34
|
| Rate for Payer: BCN Commercial |
$389.03
|
| 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: Mclaren Medicaid |
$156.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.23
|
| Rate for Payer: Meridian Medicaid |
$163.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43,547.00
|
| 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 Choice Medicaid |
$156.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$410.62
|
| Rate for Payer: Priority Health Medicare |
$238.31
|
| Rate for Payer: Priority Health Narrow Network |
$410.62
|
| Rate for Payer: Priority Health SBD |
$410.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.31
|
| Rate for Payer: UHC Exchange |
$346.35
|
| Rate for Payer: UHC Medicare Advantage |
$238.31
|
| Rate for Payer: UHCCP Medicaid |
$156.13
|
|
|
PR DISCECTOMY ANT DCMPRN CORD THORACIC 1 NTRSPC
|
Professional
|
Both
|
$5,692.00
|
|
|
Service Code
|
HCPCS 63077
|
| Min. Negotiated Rate |
$145.28 |
| Max. Negotiated Rate |
$274,811.00 |
| Rate for Payer: Aetna Commercial |
$1,888.58
|
| Rate for Payer: Aetna Medicare |
$1,465.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,888.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,029.52
|
| Rate for Payer: BCBS Complete |
$989.66
|
| Rate for Payer: BCBS MAPPO |
$1,409.39
|
| Rate for Payer: BCBS Trust/PPO |
$145.28
|
| Rate for Payer: BCN Commercial |
$2,469.21
|
| 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 |
$2,607.37
|
| Rate for Payer: Healthscope Commercial |
$2,255.02
|
| Rate for Payer: Mclaren Medicaid |
$942.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,479.86
|
| Rate for Payer: Meridian Medicaid |
$989.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274,811.00
|
| 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 Choice Medicaid |
$942.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,699.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,497.22
|
| Rate for Payer: Priority Health Medicare |
$1,409.39
|
| Rate for Payer: Priority Health Narrow Network |
$2,497.22
|
| Rate for Payer: Priority Health SBD |
$2,497.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,154.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,409.39
|
| Rate for Payer: UHC Exchange |
$2,154.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,409.39
|
| Rate for Payer: UHCCP Medicaid |
$942.53
|
|
|
PR DISEASE MANAGEMENT PROGRAM
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS S0315
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.00
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: BCBS Trust/PPO |
$111.47
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$367.20
|
| 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
|
$102.00
|
|
|
Service Code
|
HCPCS S0317
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$175.00
|
| Rate for Payer: Aetna Commercial |
$175.00
|
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.00
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$58.11
|
| Rate for Payer: BCBS Trust/PPO |
$58.11
|
| Rate for Payer: BCN Commercial |
$1,000.00
|
| Rate for Payer: BCN Commercial |
$1,000.00
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$122.40
|
| 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 |
$62.20 |
| Max. Negotiated Rate |
$16,972.00 |
| Rate for Payer: Aetna Commercial |
$123.90
|
| Rate for Payer: Aetna Medicare |
$96.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.90
|
| Rate for Payer: BCBS Complete |
$65.31
|
| Rate for Payer: BCBS MAPPO |
$92.46
|
| Rate for Payer: BCBS Trust/PPO |
$284.23
|
| Rate for Payer: BCN Commercial |
$139.76
|
| 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 |
$133.14
|
| Rate for Payer: Cofinity Commercial |
$123.90
|
| 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: Mclaren Medicaid |
$62.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.08
|
| Rate for Payer: Meridian Medicaid |
$65.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,972.00
|
| 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 Choice Medicaid |
$62.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.61
|
| Rate for Payer: Priority Health Medicare |
$92.46
|
| Rate for Payer: Priority Health Narrow Network |
$173.61
|
| Rate for Payer: Priority Health SBD |
$173.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.46
|
| Rate for Payer: UHC Medicare Advantage |
$92.46
|
| Rate for Payer: UHCCP Medicaid |
$62.20
|
|
|
PR DISPENSING FEE BINAURAL
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS V5160
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$42,186.00 |
| Rate for Payer: Aetna Commercial |
$289.59
|
| Rate for Payer: Aetna Medicare |
$242.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.59
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,186.00
|
| 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 |
$0.01 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| 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 |
$36,165.00 |
| Rate for Payer: Aetna Commercial |
$248.26
|
| Rate for Payer: Aetna Medicare |
$242.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.26
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,165.00
|
| 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 |
$34,916.00 |
| Rate for Payer: Aetna Commercial |
$239.68
|
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.68
