|
PR NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 96121
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Aetna Commercial |
$81.94
|
| Rate for Payer: Aetna Medicare |
$63.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.06
|
| Rate for Payer: BCBS Complete |
$41.15
|
| Rate for Payer: BCBS MAPPO |
$61.15
|
| Rate for Payer: BCN Commercial |
$98.10
|
| Rate for Payer: BCN Medicare Advantage |
$61.15
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$88.06
|
| Rate for Payer: Cofinity Commercial |
$81.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.15
|
| Rate for Payer: Healthscope Commercial |
$97.84
|
| Rate for Payer: Healthscope Commercial |
$113.13
|
| Rate for Payer: Mclaren Medicaid |
$39.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.21
|
| Rate for Payer: Meridian Medicaid |
$41.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$67.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.77
|
| Rate for Payer: Nomi Health Commercial |
$73.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.00
|
| Rate for Payer: PACE SWMI |
$61.15
|
| Rate for Payer: PHP Medicare Advantage |
$61.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$90.47
|
| Rate for Payer: Priority Health Medicare |
$61.15
|
| Rate for Payer: Priority Health SBD |
$90.47
|
| Rate for Payer: Priority Health Tiered Network |
$90.47
|
| Rate for Payer: Railroad Medicare Medicare |
$61.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.92
|
| Rate for Payer: UHC Core |
$126.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$61.15
|
| Rate for Payer: UHC Exchange |
$126.92
|
| Rate for Payer: UHC Medicaid |
$39.19
|
| Rate for Payer: UHCCP Medicaid |
$39.19
|
|
|
PR NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY
|
Professional
|
Both
|
$4,520.00
|
|
|
Service Code
|
HCPCS 62164
|
| Min. Negotiated Rate |
$1,313.57 |
| Max. Negotiated Rate |
$4,415.41 |
| Rate for Payer: Aetna Commercial |
$2,749.02
|
| Rate for Payer: Aetna Medicare |
$2,133.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,749.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,954.17
|
| Rate for Payer: BCBS Complete |
$1,379.25
|
| Rate for Payer: BCBS MAPPO |
$2,051.51
|
| Rate for Payer: BCN Commercial |
$4,415.41
|
| Rate for Payer: BCN Medicare Advantage |
$2,051.51
|
| Rate for Payer: Cash Price |
$3,616.00
|
| Rate for Payer: Cash Price |
$3,616.00
|
| Rate for Payer: Cofinity Commercial |
$2,954.17
|
| Rate for Payer: Cofinity Commercial |
$2,749.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,051.51
|
| Rate for Payer: Healthscope Commercial |
$3,795.29
|
| Rate for Payer: Healthscope Commercial |
$3,282.42
|
| Rate for Payer: Mclaren Medicaid |
$1,313.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,154.09
|
| Rate for Payer: Meridian Medicaid |
$1,379.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,256.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,796.65
|
| Rate for Payer: Nomi Health Commercial |
$2,461.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,390.00
|
| Rate for Payer: PACE SWMI |
$2,051.51
|
| Rate for Payer: PHP Medicare Advantage |
$2,051.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,313.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,712.15
|
| Rate for Payer: Priority Health Medicare |
$2,051.51
|
| Rate for Payer: Priority Health SBD |
$3,712.15
|
| Rate for Payer: Priority Health Tiered Network |
$3,712.15
|
| Rate for Payer: Railroad Medicare Medicare |
$2,051.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,683.91
|
| Rate for Payer: UHC Core |
$3,683.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,051.51
|
| Rate for Payer: UHC Exchange |
$3,683.91
|
| Rate for Payer: UHC Medicaid |
$1,313.57
|
| Rate for Payer: UHCCP Medicaid |
$1,313.57
|
|
|
PR NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 95937
|
| Min. Negotiated Rate |
$99.40 |
| Max. Negotiated Rate |
$183.89 |
| Rate for Payer: Aetna Medicare |
$103.38
|
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.20
|
| Rate for Payer: BCBS MAPPO |
$99.40
|
| Rate for Payer: BCN Commercial |
$151.39
|
| Rate for Payer: BCN Medicare Advantage |
$99.40
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$143.14
|
| Rate for Payer: Cofinity Commercial |
$133.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.40
|
| Rate for Payer: Healthscope Commercial |
$159.04
|
| Rate for Payer: Healthscope Commercial |
$183.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$109.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.22
|
| Rate for Payer: Nomi Health Commercial |
$119.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.75
|
| Rate for Payer: PACE SWMI |
$99.40
|
| Rate for Payer: PHP Medicare Advantage |
$99.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$139.61
|
| Rate for Payer: Priority Health Medicare |
$99.40
|
| Rate for Payer: Priority Health SBD |
$139.61
|
| Rate for Payer: Priority Health Tiered Network |
$139.61
|
| Rate for Payer: Railroad Medicare Medicare |
$99.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.82
|
| Rate for Payer: UHC Core |
