|
PR NEPHRECTOMY W/TOT URETERECT&BLDR CUFF SAME INC
|
Professional
|
Both
|
$2,488.00
|
|
|
Service Code
|
HCPCS 50234
|
| Min. Negotiated Rate |
$995.20 |
| Max. Negotiated Rate |
$2,297.57 |
| Rate for Payer: Aetna Commercial |
$1,664.19
|
| Rate for Payer: Aetna Medicare |
$1,291.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,788.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,664.19
|
| Rate for Payer: BCBS Complete |
$995.20
|
| Rate for Payer: BCBS MAPPO |
$1,241.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,241.93
|
| Rate for Payer: Cash Price |
$1,990.40
|
| Rate for Payer: Cash Price |
$1,990.40
|
| Rate for Payer: Cofinity Commercial |
$1,788.38
|
| Rate for Payer: Cofinity Commercial |
$1,664.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,241.93
|
| Rate for Payer: Healthscope Commercial |
$1,987.09
|
| Rate for Payer: Healthscope Commercial |
$2,297.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,304.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,617.20
|
| Rate for Payer: Nomi Health Commercial |
$1,490.32
|
| Rate for Payer: PACE SWMI |
$1,241.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,241.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,617.20
|
| Rate for Payer: Priority Health Medicare |
$1,241.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,241.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,241.93
|
|
|
PR NEPHROLITHOTOMY REMOVAL CALCULUS
|
Professional
|
Both
|
$2,064.00
|
|
|
Service Code
|
HCPCS 50060
|
| Min. Negotiated Rate |
$825.60 |
| Max. Negotiated Rate |
$2,008.27 |
| Rate for Payer: Aetna Commercial |
$1,454.64
|
| Rate for Payer: Aetna Medicare |
$1,128.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,563.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,454.64
|
| Rate for Payer: BCBS Complete |
$825.60
|
| Rate for Payer: BCBS MAPPO |
$1,085.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,085.55
|
| Rate for Payer: Cash Price |
$1,651.20
|
| Rate for Payer: Cash Price |
$1,651.20
|
| Rate for Payer: Cofinity Commercial |
$1,563.19
|
| Rate for Payer: Cofinity Commercial |
$1,454.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,085.55
|
| Rate for Payer: Healthscope Commercial |
$2,008.27
|
| Rate for Payer: Healthscope Commercial |
$1,736.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,139.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,341.60
|
| Rate for Payer: Nomi Health Commercial |
$1,302.66
|
| Rate for Payer: PACE SWMI |
$1,085.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,085.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,341.60
|
| Rate for Payer: Priority Health Medicare |
$1,085.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,085.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,085.55
|
|
|
PR NEPHROLITHOTOMY RMVL LARGE STAGHORN CALCULUS
|
Professional
|
Both
|
$3,414.00
|
|
|
Service Code
|
HCPCS 50075
|
| Min. Negotiated Rate |
$1,365.60 |
| Max. Negotiated Rate |
$2,566.95 |
| Rate for Payer: Aetna Commercial |
$1,859.30
|
| Rate for Payer: Aetna Medicare |
$1,443.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,998.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,859.30
|
| Rate for Payer: BCBS Complete |
$1,365.60
|
| Rate for Payer: BCBS MAPPO |
$1,387.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,387.54
|
| Rate for Payer: Cash Price |
$2,731.20
|
| Rate for Payer: Cash Price |
$2,731.20
|
| Rate for Payer: Cofinity Commercial |
$1,998.06
|
| Rate for Payer: Cofinity Commercial |
$1,859.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,387.54
|
| Rate for Payer: Healthscope Commercial |
$2,220.06
|
| Rate for Payer: Healthscope Commercial |
$2,566.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,456.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,219.10
|
| Rate for Payer: Nomi Health Commercial |
$1,665.05
|
| Rate for Payer: PACE SWMI |
$1,387.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,387.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,219.10
|
| Rate for Payer: Priority Health Medicare |
$1,387.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,387.54
|
| Rate for Payer: UHC Medicare Advantage |
$1,387.54
|
|
|
PR NEPHRORRHAPHY SUTURE KIDNEY WOUND/INJURY
|
Professional
|
Both
|
$2,305.00
|
|
|
Service Code
|
HCPCS 50500
|
| Min. Negotiated Rate |
$922.00 |
| Max. Negotiated Rate |
$2,318.31 |
| Rate for Payer: Aetna Commercial |
$1,679.21
|
| Rate for Payer: Aetna Medicare |
$1,303.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,804.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,679.21
