|
PR NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 96121
|
| Min. Negotiated Rate |
$63.31 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$84.84
|
| Rate for Payer: Aetna Medicare |
$65.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.84
|
| Rate for Payer: BCBS Complete |
$66.80
|
| Rate for Payer: BCBS MAPPO |
$63.31
|
| Rate for Payer: BCN Medicare Advantage |
$63.31
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$91.17
|
| Rate for Payer: Cofinity Commercial |
$84.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.31
|
| Rate for Payer: Healthscope Commercial |
$117.12
|
| Rate for Payer: Healthscope Commercial |
$101.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.55
|
| Rate for Payer: Nomi Health Commercial |
$75.97
|
| Rate for Payer: PACE SWMI |
$63.31
|
| Rate for Payer: PHP Medicare Advantage |
$63.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health Medicare |
$63.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.31
|
| Rate for Payer: UHC Medicare Advantage |
$63.31
|
|
|
PR NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY
|
Professional
|
Both
|
$4,388.00
|
|
|
Service Code
|
HCPCS 62164
|
| Min. Negotiated Rate |
$1,755.20 |
| Max. Negotiated Rate |
$3,845.39 |
| Rate for Payer: Aetna Commercial |
$2,785.31
|
| Rate for Payer: Aetna Medicare |
$2,161.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,993.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,785.31
|
| Rate for Payer: BCBS Complete |
$1,755.20
|
| Rate for Payer: BCBS MAPPO |
$2,078.59
|
| Rate for Payer: BCN Medicare Advantage |
$2,078.59
|
| Rate for Payer: Cash Price |
$3,510.40
|
| Rate for Payer: Cash Price |
$3,510.40
|
| Rate for Payer: Cofinity Commercial |
$2,993.17
|
| Rate for Payer: Cofinity Commercial |
$2,785.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,078.59
|
| Rate for Payer: Healthscope Commercial |
$3,325.74
|
| Rate for Payer: Healthscope Commercial |
$3,845.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,182.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,852.20
|
| Rate for Payer: Nomi Health Commercial |
$2,494.31
|
| Rate for Payer: PACE SWMI |
$2,078.59
|
| Rate for Payer: PHP Medicare Advantage |
$2,078.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,852.20
|
| Rate for Payer: Priority Health Medicare |
$2,078.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,078.59
|
| Rate for Payer: UHC Medicare Advantage |
$2,078.59
|
|
|
PR NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 95937
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$169.81 |
| Rate for Payer: Aetna Commercial |
$123.00
|
| Rate for Payer: Aetna Medicare |
$95.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.00
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS MAPPO |
$91.79
|
| Rate for Payer: BCN Medicare Advantage |
$91.79
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$132.18
|
| Rate for Payer: Cofinity Commercial |
$123.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.79
|
| Rate for Payer: Healthscope Commercial |
$169.81
|
| Rate for Payer: Healthscope Commercial |
$146.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.40
|
| Rate for Payer: Nomi Health Commercial |
$110.15
|
| Rate for Payer: PACE SWMI |
$91.79
|
| Rate for Payer: PHP Medicare Advantage |
$91.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
| Rate for Payer: Priority Health Medicare |
$91.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.79
|
| Rate for Payer: UHC Medicare Advantage |
$91.79
|
|
|
PR NEUROPLASTY DIGITAL 1/BOTH SAME DIGIT
|
Professional
|
Both
|
$2,488.00
|
|
|
Service Code
|
HCPCS 64702
|
| Min. Negotiated Rate |
$493.31 |
| Max. Negotiated Rate |
$1,617.20 |
| Rate for Payer: Aetna Commercial |
$661.04
|
| Rate for Payer: Aetna Medicare |
$513.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.04
|
| Rate for Payer: BCBS Complete |
$995.20
|
| Rate for Payer: BCBS MAPPO |
$493.31
|
| Rate for Payer: BCN Medicare Advantage |
$493.31
|
| Rate for Payer: Cash Price |
$1,990.40
|
| Rate for Payer: Cash Price |
$1,990.40
|
| Rate for Payer: Cofinity Commercial |
$710.37
|
| Rate for Payer: Cofinity Commercial |
$661.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$493.31
|
| Rate for Payer: Healthscope Commercial |
$789.30
|
| Rate for Payer: Healthscope Commercial |
$912.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$517.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,617.20
|
| Rate for Payer: Nomi Health Commercial |
$591.97
|
| Rate for Payer: PACE SWMI |
$493.31
|
| Rate for Payer: PHP Medicare Advantage |
$493.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,617.20
|
| Rate for Payer: Priority Health Medicare |
$493.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$493.31
|
| Rate for Payer: UHC Medicare Advantage |
$493.31
|
|
|
PR NEUROPLASTY NERVE HAND/FOOT
|
Professional
|
Both
|
$1,888.00
|
|
|
Service Code
|
HCPCS 64704
|
| Min. Negotiated Rate |
$311.16 |
| Max. Negotiated Rate |
$1,227.20 |
| Rate for Payer: Aetna Commercial |
$416.95
|
| Rate for Payer: Aetna Medicare |
$323.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.95
|
| Rate for Payer: BCBS Complete |
$755.20
|
| Rate for Payer: BCBS MAPPO |