$144.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$99.40
|
| Rate for Payer: UHC Exchange |
$144.82
|
|
|
PR NEUROPLASTY DIGITAL 1/BOTH SAME DIGIT
|
Professional
|
Both
|
$2,563.00
|
|
|
Service Code
|
HCPCS 64702
|
| Min. Negotiated Rate |
$311.62 |
| Max. Negotiated Rate |
$1,922.25 |
| Rate for Payer: Aetna Commercial |
$632.12
|
| Rate for Payer: Aetna Medicare |
$490.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$632.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$679.29
|
| Rate for Payer: BCBS Complete |
$327.20
|
| Rate for Payer: BCBS MAPPO |
$471.73
|
| Rate for Payer: BCN Commercial |
$787.31
|
| Rate for Payer: BCN Medicare Advantage |
$471.73
|
| Rate for Payer: Cash Price |
$2,050.40
|
| Rate for Payer: Cash Price |
$2,050.40
|
| Rate for Payer: Cofinity Commercial |
$679.29
|
| Rate for Payer: Cofinity Commercial |
$632.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$471.73
|
| Rate for Payer: Healthscope Commercial |
$872.70
|
| Rate for Payer: Healthscope Commercial |
$754.77
|
| Rate for Payer: Mclaren Medicaid |
$311.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$495.32
|
| Rate for Payer: Meridian Medicaid |
$327.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$518.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$905.81
|
| Rate for Payer: Nomi Health Commercial |
$566.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,922.25
|
| Rate for Payer: PACE SWMI |
$471.73
|
| Rate for Payer: PHP Medicare Advantage |
$471.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$311.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$914.45
|
| Rate for Payer: Priority Health Medicare |
$471.73
|
| Rate for Payer: Priority Health SBD |
$914.45
|
| Rate for Payer: Priority Health Tiered Network |
$914.45
|
| Rate for Payer: Railroad Medicare Medicare |
$471.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$871.51
|
| Rate for Payer: UHC Core |
$871.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$471.73
|
| Rate for Payer: UHC Exchange |
$871.51
|
| Rate for Payer: UHC Medicaid |
$311.62
|
| Rate for Payer: UHCCP Medicaid |
$311.62
|
|
|
PR NEUROPLASTY NERVE HAND/FOOT
|
Professional
|
Both
|
$1,945.00
|
|
|
Service Code
|
HCPCS 64704
|
| Min. Negotiated Rate |
$196.60 |
| Max. Negotiated Rate |
$1,458.75 |
| Rate for Payer: Aetna Commercial |
$400.38
|
| Rate for Payer: Aetna Medicare |
$310.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.26
|
| Rate for Payer: BCBS Complete |
$206.43
|
| Rate for Payer: BCBS MAPPO |
$298.79
|
| Rate for Payer: BCN Commercial |
$494.99
|
| Rate for Payer: BCN Medicare Advantage |
$298.79
|
| Rate for Payer: Cash Price |
$1,556.00
|
| Rate for Payer: Cash Price |
$1,556.00
|
| Rate for Payer: Cofinity Commercial |
$430.26
|
| Rate for Payer: Cofinity Commercial |
$400.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.79
|
| Rate for Payer: Healthscope Commercial |
$552.76
|
| Rate for Payer: Healthscope Commercial |
$478.06
|
| Rate for Payer: Mclaren Medicaid |
$196.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$313.73
|
| Rate for Payer: Meridian Medicaid |
$206.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$328.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.46
|
| Rate for Payer: Nomi Health Commercial |
$358.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,458.75
|
| Rate for Payer: PACE SWMI |
$298.79
|
| Rate for Payer: PHP Medicare Advantage |
$298.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$574.92
|
| Rate for Payer: Priority Health Medicare |
$298.79
|
| Rate for Payer: Priority Health SBD |
$574.92
|
| Rate for Payer: Priority Health Tiered Network |
$574.92
|
| Rate for Payer: Railroad Medicare Medicare |
$298.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$559.90
|
| Rate for Payer: UHC Core |
$559.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$298.79
|
| Rate for Payer: UHC Exchange |
$559.90
|
| Rate for Payer: UHC Medicaid |
$196.60
|
| Rate for Payer: UHCCP Medicaid |
$196.60
|
|
|
PR NEUROPLASTY &/TRANSPOSITION CRANIAL NERVE
|
Professional
|
Both
|
$989.00
|
|
|
Service Code
|
HCPCS 64716
|
| Min. Negotiated Rate |
$299.69 |
| Max. Negotiated Rate |
$903.96 |
| Rate for Payer: Aetna Commercial |
$612.62
|
| Rate for Payer: Aetna Medicare |
$475.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$658.34
|
| Rate for Payer: BCBS Complete |
$314.67
|
| Rate for Payer: BCBS MAPPO |
$457.18
|
| Rate for Payer: BCN Commercial |
$773.37
|
| Rate for Payer: BCN Medicare Advantage |
$457.18
|
| Rate for Payer: Cash Price |
$791.20
|
| Rate for Payer: Cash Price |
$791.20
|
| Rate for Payer: Cofinity Commercial |
$658.34
|
| Rate for Payer: Cofinity Commercial |
$612.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$457.18
|
| Rate for Payer: Healthscope Commercial |
$845.78
|
| Rate for Payer: Healthscope Commercial |
$731.49
|
| Rate for Payer: Mclaren Medicaid |
$299.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$480.04
|
| Rate for Payer: Meridian Medicaid |
$314.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$502.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$903.96