|
| Rate for Payer: BCBS Complete |
$922.00
|
| Rate for Payer: BCBS MAPPO |
$1,253.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,253.14
|
| Rate for Payer: Cash Price |
$1,844.00
|
| Rate for Payer: Cash Price |
$1,844.00
|
| Rate for Payer: Cofinity Commercial |
$1,804.52
|
| Rate for Payer: Cofinity Commercial |
$1,679.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,253.14
|
| Rate for Payer: Healthscope Commercial |
$2,318.31
|
| Rate for Payer: Healthscope Commercial |
$2,005.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,315.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,498.25
|
| Rate for Payer: Nomi Health Commercial |
$1,503.77
|
| Rate for Payer: PACE SWMI |
$1,253.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,253.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,498.25
|
| Rate for Payer: Priority Health Medicare |
$1,253.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,253.14
|
| Rate for Payer: UHC Medicare Advantage |
$1,253.14
|
|
|
PR NEPHROSTOMY NEPHROTOMY W/DRAINAGE
|
Professional
|
Both
|
$1,765.00
|
|
|
Service Code
|
HCPCS 50040
|
| Min. Negotiated Rate |
$706.00 |
| Max. Negotiated Rate |
$1,634.94 |
| Rate for Payer: Aetna Commercial |
$1,184.22
|
| Rate for Payer: Aetna Medicare |
$919.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,272.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,184.22
|
| Rate for Payer: BCBS Complete |
$706.00
|
| Rate for Payer: BCBS MAPPO |
$883.75
|
| Rate for Payer: BCN Medicare Advantage |
$883.75
|
| Rate for Payer: Cash Price |
$1,412.00
|
| Rate for Payer: Cash Price |
$1,412.00
|
| Rate for Payer: Cofinity Commercial |
$1,272.60
|
| Rate for Payer: Cofinity Commercial |
$1,184.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$883.75
|
| Rate for Payer: Healthscope Commercial |
$1,414.00
|
| Rate for Payer: Healthscope Commercial |
$1,634.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$927.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,147.25
|
| Rate for Payer: Nomi Health Commercial |
$1,060.50
|
| Rate for Payer: PACE SWMI |
$883.75
|
| Rate for Payer: PHP Medicare Advantage |
$883.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,147.25
|
| Rate for Payer: Priority Health Medicare |
$883.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$883.75
|
| Rate for Payer: UHC Medicare Advantage |
$883.75
|
|
|
PR NERVE CONDUCTION STUDIES 11-12 STUDIES
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
HCPCS 95912
|
| Min. Negotiated Rate |
$212.80 |
| Max. Negotiated Rate |
$414.10 |
| Rate for Payer: Aetna Commercial |
$299.95
|
| Rate for Payer: Aetna Commercial |
$299.95
|
| Rate for Payer: Aetna Medicare |
$232.79
|
| Rate for Payer: Aetna Medicare |
$232.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.33
|
| Rate for Payer: BCBS Complete |
$212.80
|
| Rate for Payer: BCBS Complete |
$127.60
|
| Rate for Payer: BCBS MAPPO |
$223.84
|
| Rate for Payer: BCBS MAPPO |
$223.84
|
| Rate for Payer: BCN Medicare Advantage |
$223.84
|
| Rate for Payer: BCN Medicare Advantage |
$223.84
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cofinity Commercial |
$299.95
|
| Rate for Payer: Cofinity Commercial |
$322.33
|
| Rate for Payer: Cofinity Commercial |
$299.95
|
| Rate for Payer: Cofinity Commercial |
$322.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.84
|
| Rate for Payer: Healthscope Commercial |
$414.10
|
| Rate for Payer: Healthscope Commercial |
$414.10
|
| Rate for Payer: Healthscope Commercial |
$358.14
|
| Rate for Payer: Healthscope Commercial |
$358.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$235.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.35
|
| Rate for Payer: Nomi Health Commercial |
$268.61
|
| Rate for Payer: Nomi Health Commercial |
$268.61
|
| Rate for Payer: PACE SWMI |
$223.84
|
| Rate for Payer: PACE SWMI |
$223.84
|
| Rate for Payer: PHP Medicare Advantage |
$223.84
|
| Rate for Payer: PHP Medicare Advantage |
$223.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health Medicare |
$223.84
|
| Rate for Payer: Priority Health Medicare |
$223.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.84
|
| Rate for Payer: UHC Medicare Advantage |
$223.84
|
| Rate for Payer: UHC Medicare Advantage |
$223.84
|
|
|
PR NERVE CONDUCTION STUDIES 1-2 STUDIES
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 95907
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$150.57 |
| Rate for Payer: Aetna Commercial |
$109.06
|
| Rate for Payer: Aetna Commercial |