$311.16
|
| Rate for Payer: BCN Medicare Advantage |
$311.16
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cofinity Commercial |
$448.07
|
| Rate for Payer: Cofinity Commercial |
$416.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.16
|
| Rate for Payer: Healthscope Commercial |
$575.65
|
| Rate for Payer: Healthscope Commercial |
$497.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$326.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,227.20
|
| Rate for Payer: Nomi Health Commercial |
$373.39
|
| Rate for Payer: PACE SWMI |
$311.16
|
| Rate for Payer: PHP Medicare Advantage |
$311.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.20
|
| Rate for Payer: Priority Health Medicare |
$311.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$311.16
|
| Rate for Payer: UHC Medicare Advantage |
$311.16
|
|
|
PR NEUROPLASTY &/TRANSPOSITION CRANIAL NERVE
|
Professional
|
Both
|
$960.00
|
|
|
Service Code
|
HCPCS 64716
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$901.88 |
| Rate for Payer: Aetna Commercial |
$653.25
|
| Rate for Payer: Aetna Medicare |
$507.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$702.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$653.25
|
| Rate for Payer: BCBS Complete |
$384.00
|
| Rate for Payer: BCBS MAPPO |
$487.50
|
| Rate for Payer: BCN Medicare Advantage |
$487.50
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cofinity Commercial |
$702.00
|
| Rate for Payer: Cofinity Commercial |
$653.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$487.50
|
| Rate for Payer: Healthscope Commercial |
$780.00
|
| Rate for Payer: Healthscope Commercial |
$901.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$511.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.00
|
| Rate for Payer: Nomi Health Commercial |
$585.00
|
| Rate for Payer: PACE SWMI |
$487.50
|
| Rate for Payer: PHP Medicare Advantage |
$487.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$624.00
|
| Rate for Payer: Priority Health Medicare |
$487.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$487.50
|
| Rate for Payer: UHC Medicare Advantage |
$487.50
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW
|
Facility
|
OP
|
$3,146.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
64718
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Commercial |
$2,674.10
|
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,044.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Cofinity Commercial |
$2,202.20
|
| Rate for Payer: Cofinity Commercial |
$2,705.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,202.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,516.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Healthscope Commercial |
$2,831.40
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,674.10
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Commercial |
$2,674.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,044.90
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Priority Health SBD |
$1,981.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,072.23
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW
|
Professional
|
Both
|
$3,146.00
|
|
|
Service Code
|
HCPCS 64718
|
| Hospital Charge Code |
64718
|
| Min. Negotiated Rate |
$581.37 |
| Max. Negotiated Rate |
$2,044.90 |
| Rate for Payer: Aetna Commercial |
$779.04
|
| Rate for Payer: Aetna Medicare |
$604.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$779.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.17
|
| Rate for Payer: BCBS Complete |
$1,258.40
|
| Rate for Payer: BCBS MAPPO |
$581.37
|
| Rate for Payer: BCN Medicare Advantage |
$581.37
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Cofinity Commercial |
$837.17
|
| Rate for Payer: Cofinity Commercial |
$779.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$581.37
|
| Rate for Payer: Healthscope Commercial |
$1,075.53
|
| Rate for Payer: Healthscope Commercial |
$930.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$610.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,044.90
|
| Rate for Payer: Nomi Health Commercial |
$697.64
|
| Rate for Payer: PACE SWMI |
$581.37
|
| Rate for Payer: PHP Medicare Advantage |
$581.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,044.90
|
| Rate for Payer: Priority Health Medicare |
$581.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$581.37
|
| Rate for Payer: UHC Medicare Advantage |
$581.37
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW
|
Professional
|
Both
|
$3,146.00
|
|
|
Service Code
|
HCPCS 64718
|
| Min. Negotiated Rate |
$581.37 |
| Max. Negotiated Rate |
$2,044.90 |
| Rate for Payer: Aetna Commercial |
$779.04
|
| Rate for Payer: Aetna Medicare |
$604.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$779.04
|
| Rate for Payer: BCBS Complete |
$1,258.40
|
| Rate for Payer: BCBS MAPPO |
$581.37
|
| Rate for Payer: BCN Medicare Advantage |
$581.37
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Cofinity Commercial |
$837.17
|
| Rate for Payer: Cofinity Commercial |
$779.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$581.37
|
| Rate for Payer: Healthscope Commercial |
$930.19
|
| Rate for Payer: Healthscope Commercial |
