|
PR DACRYOCSTORHINOSTOMY
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
HCPCS 68720
|
| Min. Negotiated Rate |
$628.80 |
| Max. Negotiated Rate |
$1,071.40 |
| Rate for Payer: Aetna Commercial |
$997.00
|
| Rate for Payer: Aetna Medicare |
$773.79
|
| Rate for Payer: BCBS Complete |
$628.80
|
| Rate for Payer: BCBS MAPPO |
$744.03
|
| Rate for Payer: BCN Medicare Advantage |
$744.03
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cofinity Commercial |
$997.00
|
| Rate for Payer: Cofinity Commercial |
$1,071.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$744.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$781.23
|
| Rate for Payer: Nomi Health Commercial |
$892.84
|
| Rate for Payer: PACE SWMI |
$744.03
|
| Rate for Payer: PHP Medicare Advantage |
$744.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.80
|
| Rate for Payer: Priority Health Medicare |
$751.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$744.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$744.03
|
| Rate for Payer: UHC Exchange |
$744.03
|
| Rate for Payer: UHC Medicare Advantage |
$744.03
|
|
|
PR DAILY HOSP MGMT EDRL/SARACH CONT DRUG ADMN
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS 01996
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
|
|
PR DBRDMT EXTENSV ECZMT/INFCT SKIN UP 10% BDY SURF
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 11000
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$34.36
|
| Rate for Payer: Aetna Medicare |
$26.67
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$25.64
|
| Rate for Payer: BCN Medicare Advantage |
$25.64
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$36.92
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.92
|
| Rate for Payer: Nomi Health Commercial |
$30.77
|
| Rate for Payer: PACE SWMI |
$25.64
|
| Rate for Payer: PHP Medicare Advantage |
$25.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.50
|
| Rate for Payer: Priority Health Medicare |
$25.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.64
|
| Rate for Payer: UHC Exchange |
$25.64
|
| Rate for Payer: UHC Medicare Advantage |
$25.64
|
|
|
PR DBRDMT EXTNSVE ECZMT/INFCT SKN EA ADDL 10%
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 11001
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna Medicare |
$14.64
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS MAPPO |
$14.08
|
| Rate for Payer: BCN Medicare Advantage |
$14.08
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| Rate for Payer: Cofinity Commercial |
$18.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.78
|
| Rate for Payer: Nomi Health Commercial |
$16.90
|
| Rate for Payer: PACE SWMI |
$14.08
|
| Rate for Payer: PHP Medicare Advantage |
$14.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health Medicare |
$14.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.08
|
| Rate for Payer: UHC Exchange |
$14.08
|
| Rate for Payer: UHC Medicare Advantage |
$14.08
|
|
|
PR DBRDMT FX&/DISLC SUBQ T/M/F BONE
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 11012
|
| Min. Negotiated Rate |
$398.34 |
| Max. Negotiated Rate |
$791.70 |
| Rate for Payer: Aetna Commercial |
$533.78
|
| Rate for Payer: Aetna Medicare |
$414.27
|
| Rate for Payer: BCBS Complete |
$487.20
|
| Rate for Payer: BCBS MAPPO |
$398.34
|
| Rate for Payer: BCN Medicare Advantage |
$398.34
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$573.61
|
| Rate for Payer: Cofinity Commercial |
$533.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.26
|
| Rate for Payer: Nomi Health Commercial |
$478.01
|
| Rate for Payer: PACE SWMI |
$398.34
|
| Rate for Payer: PHP Medicare Advantage |
$398.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health Medicare |
$402.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$398.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$398.34
|
| Rate for Payer: UHC Exchange |
$398.34
|
| Rate for Payer: UHC Medicare Advantage |
$398.34
|
|
|
PR DBRDMT SKN SBQ T/M/F NECRO INFCTJ XTRNL GENT&PER
|
Professional
|
Both
|
$1,067.00
|
|
|
Service Code
|
HCPCS 11004
|
| Min. Negotiated Rate |
$426.80 |
| Max. Negotiated Rate |
$787.46 |