$109.06
|
| Rate for Payer: Aetna Medicare |
$84.65
|
| Rate for Payer: Aetna Medicare |
$84.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.20
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: BCBS Complete |
$68.00
|
| Rate for Payer: BCBS MAPPO |
$81.39
|
| Rate for Payer: BCBS MAPPO |
$81.39
|
| Rate for Payer: BCN Medicare Advantage |
$81.39
|
| Rate for Payer: BCN Medicare Advantage |
$81.39
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$109.06
|
| Rate for Payer: Cofinity Commercial |
$117.20
|
| Rate for Payer: Cofinity Commercial |
$109.06
|
| Rate for Payer: Cofinity Commercial |
$117.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.39
|
| Rate for Payer: Healthscope Commercial |
$150.57
|
| Rate for Payer: Healthscope Commercial |
$150.57
|
| Rate for Payer: Healthscope Commercial |
$130.22
|
| Rate for Payer: Healthscope Commercial |
$130.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.50
|
| Rate for Payer: Nomi Health Commercial |
$97.67
|
| Rate for Payer: Nomi Health Commercial |
$97.67
|
| Rate for Payer: PACE SWMI |
$81.39
|
| Rate for Payer: PACE SWMI |
$81.39
|
| Rate for Payer: PHP Medicare Advantage |
$81.39
|
| Rate for Payer: PHP Medicare Advantage |
$81.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health Medicare |
$81.39
|
| Rate for Payer: Priority Health Medicare |
$81.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.39
|
| Rate for Payer: UHC Medicare Advantage |
$81.39
|
| Rate for Payer: UHC Medicare Advantage |
$81.39
|
|
|
PR NERVE CONDUCTION STUDIES 13/> STUDIES
|
Professional
|
Both
|
$877.00
|
|
|
Service Code
|
HCPCS 95913
|
| Min. Negotiated Rate |
$262.16 |
| Max. Negotiated Rate |
$570.05 |
| Rate for Payer: Aetna Commercial |
$351.29
|
| Rate for Payer: Aetna Commercial |
$351.29
|
| Rate for Payer: Aetna Medicare |
$272.65
|
| Rate for Payer: Aetna Medicare |
$272.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.51
|
| Rate for Payer: BCBS Complete |
$350.80
|
| Rate for Payer: BCBS Complete |
$213.60
|
| Rate for Payer: BCBS MAPPO |
$262.16
|
| Rate for Payer: BCBS MAPPO |
$262.16
|
| Rate for Payer: BCN Medicare Advantage |
$262.16
|
| Rate for Payer: BCN Medicare Advantage |
$262.16
|
| Rate for Payer: Cash Price |
$701.60
|
| Rate for Payer: Cash Price |
$701.60
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cofinity Commercial |
$351.29
|
| Rate for Payer: Cofinity Commercial |
$377.51
|
| Rate for Payer: Cofinity Commercial |
$351.29
|
| Rate for Payer: Cofinity Commercial |
$377.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.16
|
| Rate for Payer: Healthscope Commercial |
$485.00
|
| Rate for Payer: Healthscope Commercial |
$485.00
|
| Rate for Payer: Healthscope Commercial |
$419.46
|
| Rate for Payer: Healthscope Commercial |
$419.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$275.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$275.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.10
|
| Rate for Payer: Nomi Health Commercial |
$314.59
|
| Rate for Payer: Nomi Health Commercial |
$314.59
|
| Rate for Payer: PACE SWMI |
$262.16
|
| Rate for Payer: PACE SWMI |
$262.16
|
| Rate for Payer: PHP Medicare Advantage |
$262.16
|
| Rate for Payer: PHP Medicare Advantage |
$262.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.05
|
| Rate for Payer: Priority Health Medicare |
$262.16
|
| Rate for Payer: Priority Health Medicare |
$262.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$262.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$262.16
|
| Rate for Payer: UHC Medicare Advantage |
$262.16
|
| Rate for Payer: UHC Medicare Advantage |
$262.16
|
|
|
PR NERVE CONDUCTION STUDIES 3-4 STUDIES
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
HCPCS 95908
|
| Min. Negotiated Rate |
$101.27 |
| Max. Negotiated Rate |
$220.35 |
| Rate for Payer: Aetna Commercial |
$135.70
|
| Rate for Payer: Aetna Commercial |
$135.70
|
| Rate for Payer: Aetna Medicare |
$105.32
|
| Rate for Payer: Aetna Medicare |
$105.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.83
|
| Rate for Payer: BCBS Complete |
$135.60
|
| Rate for Payer: BCBS Complete |
$87.20
|
| Rate for Payer: BCBS MAPPO |
$101.27
|
| Rate for Payer: BCBS MAPPO |
$101.27
|
| Rate for Payer: BCN Medicare Advantage |
$101.27
|
| Rate for Payer: BCN Medicare Advantage |
$101.27
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cofinity Commercial |
$135.70
|
| Rate for Payer: Cofinity Commercial |
$145.83
|
| Rate for Payer: Cofinity Commercial |
$135.70
|
| Rate for Payer: Cofinity Commercial |