$1,075.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$610.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,044.90
|
| Rate for Payer: Nomi Health Commercial |
$697.64
|
| Rate for Payer: PACE SWMI |
$581.37
|
| Rate for Payer: PHP Medicare Advantage |
$581.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,044.90
|
| Rate for Payer: Priority Health Medicare |
$581.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$581.37
|
| Rate for Payer: UHC Medicare Advantage |
$581.37
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW
|
Facility
|
IP
|
$3,146.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
64718
|
| Min. Negotiated Rate |
$1,981.98 |
| Max. Negotiated Rate |
$2,831.40 |
| Rate for Payer: Aetna Commercial |
$2,674.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,044.90
|
| Rate for Payer: Cash Price |
$2,516.80
|
| Rate for Payer: Cofinity Commercial |
$2,202.20
|
| Rate for Payer: Cofinity Commercial |
$2,705.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,202.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,516.80
|
| Rate for Payer: Healthscope Commercial |
$2,831.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,674.10
|
| Rate for Payer: PHP Commercial |
$2,674.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,044.90
|
| Rate for Payer: Priority Health SBD |
$1,981.98
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
HCPCS 64719
|
| Hospital Charge Code |
64719
|
| Min. Negotiated Rate |
$392.77 |
| Max. Negotiated Rate |
$1,021.80 |
| Rate for Payer: Aetna Commercial |
$526.31
|
| Rate for Payer: Aetna Medicare |
$408.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.31
|
| Rate for Payer: BCBS Complete |
$628.80
|
| Rate for Payer: BCBS MAPPO |
$392.77
|
| Rate for Payer: BCN Medicare Advantage |
$392.77
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cofinity Commercial |
$565.59
|
| Rate for Payer: Cofinity Commercial |
$526.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.77
|
| Rate for Payer: Healthscope Commercial |
$726.62
|
| Rate for Payer: Healthscope Commercial |
$628.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$412.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.80
|
| Rate for Payer: Nomi Health Commercial |
$471.32
|
| Rate for Payer: PACE SWMI |
$392.77
|
| Rate for Payer: PHP Medicare Advantage |
$392.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.80
|
| Rate for Payer: Priority Health Medicare |
$392.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.77
|
| Rate for Payer: UHC Medicare Advantage |
$392.77
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 64719
|
| Hospital Charge Code |
64719
|
| Min. Negotiated Rate |
$990.36 |
| Max. Negotiated Rate |
$1,414.80 |
| Rate for Payer: Aetna Commercial |
$1,336.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,021.80
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cofinity Commercial |
$1,100.40
|
| Rate for Payer: Cofinity Commercial |
$1,351.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,100.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,257.60
|
| Rate for Payer: Healthscope Commercial |
$1,414.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,336.20
|
| Rate for Payer: PHP Commercial |
$1,336.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.80
|
| Rate for Payer: Priority Health SBD |
$990.36
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
CPT 64719
|
| Hospital Charge Code |
64719
|
| Min. Negotiated Rate |
$990.36 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Commercial |
$1,336.20
|
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,021.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cofinity Commercial |
$1,100.40
|
| Rate for Payer: Cofinity Commercial |
$1,351.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,100.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,257.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Healthscope Commercial |
$1,414.80
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,336.20
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Commercial |
$1,336.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.80
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Priority Health SBD |
$990.36
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,072.23
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
HCPCS 64719
|
| Min. Negotiated Rate |
$392.77 |
| Max. Negotiated Rate |
$1,021.80 |
| Rate for Payer: Aetna Commercial |
$526.31
|
| Rate for Payer: Aetna Medicare |
$408.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.31
|
| Rate for Payer: BCBS Complete |
$628.80
|
| Rate for Payer: BCBS MAPPO |
$392.77
|
| Rate for Payer: BCN Medicare Advantage |
$392.77
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cofinity Commercial |
$565.59
|
| Rate for Payer: Cofinity Commercial |
$526.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.77
|
| Rate for Payer: Healthscope Commercial |
$628.43
|
| Rate for Payer: Healthscope Commercial |
$726.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$412.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.80
|
| Rate for Payer: Nomi Health Commercial |
$471.32
|
| Rate for Payer: PACE SWMI |