| Rate for Payer: Aetna Commercial |
$732.78
|
| Rate for Payer: Aetna Medicare |
$568.72
|
| Rate for Payer: BCBS Complete |
$426.80
|
| Rate for Payer: BCBS MAPPO |
$546.85
|
| Rate for Payer: BCN Medicare Advantage |
$546.85
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cofinity Commercial |
$787.46
|
| Rate for Payer: Cofinity Commercial |
$732.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$546.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$574.19
|
| Rate for Payer: Nomi Health Commercial |
$656.22
|
| Rate for Payer: PACE SWMI |
$546.85
|
| Rate for Payer: PHP Medicare Advantage |
$546.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.55
|
| Rate for Payer: Priority Health Medicare |
$552.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$546.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$546.85
|
| Rate for Payer: UHC Exchange |
$546.85
|
| Rate for Payer: UHC Medicare Advantage |
$546.85
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Facility
|
IP
|
$1,423.00
|
|
|
Service Code
|
CPT 11005
|
| Hospital Charge Code |
11005
|
| Min. Negotiated Rate |
$924.95 |
| Max. Negotiated Rate |
$1,280.70 |
| Rate for Payer: Aetna Commercial |
$1,209.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,161.59
|
| Rate for Payer: BCN Commercial |
$1,099.69
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cofinity Commercial |
$1,223.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.40
|
| Rate for Payer: Healthscope Commercial |
$1,280.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,067.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,209.55
|
| Rate for Payer: Nomi Health Commercial |
$1,166.86
|
| Rate for Payer: PHP Commercial |
$1,209.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: Priority Health HMO/PPO |
$1,238.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$953.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,252.24
|
| Rate for Payer: UHC Core |
$1,188.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,067.25
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$1,423.00
|
|
|
Service Code
|
HCPCS 11005
|
| Hospital Charge Code |
11005
|
| Min. Negotiated Rate |
$569.20 |
| Max. Negotiated Rate |
$1,077.09 |
| Rate for Payer: Aetna Commercial |
$1,002.29
|
| Rate for Payer: Aetna Medicare |
$777.90
|
| Rate for Payer: BCBS Complete |
$569.20
|
| Rate for Payer: BCBS MAPPO |
$747.98
|
| Rate for Payer: BCN Medicare Advantage |
$747.98
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cofinity Commercial |
$1,077.09
|
| Rate for Payer: Cofinity Commercial |
$1,002.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$785.38
|
| Rate for Payer: Nomi Health Commercial |
$897.58
|
| Rate for Payer: PACE SWMI |
$747.98
|
| Rate for Payer: PHP Medicare Advantage |
$747.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: Priority Health Medicare |
$755.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$747.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$747.98
|
| Rate for Payer: UHC Exchange |
$747.98
|
| Rate for Payer: UHC Medicare Advantage |
$747.98
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$1,423.00
|
|
|
Service Code
|
HCPCS 11005
|
| Min. Negotiated Rate |
$569.20 |
| Max. Negotiated Rate |
$1,077.09 |
| Rate for Payer: Aetna Commercial |
$1,002.29
|
| Rate for Payer: Aetna Medicare |
$777.90
|
| Rate for Payer: BCBS Complete |
$569.20
|
| Rate for Payer: BCBS MAPPO |
$747.98
|
| Rate for Payer: BCN Medicare Advantage |
$747.98
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cofinity Commercial |
$1,077.09
|
| Rate for Payer: Cofinity Commercial |
$1,002.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$785.38
|
| Rate for Payer: Nomi Health Commercial |
$897.58
|
| Rate for Payer: PACE SWMI |
$747.98
|
| Rate for Payer: PHP Medicare Advantage |
$747.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: Priority Health Medicare |
$755.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$747.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$747.98
|
| Rate for Payer: UHC Exchange |
$747.98
|
| Rate for Payer: UHC Medicare Advantage |
$747.98