$145.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.27
|
| Rate for Payer: Healthscope Commercial |
$187.35
|
| Rate for Payer: Healthscope Commercial |
$187.35
|
| Rate for Payer: Healthscope Commercial |
$162.03
|
| Rate for Payer: Healthscope Commercial |
$162.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.70
|
| Rate for Payer: Nomi Health Commercial |
$121.52
|
| Rate for Payer: Nomi Health Commercial |
$121.52
|
| Rate for Payer: PACE SWMI |
$101.27
|
| Rate for Payer: PACE SWMI |
$101.27
|
| Rate for Payer: PHP Medicare Advantage |
$101.27
|
| Rate for Payer: PHP Medicare Advantage |
$101.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health Medicare |
$101.27
|
| Rate for Payer: Priority Health Medicare |
$101.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.27
|
| Rate for Payer: UHC Medicare Advantage |
$101.27
|
| Rate for Payer: UHC Medicare Advantage |
$101.27
|
|
|
PR NERVE CONDUCTION STUDIES 5-6 STUDIES
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 95909
|
| Min. Negotiated Rate |
$121.81 |
| Max. Negotiated Rate |
$263.90 |
| Rate for Payer: Aetna Commercial |
$163.23
|
| Rate for Payer: Aetna Commercial |
$163.23
|
| Rate for Payer: Aetna Medicare |
$126.68
|
| Rate for Payer: Aetna Medicare |
$126.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.41
|
| Rate for Payer: BCBS Complete |
$162.40
|
| Rate for Payer: BCBS Complete |
$107.60
|
| Rate for Payer: BCBS MAPPO |
$121.81
|
| Rate for Payer: BCBS MAPPO |
$121.81
|
| Rate for Payer: BCN Medicare Advantage |
$121.81
|
| Rate for Payer: BCN Medicare Advantage |
$121.81
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cofinity Commercial |
$163.23
|
| Rate for Payer: Cofinity Commercial |
$175.41
|
| Rate for Payer: Cofinity Commercial |
$163.23
|
| Rate for Payer: Cofinity Commercial |
$175.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.81
|
| Rate for Payer: Healthscope Commercial |
$225.35
|
| Rate for Payer: Healthscope Commercial |
$225.35
|
| Rate for Payer: Healthscope Commercial |
$194.90
|
| Rate for Payer: Healthscope Commercial |
$194.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.85
|
| Rate for Payer: Nomi Health Commercial |
$146.17
|
| Rate for Payer: Nomi Health Commercial |
$146.17
|
| Rate for Payer: PACE SWMI |
$121.81
|
| Rate for Payer: PACE SWMI |
$121.81
|
| Rate for Payer: PHP Medicare Advantage |
$121.81
|
| Rate for Payer: PHP Medicare Advantage |
$121.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.90
|
| Rate for Payer: Priority Health Medicare |
$121.81
|
| Rate for Payer: Priority Health Medicare |
$121.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.81
|
| Rate for Payer: UHC Medicare Advantage |
$121.81
|
| Rate for Payer: UHC Medicare Advantage |
$121.81
|
|
|
PR NERVE CONDUCTION STUDIES 7-8 STUDIES
|
Professional
|
Both
|
$534.00
|
|
|
Service Code
|
HCPCS 95910
|
| Min. Negotiated Rate |
$159.37 |
| Max. Negotiated Rate |
$347.10 |
| Rate for Payer: Aetna Commercial |
$213.56
|
| Rate for Payer: Aetna Commercial |
$213.56
|
| Rate for Payer: Aetna Medicare |
$165.74
|
| Rate for Payer: Aetna Medicare |
$165.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.49
|
| Rate for Payer: BCBS Complete |
$213.60
|
| Rate for Payer: BCBS Complete |
$152.40
|
| Rate for Payer: BCBS MAPPO |
$159.37
|
| Rate for Payer: BCBS MAPPO |
$159.37
|
| Rate for Payer: BCN Medicare Advantage |
$159.37
|
| Rate for Payer: BCN Medicare Advantage |
$159.37
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cofinity Commercial |
$213.56
|
| Rate for Payer: Cofinity Commercial |
$229.49
|
| Rate for Payer: Cofinity Commercial |
$213.56
|
| Rate for Payer: Cofinity Commercial |
$229.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.37
|
| Rate for Payer: Healthscope Commercial |
$294.83
|
| Rate for Payer: Healthscope Commercial |
$294.83
|
| Rate for Payer: Healthscope Commercial |
$254.99
|
| Rate for Payer: Healthscope Commercial |
$254.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.65
|
| Rate for Payer: Nomi Health Commercial |
$191.24
|
| Rate for Payer: Nomi Health Commercial |
$191.24
|
| Rate for Payer: PACE SWMI |
$159.37
|
| Rate for Payer: PACE SWMI |
$159.37
|
| Rate for Payer: PHP Medicare Advantage |
$159.37
|
| Rate for Payer: PHP Medicare Advantage |
$159.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.10
|
| Rate for Payer: Priority Health Medicare |
$159.37
|
| Rate for Payer: Priority Health Medicare |
$159.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.37
|
| Rate for Payer: UHC Medicare Advantage |