|
| Rate for Payer: Nomi Health Commercial |
$548.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$741.75
|
| Rate for Payer: PACE SWMI |
$457.18
|
| Rate for Payer: PHP Medicare Advantage |
$457.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$299.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$898.25
|
| Rate for Payer: Priority Health Medicare |
$457.18
|
| Rate for Payer: Priority Health SBD |
$898.25
|
| Rate for Payer: Priority Health Tiered Network |
$898.25
|
| Rate for Payer: Railroad Medicare Medicare |
$457.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$894.27
|
| Rate for Payer: UHC Core |
$894.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$457.18
|
| Rate for Payer: UHC Exchange |
$894.27
|
| Rate for Payer: UHC Medicaid |
$299.69
|
| Rate for Payer: UHCCP Medicaid |
$299.69
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW
|
Professional
|
Both
|
$3,240.00
|
|
|
Service Code
|
HCPCS 64718
|
| Min. Negotiated Rate |
$366.79 |
| Max. Negotiated Rate |
$2,430.00 |
| Rate for Payer: Aetna Commercial |
$745.05
|
| Rate for Payer: Aetna Medicare |
$578.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$745.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$800.65
|
| Rate for Payer: BCBS Complete |
$385.13
|
| Rate for Payer: BCBS MAPPO |
$556.01
|
| Rate for Payer: BCN Commercial |
$926.25
|
| Rate for Payer: BCN Medicare Advantage |
$556.01
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cofinity Commercial |
$800.65
|
| Rate for Payer: Cofinity Commercial |
$745.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$556.01
|
| Rate for Payer: Healthscope Commercial |
$889.62
|
| Rate for Payer: Healthscope Commercial |
$1,028.62
|
| Rate for Payer: Mclaren Medicaid |
$366.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$583.81
|
| Rate for Payer: Meridian Medicaid |
$385.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$611.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,065.35
|
| Rate for Payer: Nomi Health Commercial |
$667.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,430.00
|
| Rate for Payer: PACE SWMI |
$556.01
|
| Rate for Payer: PHP Medicare Advantage |
$556.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$366.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,075.81
|
| Rate for Payer: Priority Health Medicare |
$556.01
|
| Rate for Payer: Priority Health SBD |
$1,075.81
|
| Rate for Payer: Priority Health Tiered Network |
$1,075.81
|
| Rate for Payer: Railroad Medicare Medicare |
$556.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,031.07
|
| Rate for Payer: UHC Core |
$1,031.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$556.01
|
| Rate for Payer: UHC Exchange |
$1,031.07
|
| Rate for Payer: UHC Medicaid |
$366.79
|
| Rate for Payer: UHCCP Medicaid |
$366.79
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST
|
Professional
|
Both
|
$1,619.00
|
|
|
Service Code
|
HCPCS 64719
|
| Min. Negotiated Rate |
$247.29 |
| Max. Negotiated Rate |
$1,214.25 |
| Rate for Payer: Aetna Commercial |
$502.59
|
| Rate for Payer: Aetna Medicare |
$390.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$540.10
|
| Rate for Payer: BCBS Complete |
$259.65
|
| Rate for Payer: BCBS MAPPO |
$375.07
|
| Rate for Payer: BCN Commercial |
$625.96
|
| Rate for Payer: BCN Medicare Advantage |
$375.07
|
| Rate for Payer: Cash Price |
$1,295.20
|
| Rate for Payer: Cash Price |
$1,295.20
|
| Rate for Payer: Cofinity Commercial |
$540.10
|
| Rate for Payer: Cofinity Commercial |
$502.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$375.07
|
| Rate for Payer: Healthscope Commercial |
$693.88
|
| Rate for Payer: Healthscope Commercial |
$600.11
|
| Rate for Payer: Mclaren Medicaid |
$247.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$393.82
|
| Rate for Payer: Meridian Medicaid |
$259.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$412.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$721.04
|
| Rate for Payer: Nomi Health Commercial |
$450.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,214.25
|
| Rate for Payer: PACE SWMI |
$375.07
|
| Rate for Payer: PHP Medicare Advantage |
$375.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$247.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$727.05
|
| Rate for Payer: Priority Health Medicare |
$375.07
|
| Rate for Payer: Priority Health SBD |
$727.05
|
| Rate for Payer: Priority Health Tiered Network |
$727.05
|
| Rate for Payer: Railroad Medicare Medicare |
$375.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$697.22
|
| Rate for Payer: UHC Core |
$697.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$375.07
|
| Rate for Payer: UHC Exchange |
$697.22
|
| Rate for Payer: UHC Medicaid |
$247.29
|
| Rate for Payer: UHCCP Medicaid |
$247.29
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Facility
|
OP
|
$2,322.00
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
64721
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,017.60 |
| Max. Negotiated Rate |
$6,292.24 |
| Rate for Payer: Aetna Commercial |
$1,973.70
|
| Rate for Payer: Aetna Medicare |