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Facility
|
OP
|
$1,423.00
|
|
|
Service Code
|
CPT 11005
|
| Hospital Charge Code |
11005
|
| Min. Negotiated Rate |
$337.96 |
| Max. Negotiated Rate |
$1,280.70 |
| Rate for Payer: Aetna Commercial |
$1,209.55
|
| Rate for Payer: Aetna Medicare |
$369.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$444.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$444.69
|
| Rate for Payer: BCBS Complete |
$569.20
|
| Rate for Payer: BCBS MAPPO |
$355.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,169.85
|
| Rate for Payer: BCN Commercial |
$1,106.38
|
| Rate for Payer: BCN Medicare Advantage |
$355.75
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cofinity Commercial |
$1,223.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$355.75
|
| Rate for Payer: Healthscope Commercial |
$1,280.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,067.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$373.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$409.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,209.55
|
| Rate for Payer: Nomi Health Commercial |
$1,166.86
|
| Rate for Payer: PACE Senior Care Partners |
$337.96
|
| Rate for Payer: PACE SWMI |
$355.75
|
| Rate for Payer: PHP Commercial |
$1,209.55
|
| Rate for Payer: PHP Medicare Advantage |
$355.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: Priority Health HMO/PPO |
$1,238.01
|
| Rate for Payer: Priority Health Medicare |
$359.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$953.41
|
| Rate for Payer: Railroad Medicare Medicare |
$355.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,252.24
|
| Rate for Payer: UHC Core |
$1,188.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$355.75
|
| Rate for Payer: UHC Exchange |
$355.75
|
| Rate for Payer: UHC Medicare Advantage |
$355.75
|
| Rate for Payer: VA VA |
$355.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,067.25
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT PER&ABDL
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 11006
|
| Min. Negotiated Rate |
$520.40 |
| Max. Negotiated Rate |
$975.34 |
| Rate for Payer: Aetna Commercial |
$907.61
|
| Rate for Payer: Aetna Medicare |
$704.41
|
| Rate for Payer: BCBS Complete |
$520.40
|
| Rate for Payer: BCBS MAPPO |
$677.32
|
| Rate for Payer: BCN Medicare Advantage |
$677.32
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$975.34
|
| Rate for Payer: Cofinity Commercial |
$907.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$677.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$711.19
|
| Rate for Payer: Nomi Health Commercial |
$812.78
|
| Rate for Payer: PACE SWMI |
$677.32
|
| Rate for Payer: PHP Medicare Advantage |
$677.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health Medicare |
$684.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$677.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$677.32
|
| Rate for Payer: UHC Exchange |
$677.32
|
| Rate for Payer: UHC Medicare Advantage |
$677.32
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 11010
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$532.35 |
| Rate for Payer: Aetna Commercial |
$353.49
|
| Rate for Payer: Aetna Medicare |
$274.35
|
| Rate for Payer: BCBS Complete |
$327.60
|
| Rate for Payer: BCBS MAPPO |
$263.80
|
| Rate for Payer: BCN Medicare Advantage |
$263.80
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cofinity Commercial |
$379.87
|
| Rate for Payer: Cofinity Commercial |
$353.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.99
|
| Rate for Payer: Nomi Health Commercial |
$316.56
|
| Rate for Payer: PACE SWMI |
$263.80
|
| Rate for Payer: PHP Medicare Advantage |
$263.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.35
|
| Rate for Payer: Priority Health Medicare |
$266.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.80
|
| Rate for Payer: UHC Exchange |
$263.80
|
| Rate for Payer: UHC Medicare Advantage |
$263.80
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC
|
Professional
|
Both
|
$889.00
|
|
|
Service Code
|
HCPCS 11011
|
| Min. Negotiated Rate |
$286.77 |