$159.37
|
| Rate for Payer: UHC Medicare Advantage |
$159.37
|
|
|
PR NERVE CONDUCTION STUDIES 9-10 STUDIES
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
HCPCS 95911
|
| Min. Negotiated Rate |
$191.71 |
| Max. Negotiated Rate |
$420.55 |
| Rate for Payer: Aetna Commercial |
$256.89
|
| Rate for Payer: Aetna Commercial |
$256.89
|
| Rate for Payer: Aetna Medicare |
$199.38
|
| Rate for Payer: Aetna Medicare |
$199.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.06
|
| Rate for Payer: BCBS Complete |
$258.80
|
| Rate for Payer: BCBS Complete |
$181.20
|
| Rate for Payer: BCBS MAPPO |
$191.71
|
| Rate for Payer: BCBS MAPPO |
$191.71
|
| Rate for Payer: BCN Medicare Advantage |
$191.71
|
| Rate for Payer: BCN Medicare Advantage |
$191.71
|
| Rate for Payer: Cash Price |
$517.60
|
| Rate for Payer: Cash Price |
$517.60
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cofinity Commercial |
$256.89
|
| Rate for Payer: Cofinity Commercial |
$276.06
|
| Rate for Payer: Cofinity Commercial |
$256.89
|
| Rate for Payer: Cofinity Commercial |
$276.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.71
|
| Rate for Payer: Healthscope Commercial |
$354.66
|
| Rate for Payer: Healthscope Commercial |
$354.66
|
| Rate for Payer: Healthscope Commercial |
$306.74
|
| Rate for Payer: Healthscope Commercial |
$306.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.45
|
| Rate for Payer: Nomi Health Commercial |
$230.05
|
| Rate for Payer: Nomi Health Commercial |
$230.05
|
| Rate for Payer: PACE SWMI |
$191.71
|
| Rate for Payer: PACE SWMI |
$191.71
|
| Rate for Payer: PHP Medicare Advantage |
$191.71
|
| Rate for Payer: PHP Medicare Advantage |
$191.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.55
|
| Rate for Payer: Priority Health Medicare |
$191.71
|
| Rate for Payer: Priority Health Medicare |
$191.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.71
|
| Rate for Payer: UHC Medicare Advantage |
$191.71
|
| Rate for Payer: UHC Medicare Advantage |
$191.71
|
|
|
PR NERVE GRAFT 1 STRAND ARM/LEG <4 CM
|
Professional
|
Both
|
$2,147.00
|
|
|
Service Code
|
HCPCS 64892
|
| Min. Negotiated Rate |
$858.80 |
| Max. Negotiated Rate |
$1,869.22 |
| Rate for Payer: Aetna Commercial |
$1,353.92
|
| Rate for Payer: Aetna Medicare |
$1,050.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,454.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,353.92
|
| Rate for Payer: BCBS Complete |
$858.80
|
| Rate for Payer: BCBS MAPPO |
$1,010.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,010.39
|
| Rate for Payer: Cash Price |
$1,717.60
|
| Rate for Payer: Cash Price |
$1,717.60
|
| Rate for Payer: Cofinity Commercial |
$1,454.96
|
| Rate for Payer: Cofinity Commercial |
$1,353.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,010.39
|
| Rate for Payer: Healthscope Commercial |
$1,869.22
|
| Rate for Payer: Healthscope Commercial |
$1,616.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,060.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,395.55
|
| Rate for Payer: Nomi Health Commercial |
$1,212.47
|
| Rate for Payer: PACE SWMI |
$1,010.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,010.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.55
|
| Rate for Payer: Priority Health Medicare |
$1,010.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,010.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,010.39
|
|
|
PR NERVE GRAFT 1 STRAND ARM/LEG >4 CM
|
Professional
|
Both
|
$1,734.00
|
|
|
Service Code
|
HCPCS 64893
|
| Min. Negotiated Rate |
$693.60 |
| Max. Negotiated Rate |
$1,994.02 |
| Rate for Payer: Aetna Commercial |
$1,444.32
|
| Rate for Payer: Aetna Medicare |
$1,120.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,552.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,444.32
|
| Rate for Payer: BCBS Complete |
$693.60
|
| Rate for Payer: BCBS MAPPO |
$1,077.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,077.85
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cofinity Commercial |
$1,552.10
|
| Rate for Payer: Cofinity Commercial |
$1,444.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,077.85
|
| Rate for Payer: Healthscope Commercial |
$1,724.56
|
| Rate for Payer: Healthscope Commercial |
$1,994.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,131.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,127.10
|
| Rate for Payer: Nomi Health Commercial |
$1,293.42
|
| Rate for Payer: PACE SWMI |
$1,077.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,077.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.10