$2,023.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,509.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,432.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,432.12
|
| Rate for Payer: BCBS Complete |
$1,068.58
|
| Rate for Payer: BCBS MAPPO |
$1,945.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,469.90
|
| Rate for Payer: BCN Commercial |
$1,469.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,945.70
|
| Rate for Payer: Cash Price |
$1,857.60
|
| Rate for Payer: Cash Price |
$1,857.60
|
| Rate for Payer: Cash Price |
$1,857.60
|
| Rate for Payer: Cofinity Advantage |
$1,625.40
|
| Rate for Payer: Cofinity Commercial |
$1,996.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,857.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,945.70
|
| Rate for Payer: Healthscope Commercial |
$2,089.80
|
| Rate for Payer: Mclaren Medicaid |
$1,017.60
|
| Rate for Payer: Mclaren Medicare |
$1,945.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,042.98
|
| Rate for Payer: Meridian Medicaid |
$2,042.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,237.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,140.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,973.70
|
| Rate for Payer: Nomi Health Commercial |
$5,837.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,741.50
|
| Rate for Payer: PACE Medicare |
$1,848.41
|
| Rate for Payer: PACE SWMI |
$1,945.70
|
| Rate for Payer: PHP Commercial |
$1,973.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,945.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,017.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,292.24
|
| Rate for Payer: Priority Health Medicare |
$1,945.70
|
| Rate for Payer: Priority Health SBD |
$1,462.86
|
| Rate for Payer: Priority Health Tiered Network |
$5,033.79
|
| Rate for Payer: Railroad Medicare Medicare |
$1,945.70
|
| Rate for Payer: UHC Medicaid |
$1,017.60
|
| Rate for Payer: UHCCP Medicaid |
$1,017.60
|
| Rate for Payer: VA VA |
$1,945.70
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Facility
|
IP
|
$2,322.00
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
64721
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,462.86 |
| Max. Negotiated Rate |
$2,089.80 |
| Rate for Payer: Aetna Commercial |
$1,973.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,509.30
|
| Rate for Payer: Cash Price |
$1,857.60
|
| Rate for Payer: Cofinity Advantage |
$1,625.40
|
| Rate for Payer: Cofinity Commercial |
$1,996.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,857.60
|
| Rate for Payer: Healthscope Commercial |
$2,089.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,973.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,741.50
|
| Rate for Payer: PHP Commercial |
$1,973.70
|
| Rate for Payer: Priority Health SBD |
$1,462.86
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Professional
|
Both
|
$2,322.00
|
|
|
Service Code
|
HCPCS 64721
|
| Hospital Charge Code |
64721
|
| Min. Negotiated Rate |
$269.87 |
| Max. Negotiated Rate |
$1,741.50 |
| Rate for Payer: Aetna Commercial |
$546.20
|
| Rate for Payer: Aetna Medicare |
$423.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.96
|
| Rate for Payer: BCBS Complete |
$283.36
|
| Rate for Payer: BCBS MAPPO |
$407.61
|
| Rate for Payer: BCN Commercial |
$671.78
|
| Rate for Payer: BCN Medicare Advantage |
$407.61
|
| Rate for Payer: Cash Price |
$1,857.60
|
| Rate for Payer: Cash Price |
$1,857.60
|
| Rate for Payer: Cofinity Commercial |
$586.96
|
| Rate for Payer: Cofinity Commercial |
$546.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.61
|
| Rate for Payer: Healthscope Commercial |
$754.08
|
| Rate for Payer: Healthscope Commercial |
$652.18
|
| Rate for Payer: Mclaren Medicaid |
$269.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.99
|
| Rate for Payer: Meridian Medicaid |
$283.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$448.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$770.24
|
| Rate for Payer: Nomi Health Commercial |
$489.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,741.50
|
| Rate for Payer: PACE SWMI |
$407.61
|
| Rate for Payer: PHP Medicare Advantage |
$407.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$269.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$780.25
|
| Rate for Payer: Priority Health Medicare |
$407.61
|
| Rate for Payer: Priority Health SBD |
$780.25
|
| Rate for Payer: Priority Health Tiered Network |
$780.25
|
| Rate for Payer: Railroad Medicare Medicare |
$407.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$742.35
|
| Rate for Payer: UHC Core |
$742.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$407.61
|
| Rate for Payer: UHC Exchange |
$742.35
|
| Rate for Payer: UHC Medicaid |
$269.87
|
| Rate for Payer: UHCCP Medicaid |
$269.87
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Professional
|
Both
|
$2,322.00
|
|
|
Service Code
|
HCPCS 64721
|
| Min. Negotiated Rate |
$269.87 |
| Max. Negotiated Rate |
$1,741.50 |
| Rate for Payer: Aetna Commercial |
$546.20
|
| Rate for Payer: Aetna Medicare |
$423.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.96