| Max. Negotiated Rate |
$577.85 |
| Rate for Payer: Aetna Commercial |
$384.27
|
| Rate for Payer: Aetna Medicare |
$298.24
|
| Rate for Payer: BCBS Complete |
$355.60
|
| Rate for Payer: BCBS MAPPO |
$286.77
|
| Rate for Payer: BCN Medicare Advantage |
$286.77
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Cofinity Commercial |
$412.95
|
| Rate for Payer: Cofinity Commercial |
$384.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$286.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$301.11
|
| Rate for Payer: Nomi Health Commercial |
$344.12
|
| Rate for Payer: PACE SWMI |
$286.77
|
| Rate for Payer: PHP Medicare Advantage |
$286.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.85
|
| Rate for Payer: Priority Health Medicare |
$289.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$286.77
|
| Rate for Payer: UHC Exchange |
$286.77
|
| Rate for Payer: UHC Medicare Advantage |
$286.77
|
|
|
PR DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI
|
Professional
|
Both
|
$1,751.00
|
|
|
Service Code
|
HCPCS 27057
|
| Min. Negotiated Rate |
$700.40 |
| Max. Negotiated Rate |
$1,399.49 |
| Rate for Payer: Aetna Commercial |
$1,302.31
|
| Rate for Payer: Aetna Medicare |
$1,010.74
|
| Rate for Payer: BCBS Complete |
$700.40
|
| Rate for Payer: BCBS MAPPO |
$971.87
|
| Rate for Payer: BCN Medicare Advantage |
$971.87
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cofinity Commercial |
$1,399.49
|
| Rate for Payer: Cofinity Commercial |
$1,302.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$971.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,020.46
|
| Rate for Payer: Nomi Health Commercial |
$1,166.24
|
| Rate for Payer: PACE SWMI |
$971.87
|
| Rate for Payer: PHP Medicare Advantage |
$971.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,138.15
|
| Rate for Payer: Priority Health Medicare |
$981.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$971.87
|
| Rate for Payer: UHC Exchange |
$971.87
|
| Rate for Payer: UHC Medicare Advantage |
$971.87
|
|
|
PR DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 27498
|
| Min. Negotiated Rate |
$536.00 |
| Max. Negotiated Rate |
$917.32 |
| Rate for Payer: Aetna Commercial |
$853.62
|
| Rate for Payer: Aetna Medicare |
$662.51
|
| Rate for Payer: BCBS Complete |
$536.00
|
| Rate for Payer: BCBS MAPPO |
$637.03
|
| Rate for Payer: BCN Medicare Advantage |
$637.03
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cofinity Commercial |
$917.32
|
| Rate for Payer: Cofinity Commercial |
$853.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$668.88
|
| Rate for Payer: Nomi Health Commercial |
$764.44
|
| Rate for Payer: PACE SWMI |
$637.03
|
| Rate for Payer: PHP Medicare Advantage |
$637.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$871.00
|
| Rate for Payer: Priority Health Medicare |
$643.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$637.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.03
|
| Rate for Payer: UHC Exchange |
$637.03
|
| Rate for Payer: UHC Medicare Advantage |
$637.03
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT
|
Professional
|
Both
|
$2,181.00
|
|
|
Service Code
|
HCPCS 25025
|
| Min. Negotiated Rate |
$872.40 |
| Max. Negotiated Rate |
$1,703.51 |
| Rate for Payer: Aetna Commercial |
$1,585.21
|
| Rate for Payer: Aetna Medicare |
$1,230.31
|
| Rate for Payer: BCBS Complete |
$872.40
|
| Rate for Payer: BCBS MAPPO |
$1,182.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,182.99
|
| Rate for Payer: Cash Price |
$1,744.80
|
| Rate for Payer: Cash Price |
$1,744.80
|
| Rate for Payer: Cofinity Commercial |
$1,703.51
|
| Rate for Payer: Cofinity Commercial |
$1,585.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,182.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,242.14
|
| Rate for Payer: Nomi Health Commercial |
$1,419.59
|
| Rate for Payer: PACE SWMI |
$1,182.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,182.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,417.65
|
| Rate for Payer: Priority Health Medicare |
$1,194.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,182.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,182.99