|
| Rate for Payer: Priority Health Medicare |
$1,077.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,077.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,077.85
|
|
|
PR NERVE GRAFT 1 STRAND HAND/FOOT <4 CM
|
Professional
|
Both
|
$3,711.00
|
|
|
Service Code
|
HCPCS 64890
|
| Min. Negotiated Rate |
$1,038.69 |
| Max. Negotiated Rate |
$2,412.15 |
| Rate for Payer: Aetna Commercial |
$1,391.84
|
| Rate for Payer: Aetna Medicare |
$1,080.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,495.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,391.84
|
| Rate for Payer: BCBS Complete |
$1,484.40
|
| Rate for Payer: BCBS MAPPO |
$1,038.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,038.69
|
| Rate for Payer: Cash Price |
$2,968.80
|
| Rate for Payer: Cash Price |
$2,968.80
|
| Rate for Payer: Cofinity Commercial |
$1,495.71
|
| Rate for Payer: Cofinity Commercial |
$1,391.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,038.69
|
| Rate for Payer: Healthscope Commercial |
$1,921.58
|
| Rate for Payer: Healthscope Commercial |
$1,661.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,090.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,412.15
|
| Rate for Payer: Nomi Health Commercial |
$1,246.43
|
| Rate for Payer: PACE SWMI |
$1,038.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,038.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,412.15
|
| Rate for Payer: Priority Health Medicare |
$1,038.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,038.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,038.69
|
|
|
PR NERVE GRAFT EACH NERVE MULTIPLE STRANDS
|
Professional
|
Both
|
$2,944.00
|
|
|
Service Code
|
HCPCS 64902
|
| Min. Negotiated Rate |
$657.92 |
| Max. Negotiated Rate |
$1,913.60 |
| Rate for Payer: Aetna Commercial |
$881.61
|
| Rate for Payer: Aetna Medicare |
$684.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$947.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$881.61
|
| Rate for Payer: BCBS Complete |
$1,177.60
|
| Rate for Payer: BCBS MAPPO |
$657.92
|
| Rate for Payer: BCN Medicare Advantage |
$657.92
|
| Rate for Payer: Cash Price |
$2,355.20
|
| Rate for Payer: Cash Price |
$2,355.20
|
| Rate for Payer: Cofinity Commercial |
$947.40
|
| Rate for Payer: Cofinity Commercial |
$881.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$657.92
|
| Rate for Payer: Healthscope Commercial |
$1,052.67
|
| Rate for Payer: Healthscope Commercial |
$1,217.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$690.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,913.60
|
| Rate for Payer: Nomi Health Commercial |
$789.50
|
| Rate for Payer: PACE SWMI |
$657.92
|
| Rate for Payer: PHP Medicare Advantage |
$657.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,913.60
|
| Rate for Payer: Priority Health Medicare |
$657.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$657.92
|
| Rate for Payer: UHC Medicare Advantage |
$657.92
|
|
|
PR NERVE GRAFT MLT STRANDS ARM/LEG <4 CM
|
Professional
|
Both
|
$2,622.00
|
|
|
Service Code
|
HCPCS 64897
|
| Min. Negotiated Rate |
$1,048.80 |
| Max. Negotiated Rate |
$2,253.93 |
| Rate for Payer: Aetna Commercial |
$1,632.58
|
| Rate for Payer: Aetna Medicare |
$1,267.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,754.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,632.58
|
| Rate for Payer: BCBS Complete |
$1,048.80
|
| Rate for Payer: BCBS MAPPO |
$1,218.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,218.34
|
| Rate for Payer: Cash Price |
$2,097.60
|
| Rate for Payer: Cash Price |
$2,097.60
|
| Rate for Payer: Cofinity Commercial |
$1,754.41
|
| Rate for Payer: Cofinity Commercial |
$1,632.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,218.34
|
| Rate for Payer: Healthscope Commercial |
$2,253.93
|
| Rate for Payer: Healthscope Commercial |
$1,949.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,279.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,704.30
|
| Rate for Payer: Nomi Health Commercial |
$1,462.01
|
| Rate for Payer: PACE SWMI |
$1,218.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,218.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,704.30
|
| Rate for Payer: Priority Health Medicare |
$1,218.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,218.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,218.34
|
|
|
PR NERVE GRAFT MLT STRANDS ARM/LEG >4 CM
|
Professional
|
Both
|
$3,191.00
|
|
|
Service Code
|
HCPCS 64898
|
| Min. Negotiated Rate |
$1,276.40 |
| Max. Negotiated Rate |