|
| Rate for Payer: BCBS Complete |
$283.36
|
| Rate for Payer: BCBS MAPPO |
$407.61
|
| Rate for Payer: BCN Commercial |
$671.78
|
| Rate for Payer: BCN Medicare Advantage |
$407.61
|
| Rate for Payer: Cash Price |
$1,857.60
|
| Rate for Payer: Cash Price |
$1,857.60
|
| Rate for Payer: Cofinity Commercial |
$586.96
|
| Rate for Payer: Cofinity Commercial |
$546.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.61
|
| Rate for Payer: Healthscope Commercial |
$754.08
|
| Rate for Payer: Healthscope Commercial |
$652.18
|
| Rate for Payer: Mclaren Medicaid |
$269.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.99
|
| Rate for Payer: Meridian Medicaid |
$283.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$448.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$770.24
|
| Rate for Payer: Nomi Health Commercial |
$489.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,741.50
|
| Rate for Payer: PACE SWMI |
$407.61
|
| Rate for Payer: PHP Medicare Advantage |
$407.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$269.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$780.25
|
| Rate for Payer: Priority Health Medicare |
$407.61
|
| Rate for Payer: Priority Health SBD |
$780.25
|
| Rate for Payer: Priority Health Tiered Network |
$780.25
|
| Rate for Payer: Railroad Medicare Medicare |
$407.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$742.35
|
| Rate for Payer: UHC Core |
$742.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$407.61
|
| Rate for Payer: UHC Exchange |
$742.35
|
| Rate for Payer: UHC Medicaid |
$269.87
|
| Rate for Payer: UHCCP Medicaid |
$269.87
|
|
|
PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 96132
|
| Min. Negotiated Rate |
$62.84 |
| Max. Negotiated Rate |
$205.50 |
| Rate for Payer: Aetna Commercial |
$131.19
|
| Rate for Payer: Aetna Medicare |
$101.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.98
|
| Rate for Payer: BCBS Complete |
$65.98
|
| Rate for Payer: BCBS MAPPO |
$97.90
|
| Rate for Payer: BCN Commercial |
$192.72
|
| Rate for Payer: BCN Medicare Advantage |
$97.90
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$131.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.90
|
| Rate for Payer: Healthscope Commercial |
$181.12
|
| Rate for Payer: Healthscope Commercial |
$156.64
|
| Rate for Payer: Mclaren Medicaid |
$62.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.80
|
| Rate for Payer: Meridian Medicaid |
$65.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$107.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.37
|
| Rate for Payer: Nomi Health Commercial |
$117.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.50
|
| Rate for Payer: PACE SWMI |
$97.90
|
| Rate for Payer: PHP Medicare Advantage |
$97.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$146.04
|
| Rate for Payer: Priority Health Medicare |
$97.90
|
| Rate for Payer: Priority Health SBD |
$146.04
|
| Rate for Payer: Priority Health Tiered Network |
$146.04
|
| Rate for Payer: Railroad Medicare Medicare |
$97.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.70
|
| Rate for Payer: UHC Core |
$174.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$97.90
|
| Rate for Payer: UHC Exchange |
$174.70
|
| Rate for Payer: UHC Medicaid |
$62.84
|
| Rate for Payer: UHCCP Medicaid |
$62.84
|
|
|
PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 96133
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Aetna Commercial |
$94.04
|
| Rate for Payer: Aetna Medicare |
$72.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.04
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS MAPPO |
$70.18
|
| Rate for Payer: BCN Commercial |
$143.92
|
| Rate for Payer: BCN Medicare Advantage |
$70.18
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$94.04
|
| Rate for Payer: Cofinity Commercial |
$101.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$129.83
|
| Rate for Payer: Healthscope Commercial |
$112.29
|
| Rate for Payer: Mclaren Medicaid |
$44.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.69
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.85
|
| Rate for Payer: Nomi Health Commercial |
$84.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.75
|
| Rate for Payer: PACE SWMI |
$70.18
|
| Rate for Payer: PHP Medicare Advantage |
$70.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$103.33
|
| Rate for Payer: Priority Health Medicare |
$70.18
|
| Rate for Payer: Priority Health SBD |
$103.33
|
| Rate for Payer: Priority Health Tiered Network |
$103.33
|
| Rate for Payer: Railroad Medicare Medicare |
$70.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.48
|
| Rate for Payer: UHC Core |
$134.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.18
|
| Rate for Payer: UHC Exchange |
$134.48
|
| Rate for Payer: UHC Medicaid |
$44.94
|
| Rate for Payer: UHCCP Medicaid |
$44.94
|
|
|
PR NEUROPSYCH TESTING BY COMPUTER
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 96120
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$132.75 |
| Rate for Payer: Aetna Medicare |
$88.50
|
| Rate for Payer: BCBS Complete |
$70.80