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,916.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
HCPCS 38542
|
| Min. Negotiated Rate |
$337.82 |
| Max. Negotiated Rate |
$92,840.00 |
| 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 |
$354.71
|
| Rate for Payer: BCBS MAPPO |
$501.85
|
| Rate for Payer: BCBS Trust/PPO |
$975.24
|
| Rate for Payer: BCN Commercial |
$766.73
|
| 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: Mclaren Medicaid |
$337.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$526.94
|
| Rate for Payer: Meridian Medicaid |
$354.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92,840.00
|
| 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 Choice Medicaid |
$337.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,052.56
|
| Rate for Payer: Priority Health Medicare |
$501.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,052.56
|
| Rate for Payer: Priority Health SBD |
$1,052.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$501.85
|
| Rate for Payer: UHC Exchange |
$496.66
|
| Rate for Payer: UHC Medicare Advantage |
$501.85
|
| Rate for Payer: UHCCP Medicaid |
$337.82
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Facility
|
OP
|
$938.00
|
|
|
Service Code
|
CPT 38542
|
| Hospital Charge Code |
38542
|
| Min. Negotiated Rate |
$557.37 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Commercial |
$797.30
|
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,126.28
|
| Rate for Payer: BCN Commercial |
$2,126.28
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cofinity Commercial |
$806.68
|
| Rate for Payer: Cofinity Commercial |
$656.60
|
| 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 |
$5,716.39
|
| Rate for Payer: Healthscope Commercial |
$844.20
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.30
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Commercial |
$797.30
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Priority Health SBD |
$590.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$557.37
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,218.33
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
HCPCS 38542
|
| Hospital Charge Code |
38542
|
| Min. Negotiated Rate |
$337.82 |
| Max. Negotiated Rate |
$92,840.00 |
| 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 |
$354.71
|
| Rate for Payer: BCBS MAPPO |
$501.85
|
| Rate for Payer: BCBS Trust/PPO |
$975.24
|
| Rate for Payer: BCN Commercial |
$766.73
|
| 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: Mclaren Medicaid |
$337.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$526.94
|
| Rate for Payer: Meridian Medicaid |
$354.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92,840.00
|
| 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 Choice Medicaid |
$337.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,052.56
|
| Rate for Payer: Priority Health Medicare |
$501.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,052.56
|
| Rate for Payer: Priority Health SBD |
$1,052.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$501.85
|
| Rate for Payer: UHC Exchange |
$496.66
|
| Rate for Payer: UHC Medicare Advantage |
$501.85
|
| Rate for Payer: UHCCP Medicaid |
$337.82
|
|
|
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 DIS SITE TELE SVCS RHC/FQHC
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS G2025
|
| Min. Negotiated Rate |
$75.20 |
| Max. Negotiated Rate |
$14,165.00 |
| Rate for Payer: Aetna Commercial |
$95.30
|
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.30
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,080.37
|
| Rate for Payer: BCN Commercial |
$141.72
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,165.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.03
|
| Rate for Payer: UHC Exchange |
$92.03
|
|
|
PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS 92587
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$3,185.00 |
| Rate for Payer: Aetna Commercial |
$27.24
|
| Rate for Payer: Aetna Medicare |
$21.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.28
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS MAPPO |
$20.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,890.26
|
| Rate for Payer: BCN Commercial |
$31.76
|
| Rate for Payer: BCN Medicare Advantage |
$20.33
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cofinity Commercial |
$29.28
|
| Rate for Payer: Cofinity Commercial |
$27.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.33
|
| Rate for Payer: Healthscope Commercial |
$37.61
|
| Rate for Payer: Healthscope Commercial |
$32.53
|
| Rate for Payer: Mclaren Medicaid |
$11.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.35
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,185.00
|
| Rate for Payer: Nomi Health Commercial |
$24.40
|
| Rate for Payer: PACE SWMI |
$20.33
|
| Rate for Payer: PHP Medicare Advantage |
$20.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.94
|
| Rate for Payer: Priority Health Medicare |
$20.33
|
| Rate for Payer: Priority Health Narrow Network |
$28.94
|
| Rate for Payer: Priority Health SBD |
$23.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.33
|
| Rate for Payer: UHC Exchange |
$64.76
|
| Rate for Payer: UHC Medicare Advantage |
$20.33
|
| Rate for Payer: UHCCP Medicaid |
$11.50
|
|
|
PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 92588
|
| Min. Negotiated Rate |
$18.11 |