$2,440.93 |
| Rate for Payer: Aetna Commercial |
$1,768.02
|
| Rate for Payer: Aetna Medicare |
$1,372.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,899.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,768.02
|
| Rate for Payer: BCBS Complete |
$1,276.40
|
| Rate for Payer: BCBS MAPPO |
$1,319.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,319.42
|
| Rate for Payer: Cash Price |
$2,552.80
|
| Rate for Payer: Cash Price |
$2,552.80
|
| Rate for Payer: Cofinity Commercial |
$1,899.96
|
| Rate for Payer: Cofinity Commercial |
$1,768.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,319.42
|
| Rate for Payer: Healthscope Commercial |
$2,111.07
|
| Rate for Payer: Healthscope Commercial |
$2,440.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,385.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,074.15
|
| Rate for Payer: Nomi Health Commercial |
$1,583.30
|
| Rate for Payer: PACE SWMI |
$1,319.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,319.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.15
|
| Rate for Payer: Priority Health Medicare |
$1,319.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,319.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,319.42
|
|
|
PR NERVE GRAFT MLT STRANDS HAND/FOOT <4 CM
|
Professional
|
Both
|
$3,215.00
|
|
|
Service Code
|
HCPCS 64895
|
| Min. Negotiated Rate |
$1,274.13 |
| Max. Negotiated Rate |
$2,357.14 |
| Rate for Payer: Aetna Commercial |
$1,707.33
|
| Rate for Payer: Aetna Medicare |
$1,325.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,834.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,707.33
|
| Rate for Payer: BCBS Complete |
$1,286.00
|
| Rate for Payer: BCBS MAPPO |
$1,274.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,274.13
|
| Rate for Payer: Cash Price |
$2,572.00
|
| Rate for Payer: Cash Price |
$2,572.00
|
| Rate for Payer: Cofinity Commercial |
$1,834.75
|
| Rate for Payer: Cofinity Commercial |
$1,707.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,274.13
|
| Rate for Payer: Healthscope Commercial |
$2,357.14
|
| Rate for Payer: Healthscope Commercial |
$2,038.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,337.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,089.75
|
| Rate for Payer: Nomi Health Commercial |
$1,528.96
|
| Rate for Payer: PACE SWMI |
$1,274.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,274.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,089.75
|
| Rate for Payer: Priority Health Medicare |
$1,274.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,274.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,274.13
|
|
|
PR NERVE PEDICLE TRANSFER FIRST STAGE
|
Professional
|
Both
|
$2,227.00
|
|
|
Service Code
|
HCPCS 64905
|
| Min. Negotiated Rate |
$890.80 |
| Max. Negotiated Rate |
$1,769.27 |
| Rate for Payer: Aetna Commercial |
$1,281.52
|
| Rate for Payer: Aetna Medicare |
$994.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,377.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,281.52
|
| Rate for Payer: BCBS Complete |
$890.80
|
| Rate for Payer: BCBS MAPPO |
$956.36
|
| Rate for Payer: BCN Medicare Advantage |
$956.36
|
| Rate for Payer: Cash Price |
$1,781.60
|
| Rate for Payer: Cash Price |
$1,781.60
|
| Rate for Payer: Cofinity Commercial |
$1,377.16
|
| Rate for Payer: Cofinity Commercial |
$1,281.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$956.36
|
| Rate for Payer: Healthscope Commercial |
$1,530.18
|
| Rate for Payer: Healthscope Commercial |
$1,769.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,004.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,447.55
|
| Rate for Payer: Nomi Health Commercial |
$1,147.63
|
| Rate for Payer: PACE SWMI |
$956.36
|
| Rate for Payer: PHP Medicare Advantage |
$956.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,447.55
|
| Rate for Payer: Priority Health Medicare |
$956.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$956.36
|
| Rate for Payer: UHC Medicare Advantage |
$956.36
|
|
|
PR NERVE REPAIR W/CONDUIT EACH NERVE
|
Professional
|
Both
|
$2,621.00
|
|
|
Service Code
|
HCPCS 64910
|
| Min. Negotiated Rate |
$727.42 |
| Max. Negotiated Rate |
$1,703.65 |
| Rate for Payer: Aetna Commercial |
$974.74
|
| Rate for Payer: Aetna Medicare |
$756.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,047.48
|
| Rate for Payer: BCBS Complete |
$1,048.40
|
| Rate for Payer: BCBS MAPPO |
$727.42
|
| Rate for Payer: BCN Medicare Advantage |
$727.42
|
| Rate for Payer: Cash Price |
$2,096.80
|
| Rate for Payer: Cash Price |