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.75
|
|
|
PR NEUROPSYCH TESTING BY PSYCH/PHYS
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 96118
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$172.50 |
| Rate for Payer: Aetna Medicare |
$115.00
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.50
|
|
|
PR NEUROPSYCH TESTING BY TECHNICIAN
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 96119
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$96.75 |
| Rate for Payer: Aetna Medicare |
$64.50
|
| Rate for Payer: BCBS Complete |
$51.60
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.75
|
|
|
PR NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC
|
Professional
|
Both
|
$2,725.00
|
|
|
Service Code
|
HCPCS 64708
|
| Min. Negotiated Rate |
$296.07 |
| Max. Negotiated Rate |
$2,043.75 |
| Rate for Payer: Aetna Commercial |
$600.36
|
| Rate for Payer: Aetna Medicare |
$465.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$600.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$645.16
|
| Rate for Payer: BCBS Complete |
$310.87
|
| Rate for Payer: BCBS MAPPO |
$448.03
|
| Rate for Payer: BCN Commercial |
$772.37
|
| Rate for Payer: BCN Medicare Advantage |
$448.03
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cofinity Commercial |
$645.16
|
| Rate for Payer: Cofinity Commercial |
$600.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$448.03
|
| Rate for Payer: Healthscope Commercial |
$828.86
|
| Rate for Payer: Healthscope Commercial |
$716.85
|
| Rate for Payer: Mclaren Medicaid |
$296.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$470.43
|
| Rate for Payer: Meridian Medicaid |
$310.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$492.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$882.61
|
| Rate for Payer: Nomi Health Commercial |
$537.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,043.75
|
| Rate for Payer: PACE SWMI |
$448.03
|
| Rate for Payer: PHP Medicare Advantage |
$448.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$296.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$897.08
|
| Rate for Payer: Priority Health Medicare |
$448.03
|
| Rate for Payer: Priority Health SBD |
$897.08
|
| Rate for Payer: Priority Health Tiered Network |
$897.08
|
| Rate for Payer: Railroad Medicare Medicare |
$448.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$873.95
|
| Rate for Payer: UHC Core |
$873.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$448.03
|
| Rate for Payer: UHC Exchange |
$873.95
|
| Rate for Payer: UHC Medicaid |
$296.07
|
| Rate for Payer: UHCCP Medicaid |
$296.07
|
|
|
PR NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS
|
Professional
|
Both
|
$2,857.00
|
|
|
Service Code
|
HCPCS 64713
|
| Min. Negotiated Rate |
$475.20 |
| Max. Negotiated Rate |
$2,142.75 |
| Rate for Payer: Aetna Commercial |
$979.90
|
| Rate for Payer: Aetna Medicare |
$760.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,053.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.90
|
| Rate for Payer: BCBS Complete |
$498.96
|
| Rate for Payer: BCBS MAPPO |
$731.27
|
| Rate for Payer: BCN Commercial |
$1,215.57
|
| Rate for Payer: BCN Medicare Advantage |
$731.27
|
| Rate for Payer: Cash Price |
$2,285.60
|
| Rate for Payer: Cash Price |
$2,285.60
|
| Rate for Payer: Cofinity Commercial |
$979.90
|
| Rate for Payer: Cofinity Commercial |
$1,053.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$731.27
|
| Rate for Payer: Healthscope Commercial |
$1,352.85
|
| Rate for Payer: Healthscope Commercial |
$1,170.03
|
| Rate for Payer: Mclaren Medicaid |
$475.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$767.83
|
| Rate for Payer: Meridian Medicaid |
$498.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$804.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,417.09
|
| Rate for Payer: Nomi Health Commercial |
$877.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,142.75
|
| Rate for Payer: PACE SWMI |
$731.27
|
| Rate for Payer: PHP Medicare Advantage |
$731.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$475.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,411.87
|
| Rate for Payer: Priority Health Medicare |
$731.27
|
| Rate for Payer: Priority Health SBD |
$1,411.87
|
| Rate for Payer: Priority Health Tiered Network |
$1,411.87
|
| Rate for Payer: Railroad Medicare Medicare |
$731.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,370.18
|
| Rate for Payer: UHC Core |
$1,370.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$731.27
|
| Rate for Payer: UHC Exchange |
$1,370.18
|
| Rate for Payer: UHC Medicaid |
$475.20
|
| Rate for Payer: UHCCP Medicaid |
$475.20
|
|
|
PR NEURP MAJOR PRPH NRV OPN ARM/LEG LMBR PLEXUS
|
Professional
|
Both
|
$3,510.00
|
|
|
Service Code
|
HCPCS 64714
|
| Min. Negotiated Rate |
$456.46 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Aetna Commercial |
$939.07
|
| Rate for Payer: Aetna Medicare |
$728.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,009.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$939.07
|
| Rate for Payer: BCBS Complete |
$479.28
|
| Rate for Payer: BCBS MAPPO |