| Max. Negotiated Rate |
$4,943.00 |
| Rate for Payer: Aetna Commercial |
$41.83
|
| Rate for Payer: Aetna Medicare |
$32.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.96
|
| Rate for Payer: BCBS Complete |
$19.02
|
| Rate for Payer: BCBS MAPPO |
$31.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,499.32
|
| Rate for Payer: BCN Commercial |
$49.36
|
| Rate for Payer: BCN Medicare Advantage |
$31.22
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$44.96
|
| Rate for Payer: Cofinity Commercial |
$41.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.22
|
| Rate for Payer: Healthscope Commercial |
$57.76
|
| Rate for Payer: Healthscope Commercial |
$49.95
|
| Rate for Payer: Mclaren Medicaid |
$18.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.78
|
| Rate for Payer: Meridian Medicaid |
$19.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,943.00
|
| Rate for Payer: Nomi Health Commercial |
$37.46
|
| Rate for Payer: PACE SWMI |
$31.22
|
| Rate for Payer: PHP Medicare Advantage |
$31.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.77
|
| Rate for Payer: Priority Health Medicare |
$31.22
|
| Rate for Payer: Priority Health Narrow Network |
$44.77
|
| Rate for Payer: Priority Health SBD |
$37.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.22
|
| Rate for Payer: UHC Exchange |
$85.55
|
| Rate for Payer: UHC Medicare Advantage |
$31.22
|
| Rate for Payer: UHCCP Medicaid |
$18.11
|
|
|
PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH CRV APPR
|
Professional
|
Both
|
$2,437.00
|
|
|
Service Code
|
HCPCS 43130
|
| Min. Negotiated Rate |
$85.32 |
| Max. Negotiated Rate |
$140,951.00 |
| Rate for Payer: Aetna Commercial |
$1,019.59
|
| Rate for Payer: Aetna Medicare |
$791.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,019.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,095.68
|
| Rate for Payer: BCBS Complete |
$535.65
|
| Rate for Payer: BCBS MAPPO |
$760.89
|
| Rate for Payer: BCBS Trust/PPO |
$85.32
|
| Rate for Payer: BCN Commercial |
$1,160.61
|
| Rate for Payer: BCN Medicare Advantage |
$760.89
|
| Rate for Payer: Cash Price |
$1,949.60
|
| Rate for Payer: Cash Price |
$1,949.60
|
| Rate for Payer: Cofinity Commercial |
$1,095.68
|
| Rate for Payer: Cofinity Commercial |
$1,019.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$760.89
|
| Rate for Payer: Healthscope Commercial |
$1,407.65
|
| Rate for Payer: Healthscope Commercial |
$1,217.42
|
| Rate for Payer: Mclaren Medicaid |
$510.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$798.93
|
| Rate for Payer: Meridian Medicaid |
$535.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140,951.00
|
| Rate for Payer: Nomi Health Commercial |
$913.07
|
| Rate for Payer: PACE SWMI |
$760.89
|
| Rate for Payer: PHP Medicare Advantage |
$760.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$510.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,584.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,426.45
|
| Rate for Payer: Priority Health Medicare |
$760.89
|
| Rate for Payer: Priority Health Narrow Network |
$1,426.45
|
| Rate for Payer: Priority Health SBD |
$1,426.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,010.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$760.89
|
| Rate for Payer: UHC Exchange |
$1,010.87
|
| Rate for Payer: UHC Medicare Advantage |
$760.89
|
| Rate for Payer: UHCCP Medicaid |
$510.14
|
|
|
PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH THRC APPR
|
Professional
|
Both
|
$3,167.00
|
|
|
Service Code
|
HCPCS 43135
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$261,223.00 |
| Rate for Payer: Aetna Commercial |
$1,896.94
|
| Rate for Payer: Aetna Medicare |
$1,472.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,896.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,038.51
|
| Rate for Payer: BCBS Complete |
$976.01
|
| Rate for Payer: BCBS MAPPO |
$1,415.63
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: BCN Commercial |
$2,116.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,415.63
|
| Rate for Payer: Cash Price |
$2,533.60
|
| Rate for Payer: Cash Price |
$2,533.60
|
| Rate for Payer: Cofinity Commercial |
$2,038.51
|
| Rate for Payer: Cofinity Commercial |
$1,896.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,415.63
|
| Rate for Payer: Healthscope Commercial |
$2,618.92
|
| Rate for Payer: Healthscope Commercial |
$2,265.01
|
| Rate for Payer: Mclaren Medicaid |
$929.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,486.41
|
| Rate for Payer: Meridian Medicaid |
$976.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261,223.00
|
| Rate for Payer: Nomi Health Commercial |
$1,698.76
|
| Rate for Payer: PACE SWMI |
$1,415.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,415.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$929.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,058.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,595.19
|
| Rate for Payer: Priority Health Medicare |
$1,415.63
|
| Rate for Payer: Priority Health Narrow Network |
$2,595.19
|
| Rate for Payer: Priority Health SBD |
$2,595.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,402.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,415.63
|
| Rate for Payer: UHC Exchange |
$1,402.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,415.63
|
| Rate for Payer: UHCCP Medicaid |
$929.53
|
|