$2,096.80
|
| Rate for Payer: Cofinity Commercial |
$974.74
|
| Rate for Payer: Cofinity Commercial |
$1,047.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$727.42
|
| Rate for Payer: Healthscope Commercial |
$1,345.73
|
| Rate for Payer: Healthscope Commercial |
$1,163.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$763.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,703.65
|
| Rate for Payer: Nomi Health Commercial |
$872.90
|
| Rate for Payer: PACE SWMI |
$727.42
|
| Rate for Payer: PHP Medicare Advantage |
$727.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,703.65
|
| Rate for Payer: Priority Health Medicare |
$727.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$727.42
|
| Rate for Payer: UHC Medicare Advantage |
$727.42
|
|
|
PR NERVE REPAIR W/NERVE ALLOGRAFT EA ADDL STRAND
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 64913
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$302.86 |
| Rate for Payer: Aetna Commercial |
$219.37
|
| Rate for Payer: Aetna Medicare |
$170.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.37
|
| Rate for Payer: BCBS Complete |
$130.00
|
| Rate for Payer: BCBS MAPPO |
$163.71
|
| Rate for Payer: BCN Medicare Advantage |
$163.71
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$235.74
|
| Rate for Payer: Cofinity Commercial |
$219.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.71
|
| Rate for Payer: Healthscope Commercial |
$261.94
|
| Rate for Payer: Healthscope Commercial |
$302.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.25
|
| Rate for Payer: Nomi Health Commercial |
$196.45
|
| Rate for Payer: PACE SWMI |
$163.71
|
| Rate for Payer: PHP Medicare Advantage |
$163.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.25
|
| Rate for Payer: Priority Health Medicare |
$163.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.71
|
| Rate for Payer: UHC Medicare Advantage |
$163.71
|
|
|
PR NERVE REPAIR W/NERVE ALLOGRAFT FIRST STRAND
|
Professional
|
Both
|
$1,592.00
|
|
|
Service Code
|
HCPCS 64912
|
| Min. Negotiated Rate |
$636.80 |
| Max. Negotiated Rate |
$1,575.77 |
| Rate for Payer: Aetna Commercial |
$1,141.37
|
| Rate for Payer: Aetna Medicare |
$885.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,226.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,141.37
|
| Rate for Payer: BCBS Complete |
$636.80
|
| Rate for Payer: BCBS MAPPO |
$851.77
|
| Rate for Payer: BCN Medicare Advantage |
$851.77
|
| Rate for Payer: Cash Price |
$1,273.60
|
| Rate for Payer: Cash Price |
$1,273.60
|
| Rate for Payer: Cofinity Commercial |
$1,226.55
|
| Rate for Payer: Cofinity Commercial |
$1,141.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$851.77
|
| Rate for Payer: Healthscope Commercial |
$1,362.83
|
| Rate for Payer: Healthscope Commercial |
$1,575.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$894.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,034.80
|
| Rate for Payer: Nomi Health Commercial |
$1,022.12
|
| Rate for Payer: PACE SWMI |
$851.77
|
| Rate for Payer: PHP Medicare Advantage |
$851.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.80
|
| Rate for Payer: Priority Health Medicare |
$851.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$851.77
|
| Rate for Payer: UHC Medicare Advantage |
$851.77
|
|
|
PR NEURAXIAL LABOR ANALG/ANES PLND VAGINAL DELIVERY
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS 01967
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
|
|
PR NEUROBEHAVIORAL STATUS XM PHYS/QHP 1ST HOUR
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 96116
|
| Min. Negotiated Rate |
$75.49 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna Commercial |
$101.16
|
| Rate for Payer: Aetna Medicare |
$78.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.71
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS MAPPO |
$75.49
|
| Rate for Payer: BCN Medicare Advantage |
$75.49
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$101.16
|
| Rate for Payer: Cofinity Commercial |
$108.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.49
|
| Rate for Payer: Healthscope Commercial |
$120.78
|
| Rate for Payer: Healthscope Commercial |
$139.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.40
|
| Rate for Payer: Nomi Health Commercial |
$90.59
|
| Rate for Payer: PACE SWMI |
$75.49
|
| Rate for Payer: PHP Medicare Advantage |
$75.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health Medicare |
$75.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.49
|
| Rate for Payer: UHC Medicare Advantage |
$75.49
|
|