|
| Rate for Payer: UHC Exchange |
$1,182.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,182.99
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT
|
Professional
|
Both
|
$1,969.00
|
|
|
Service Code
|
HCPCS 25023
|
| Min. Negotiated Rate |
$787.60 |
| Max. Negotiated Rate |
$1,766.89 |
| Rate for Payer: Aetna Commercial |
$1,644.19
|
| Rate for Payer: Aetna Medicare |
$1,276.09
|
| Rate for Payer: BCBS Complete |
$787.60
|
| Rate for Payer: BCBS MAPPO |
$1,227.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,227.01
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cofinity Commercial |
$1,766.89
|
| Rate for Payer: Cofinity Commercial |
$1,644.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,227.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,288.36
|
| Rate for Payer: Nomi Health Commercial |
$1,472.41
|
| Rate for Payer: PACE SWMI |
$1,227.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,227.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,279.85
|
| Rate for Payer: Priority Health Medicare |
$1,239.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,227.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,227.01
|
| Rate for Payer: UHC Exchange |
$1,227.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,227.01
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DB
|
Professional
|
Both
|
$1,823.00
|
|
|
Service Code
|
HCPCS 25024
|
| Min. Negotiated Rate |
$729.20 |
| Max. Negotiated Rate |
$1,184.95 |
| Rate for Payer: Aetna Commercial |
$1,006.33
|
| Rate for Payer: Aetna Medicare |
$781.03
|
| Rate for Payer: BCBS Complete |
$729.20
|
| Rate for Payer: BCBS MAPPO |
$750.99
|
| Rate for Payer: BCN Medicare Advantage |
$750.99
|
| Rate for Payer: Cash Price |
$1,458.40
|
| Rate for Payer: Cash Price |
$1,458.40
|
| Rate for Payer: Cofinity Commercial |
$1,081.43
|
| Rate for Payer: Cofinity Commercial |
$1,006.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$750.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$788.54
|
| Rate for Payer: Nomi Health Commercial |
$901.19
|
| Rate for Payer: PACE SWMI |
$750.99
|
| Rate for Payer: PHP Medicare Advantage |
$750.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,184.95
|
| Rate for Payer: Priority Health Medicare |
$758.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$750.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$750.99
|
| Rate for Payer: UHC Exchange |
$750.99
|
| Rate for Payer: UHC Medicare Advantage |
$750.99
|
|
|
PR DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT
|
Professional
|
Both
|
$1,418.00
|
|
|
Service Code
|
HCPCS 25020
|
| Min. Negotiated Rate |
$567.20 |
| Max. Negotiated Rate |
$982.02 |
| Rate for Payer: Aetna Commercial |
$913.83
|
| Rate for Payer: Aetna Medicare |
$709.24
|
| Rate for Payer: BCBS Complete |
$567.20
|
| Rate for Payer: BCBS MAPPO |
$681.96
|
| Rate for Payer: BCN Medicare Advantage |
$681.96
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Cofinity Commercial |
$982.02
|
| Rate for Payer: Cofinity Commercial |
$913.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$681.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$716.06
|
| Rate for Payer: Nomi Health Commercial |
$818.35
|
| Rate for Payer: PACE SWMI |
$681.96
|
| Rate for Payer: PHP Medicare Advantage |
$681.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.70
|
| Rate for Payer: Priority Health Medicare |
$688.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$681.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$681.96
|
| Rate for Payer: UHC Exchange |
$681.96
|
| Rate for Payer: UHC Medicare Advantage |
$681.96
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY
|
Professional
|
Both
|
$1,241.00
|
|
|
Service Code
|
HCPCS 27600
|
| Min. Negotiated Rate |
$387.08 |
| Max. Negotiated Rate |
$806.65 |
| Rate for Payer: Aetna Commercial |
$518.69
|
| Rate for Payer: Aetna Medicare |
$402.56
|
| Rate for Payer: BCBS Complete |
$496.40
|
| Rate for Payer: BCBS MAPPO |
$387.08
|
| Rate for Payer: BCN Medicare Advantage |
$387.08
|
| Rate for Payer: Cash Price |
$992.80
|
| Rate for Payer: Cash Price |