$700.80
|
| Rate for Payer: BCN Commercial |
$1,166.77
|
| Rate for Payer: BCN Medicare Advantage |
$700.80
|
| Rate for Payer: Cash Price |
$2,808.00
|
| Rate for Payer: Cash Price |
$2,808.00
|
| Rate for Payer: Cofinity Commercial |
$939.07
|
| Rate for Payer: Cofinity Commercial |
$1,009.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$700.80
|
| Rate for Payer: Healthscope Commercial |
$1,296.48
|
| Rate for Payer: Healthscope Commercial |
$1,121.28
|
| Rate for Payer: Mclaren Medicaid |
$456.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$735.84
|
| Rate for Payer: Meridian Medicaid |
$479.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$770.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,348.94
|
| Rate for Payer: Nomi Health Commercial |
$840.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,632.50
|
| Rate for Payer: PACE SWMI |
$700.80
|
| Rate for Payer: PHP Medicare Advantage |
$700.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$456.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,355.18
|
| Rate for Payer: Priority Health Medicare |
$700.80
|
| Rate for Payer: Priority Health SBD |
$1,355.18
|
| Rate for Payer: Priority Health Tiered Network |
$1,355.18
|
| Rate for Payer: Railroad Medicare Medicare |
$700.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,281.11
|
| Rate for Payer: UHC Core |
$1,281.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$700.80
|
| Rate for Payer: UHC Exchange |
$1,281.11
|
| Rate for Payer: UHC Medicaid |
$456.46
|
| Rate for Payer: UHCCP Medicaid |
$456.46
|
|
|
PR NEURP MAJOR PRPH NRV OPN ARM/LEG SCIATIC NRV
|
Professional
|
Both
|
$1,027.00
|
|
|
Service Code
|
HCPCS 64712
|
| Min. Negotiated Rate |
$355.50 |
| Max. Negotiated Rate |
$1,053.77 |
| Rate for Payer: Aetna Commercial |
$728.89
|
| Rate for Payer: Aetna Medicare |
$565.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$728.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$783.29
|
| Rate for Payer: BCBS Complete |
$373.27
|
| Rate for Payer: BCBS MAPPO |
$543.95
|
| Rate for Payer: BCN Commercial |
$904.83
|
| Rate for Payer: BCN Medicare Advantage |
$543.95
|
| Rate for Payer: Cash Price |
$821.60
|
| Rate for Payer: Cash Price |
$821.60
|
| Rate for Payer: Cofinity Commercial |
$783.29
|
| Rate for Payer: Cofinity Commercial |
$728.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$543.95
|
| Rate for Payer: Healthscope Commercial |
$870.32
|
| Rate for Payer: Healthscope Commercial |
$1,006.31
|
| Rate for Payer: Mclaren Medicaid |
$355.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$571.15
|
| Rate for Payer: Meridian Medicaid |
$373.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$598.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.77
|
| Rate for Payer: Nomi Health Commercial |
$652.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$770.25
|
| Rate for Payer: PACE SWMI |
$543.95
|
| Rate for Payer: PHP Medicare Advantage |
$543.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$355.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,050.95
|
| Rate for Payer: Priority Health Medicare |
$543.95
|
| Rate for Payer: Priority Health SBD |
$1,050.95
|
| Rate for Payer: Priority Health Tiered Network |
$1,050.95
|
| Rate for Payer: Railroad Medicare Medicare |
$543.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,025.33
|
| Rate for Payer: UHC Core |
$1,025.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$543.95
|
| Rate for Payer: UHC Exchange |
$1,025.33
|
| Rate for Payer: UHC Medicaid |
$355.50
|
| Rate for Payer: UHCCP Medicaid |
$355.50
|
|
|
PR N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
HCPCS 93924
|
| Min. Negotiated Rate |
$153.02 |
| Max. Negotiated Rate |
$283.09 |
| Rate for Payer: Aetna Commercial |
$205.05
|
| Rate for Payer: Aetna Medicare |
$159.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.05
|
| Rate for Payer: BCBS MAPPO |
$153.02
|
| Rate for Payer: BCN Commercial |
$237.54
|
| Rate for Payer: BCN Medicare Advantage |
$153.02
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$220.35
|
| Rate for Payer: Cofinity Commercial |
$205.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.02
|
| Rate for Payer: Healthscope Commercial |
$244.83
|
| Rate for Payer: Healthscope Commercial |
$283.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$168.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.67
|
| Rate for Payer: Nomi Health Commercial |
$183.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.75
|
| Rate for Payer: PACE SWMI |
$153.02
|
| Rate for Payer: PHP Medicare Advantage |
$153.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$219.06
|
| Rate for Payer: Priority Health Medicare |
$153.02
|
| Rate for Payer: Priority Health SBD |
$219.06
|
| Rate for Payer: Priority Health Tiered Network |
$219.06
|
| Rate for Payer: Railroad Medicare Medicare |
$153.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.44
|
| Rate for Payer: UHC Core |
$248.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$153.02
|
| Rate for Payer: UHC Exchange |
$248.44
|
|
|
PR NIPPLE/AREOLA RECONSTRUCTION