$392.77
|
| Rate for Payer: PHP Medicare Advantage |
$392.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.80
|
| Rate for Payer: Priority Health Medicare |
$392.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.77
|
| Rate for Payer: UHC Medicare Advantage |
$392.77
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Professional
|
Both
|
$2,254.00
|
|
|
Service Code
|
HCPCS 64721
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$1,465.10 |
| Rate for Payer: Aetna Commercial |
$563.09
|
| Rate for Payer: Aetna Medicare |
$437.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$605.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.09
|
| Rate for Payer: BCBS Complete |
$901.60
|
| Rate for Payer: BCBS MAPPO |
$420.22
|
| Rate for Payer: BCN Medicare Advantage |
$420.22
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Cofinity Commercial |
$605.12
|
| Rate for Payer: Cofinity Commercial |
$563.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.22
|
| Rate for Payer: Healthscope Commercial |
$777.41
|
| Rate for Payer: Healthscope Commercial |
$672.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$441.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,465.10
|
| Rate for Payer: Nomi Health Commercial |
$504.26
|
| Rate for Payer: PACE SWMI |
$420.22
|
| Rate for Payer: PHP Medicare Advantage |
$420.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.10
|
| Rate for Payer: Priority Health Medicare |
$420.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$420.22
|
| Rate for Payer: UHC Medicare Advantage |
$420.22
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Professional
|
Both
|
$2,254.00
|
|
|
Service Code
|
HCPCS 64721
|
| Hospital Charge Code |
64721
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$1,465.10 |
| Rate for Payer: Aetna Commercial |
$563.09
|
| Rate for Payer: Aetna Medicare |
$437.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$605.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.09
|
| Rate for Payer: BCBS Complete |
$901.60
|
| Rate for Payer: BCBS MAPPO |
$420.22
|
| Rate for Payer: BCN Medicare Advantage |
$420.22
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Cofinity Commercial |
$605.12
|
| Rate for Payer: Cofinity Commercial |
$563.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.22
|
| Rate for Payer: Healthscope Commercial |
$672.35
|
| Rate for Payer: Healthscope Commercial |
$777.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$441.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,465.10
|
| Rate for Payer: Nomi Health Commercial |
$504.26
|
| Rate for Payer: PACE SWMI |
$420.22
|
| Rate for Payer: PHP Medicare Advantage |
$420.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.10
|
| Rate for Payer: Priority Health Medicare |
$420.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$420.22
|
| Rate for Payer: UHC Medicare Advantage |
$420.22
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Facility
|
OP
|
$2,254.00
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
64721
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Commercial |
$1,915.90
|
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,465.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Cofinity Commercial |
$1,938.44
|
| Rate for Payer: Cofinity Commercial |
$1,577.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,577.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Healthscope Commercial |
$2,028.60
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,915.90
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Commercial |
$1,915.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.10
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Priority Health SBD |
$1,420.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,072.23
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Facility
|
IP
|
$2,254.00
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
64721
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,420.02 |
| Max. Negotiated Rate |
$2,028.60 |
| Rate for Payer: Aetna Commercial |
$1,915.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,465.10
|
| Rate for Payer: Cash Price |
$1,803.20
|
| Rate for Payer: Cofinity Commercial |
$1,577.80
|
| Rate for Payer: Cofinity Commercial |
$1,938.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,577.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.20
|
| Rate for Payer: Healthscope Commercial |
$2,028.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,915.90
|
| Rate for Payer: PHP Commercial |
$1,915.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.10
|
| Rate for Payer: Priority Health SBD |
$1,420.02
|
|
|
PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
HCPCS 96132
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$188.55 |
| Rate for Payer: Aetna Commercial |
$136.57
|
| Rate for Payer: Aetna Medicare |
$106.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.57
|
| Rate for Payer: BCBS Complete |
$106.40
|
| Rate for Payer: BCBS MAPPO |
$101.92
|
| Rate for Payer: BCN Medicare Advantage |
$101.92
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cofinity Commercial |
$146.76
|
| Rate for Payer: Cofinity Commercial |