|
Professional
|
Both
|
$1,576.00
|
|
|
Service Code
|
HCPCS 19350
|
| Min. Negotiated Rate |
$392.77 |
| Max. Negotiated Rate |
$1,187.53 |
| Rate for Payer: Aetna Commercial |
$804.24
|
| Rate for Payer: Aetna Medicare |
$624.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$804.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.26
|
| Rate for Payer: BCBS Complete |
$412.41
|
| Rate for Payer: BCBS MAPPO |
$600.18
|
| Rate for Payer: BCN Commercial |
$1,020.86
|
| Rate for Payer: BCN Medicare Advantage |
$600.18
|
| Rate for Payer: Cash Price |
$1,260.80
|
| Rate for Payer: Cash Price |
$1,260.80
|
| Rate for Payer: Cofinity Commercial |
$864.26
|
| Rate for Payer: Cofinity Commercial |
$804.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$600.18
|
| Rate for Payer: Healthscope Commercial |
$960.29
|
| Rate for Payer: Healthscope Commercial |
$1,110.33
|
| Rate for Payer: Mclaren Medicaid |
$392.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$630.19
|
| Rate for Payer: Meridian Medicaid |
$412.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$660.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,187.53
|
| Rate for Payer: Nomi Health Commercial |
$720.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.00
|
| Rate for Payer: PACE SWMI |
$600.18
|
| Rate for Payer: PHP Medicare Advantage |
$600.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$392.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$934.35
|
| Rate for Payer: Priority Health Medicare |
$600.18
|
| Rate for Payer: Priority Health SBD |
$934.35
|
| Rate for Payer: Priority Health Tiered Network |
$934.35
|
| Rate for Payer: Railroad Medicare Medicare |
$600.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,173.53
|
| Rate for Payer: UHC Core |
$1,173.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$600.18
|
| Rate for Payer: UHC Exchange |
$1,173.53
|
| Rate for Payer: UHC Medicaid |
$392.77
|
| Rate for Payer: UHCCP Medicaid |
$392.77
|
|
|
PR NIPPLE EXPLORATION
|
Professional
|
Both
|
$791.00
|
|
|
Service Code
|
HCPCS 19110
|
| Min. Negotiated Rate |
$226.85 |
| Max. Negotiated Rate |
$639.19 |
| Rate for Payer: Aetna Commercial |
$462.98
|
| Rate for Payer: Aetna Medicare |
$359.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.53
|
| Rate for Payer: BCBS Complete |
$238.19
|
| Rate for Payer: BCBS MAPPO |
$345.51
|
| Rate for Payer: BCN Commercial |
$537.33
|
| Rate for Payer: BCN Medicare Advantage |
$345.51
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Cofinity Commercial |
$497.53
|
| Rate for Payer: Cofinity Commercial |
$462.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.51
|
| Rate for Payer: Healthscope Commercial |
$639.19
|
| Rate for Payer: Healthscope Commercial |
$552.82
|
| Rate for Payer: Mclaren Medicaid |
$226.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.79
|
| Rate for Payer: Meridian Medicaid |
$238.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$380.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.65
|
| Rate for Payer: Nomi Health Commercial |
$414.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.25
|
| Rate for Payer: PACE SWMI |
$345.51
|
| Rate for Payer: PHP Medicare Advantage |
$345.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$226.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$491.79
|
| Rate for Payer: Priority Health Medicare |
$345.51
|
| Rate for Payer: Priority Health SBD |
$491.79
|
| Rate for Payer: Priority Health Tiered Network |
$491.79
|
| Rate for Payer: Railroad Medicare Medicare |
$345.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.39
|
| Rate for Payer: UHC Core |
$604.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$345.51
|
| Rate for Payer: UHC Exchange |
$604.39
|
| Rate for Payer: UHC Medicaid |
$226.85
|
| Rate for Payer: UHCCP Medicaid |
$226.85
|
|
|
PR NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 95012
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$33.41 |
| Rate for Payer: Aetna Commercial |
$24.20
|
| Rate for Payer: Aetna Medicare |
$18.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.20
|
| Rate for Payer: BCBS MAPPO |
$18.06
|
| Rate for Payer: BCN Commercial |
$27.89
|
| Rate for Payer: BCN Medicare Advantage |
$18.06
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$26.01
|
| Rate for Payer: Cofinity Commercial |
$24.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$28.90
|
| Rate for Payer: Healthscope Commercial |
$33.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$21.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: PACE SWMI |
$18.06
|
| Rate for Payer: PHP Medicare Advantage |
$18.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.24
|
| Rate for Payer: Priority Health Medicare |
$18.06
|
| Rate for Payer: Priority Health SBD |
$26.24
|
| Rate for Payer: Priority Health Tiered Network |
$26.24
|
| Rate for Payer: Railroad Medicare Medicare |
$18.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.82
|
| Rate for Payer: UHC Core |
$29.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.06
|
| Rate for Payer: UHC Exchange |
$29.82
|
|