$136.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.92
|
| Rate for Payer: Healthscope Commercial |
$163.07
|
| Rate for Payer: Healthscope Commercial |
$188.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.90
|
| Rate for Payer: Nomi Health Commercial |
$122.30
|
| Rate for Payer: PACE SWMI |
$101.92
|
| Rate for Payer: PHP Medicare Advantage |
$101.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.90
|
| Rate for Payer: Priority Health Medicare |
$101.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.92
|
| Rate for Payer: UHC Medicare Advantage |
$101.92
|
|
|
PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 96133
|
| Min. Negotiated Rate |
$72.28 |
| Max. Negotiated Rate |
$133.72 |
| Rate for Payer: Aetna Commercial |
$96.86
|
| Rate for Payer: Aetna Medicare |
$75.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.08
|
| Rate for Payer: BCBS Complete |
$81.20
|
| Rate for Payer: BCBS MAPPO |
$72.28
|
| Rate for Payer: BCN Medicare Advantage |
$72.28
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cofinity Commercial |
$96.86
|
| Rate for Payer: Cofinity Commercial |
$104.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.28
|
| Rate for Payer: Healthscope Commercial |
$115.65
|
| Rate for Payer: Healthscope Commercial |
$133.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.95
|
| Rate for Payer: Nomi Health Commercial |
$86.74
|
| Rate for Payer: PACE SWMI |
$72.28
|
| Rate for Payer: PHP Medicare Advantage |
$72.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.95
|
| Rate for Payer: Priority Health Medicare |
$72.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.28
|
| Rate for Payer: UHC Medicare Advantage |
$72.28
|
|
|
PR NEUROPSYCH TESTING BY COMPUTER
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 96120
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$111.80 |
| Rate for Payer: Aetna Medicare |
$86.00
|
| Rate for Payer: BCBS Complete |
$68.80
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.80
|
|
|
PR NEUROPSYCH TESTING BY PSYCH/PHYS
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 96118
|
| Min. Negotiated Rate |
$89.20 |
| Max. Negotiated Rate |
$144.95 |
| Rate for Payer: Aetna Medicare |
$111.50
|
| Rate for Payer: BCBS Complete |
$89.20
|
| Rate for Payer: Cash Price |
$178.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.95
|
|
|
PR NEUROPSYCH TESTING BY TECHNICIAN
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 96119
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
|
|
PR NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC
|
Professional
|
Both
|
$2,646.00
|
|
|
Service Code
|
HCPCS 64708
|
| Min. Negotiated Rate |
$483.15 |
| Max. Negotiated Rate |
$1,719.90 |
| Rate for Payer: Aetna Commercial |
$647.42
|
| Rate for Payer: Aetna Medicare |
$502.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$647.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$695.74
|
| Rate for Payer: BCBS Complete |
$1,058.40
|
| Rate for Payer: BCBS MAPPO |
$483.15
|
| Rate for Payer: BCN Medicare Advantage |
$483.15
|
| Rate for Payer: Cash Price |
$2,116.80
|
| Rate for Payer: Cash Price |
$2,116.80
|
| Rate for Payer: Cofinity Commercial |
$695.74
|
| Rate for Payer: Cofinity Commercial |
$647.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$483.15
|
| Rate for Payer: Healthscope Commercial |
$893.83
|
| Rate for Payer: Healthscope Commercial |
$773.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$507.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,719.90
|
| Rate for Payer: Nomi Health Commercial |
$579.78
|
| Rate for Payer: PACE SWMI |
$483.15
|
| Rate for Payer: PHP Medicare Advantage |
$483.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,719.90
|
| Rate for Payer: Priority Health Medicare |
$483.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$483.15
|
| Rate for Payer: UHC Medicare Advantage |
$483.15
|
|
|
PR NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS
|
Professional
|
Both
|
$2,774.00
|
|
|
Service Code
|
HCPCS 64713
|
| Min. Negotiated Rate |
$774.67 |
| Max. Negotiated Rate |
$1,803.10 |
| Rate for Payer: Aetna Commercial |
$1,038.06
|
| Rate for Payer: Aetna Medicare |
$805.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,038.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,115.52
|
| Rate for Payer: BCBS Complete |
$1,109.60
|
| Rate for Payer: BCBS MAPPO |
$774.67
|
| Rate for Payer: BCN Medicare Advantage |
$774.67
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Cofinity Commercial |
$1,038.06
|
| Rate for Payer: Cofinity Commercial |
$1,115.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.67
|
| Rate for Payer: Healthscope Commercial |
$1,239.47
|
| Rate for Payer: Healthscope Commercial |
$1,433.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$813.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,803.10
|
| Rate for Payer: Nomi Health Commercial |
$929.60
|
| Rate for Payer: PACE SWMI |
$774.67
|
| Rate for Payer: PHP Medicare Advantage |
$774.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.10
|
| Rate for Payer: Priority Health Medicare |
$774.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.67
|
| Rate for Payer: UHC Medicare Advantage |
$774.67
|
|