$992.80
|
| Rate for Payer: Cofinity Commercial |
$557.40
|
| Rate for Payer: Cofinity Commercial |
$518.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$406.43
|
| Rate for Payer: Nomi Health Commercial |
$464.50
|
| Rate for Payer: PACE SWMI |
$387.08
|
| Rate for Payer: PHP Medicare Advantage |
$387.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$806.65
|
| Rate for Payer: Priority Health Medicare |
$390.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$387.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$387.08
|
| Rate for Payer: UHC Exchange |
$387.08
|
| Rate for Payer: UHC Medicare Advantage |
$387.08
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST CMPRT
|
Professional
|
Both
|
$1,769.00
|
|
|
Service Code
|
HCPCS 27602
|
| Min. Negotiated Rate |
$460.72 |
| Max. Negotiated Rate |
$1,149.85 |
| Rate for Payer: Aetna Commercial |
$617.36
|
| Rate for Payer: Aetna Medicare |
$479.15
|
| Rate for Payer: BCBS Complete |
$707.60
|
| Rate for Payer: BCBS MAPPO |
$460.72
|
| Rate for Payer: BCN Medicare Advantage |
$460.72
|
| Rate for Payer: Cash Price |
$1,415.20
|
| Rate for Payer: Cash Price |
$1,415.20
|
| Rate for Payer: Cofinity Commercial |
$663.44
|
| Rate for Payer: Cofinity Commercial |
$617.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$460.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$483.76
|
| Rate for Payer: Nomi Health Commercial |
$552.86
|
| Rate for Payer: PACE SWMI |
$460.72
|
| Rate for Payer: PHP Medicare Advantage |
$460.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,149.85
|
| Rate for Payer: Priority Health Medicare |
$465.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$460.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$460.72
|
| Rate for Payer: UHC Exchange |
$460.72
|
| Rate for Payer: UHC Medicare Advantage |
$460.72
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS
|
Professional
|
Both
|
$2,241.00
|
|
|
Service Code
|
HCPCS 27894
|
| Min. Negotiated Rate |
$793.15 |
| Max. Negotiated Rate |
$1,456.65 |
| Rate for Payer: Aetna Commercial |
$1,062.82
|
| Rate for Payer: Aetna Medicare |
$824.88
|
| Rate for Payer: BCBS Complete |
$896.40
|
| Rate for Payer: BCBS MAPPO |
$793.15
|
| Rate for Payer: BCN Medicare Advantage |
$793.15
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Cofinity Commercial |
$1,142.14
|
| Rate for Payer: Cofinity Commercial |
$1,062.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$793.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$832.81
|
| Rate for Payer: Nomi Health Commercial |
$951.78
|
| Rate for Payer: PACE SWMI |
$793.15
|
| Rate for Payer: PHP Medicare Advantage |
$793.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,456.65
|
| Rate for Payer: Priority Health Medicare |
$801.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$793.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$793.15
|
| Rate for Payer: UHC Exchange |
$793.15
|
| Rate for Payer: UHC Medicare Advantage |
$793.15
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE
|
Professional
|
Both
|
$1,645.00
|
|
|
Service Code
|
HCPCS 27892
|
| Min. Negotiated Rate |
$522.84 |
| Max. Negotiated Rate |
$1,069.25 |
| Rate for Payer: Aetna Commercial |
$700.61
|
| Rate for Payer: Aetna Medicare |
$543.75
|
| Rate for Payer: BCBS Complete |
$658.00
|
| Rate for Payer: BCBS MAPPO |
$522.84
|
| Rate for Payer: BCN Medicare Advantage |
$522.84
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Cofinity Commercial |
$752.89
|
| Rate for Payer: Cofinity Commercial |
$700.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$522.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$548.98
|
| Rate for Payer: Nomi Health Commercial |
$627.41
|
| Rate for Payer: PACE SWMI |
$522.84
|
| Rate for Payer: PHP Medicare Advantage |
$522.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,069.25
|
| Rate for Payer: Priority Health Medicare |
$528.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$522.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$522.84
|
| Rate for Payer: UHC Exchange |
$522.84
|
| Rate for Payer: UHC Medicare Advantage |
$522.84
|
|
|
PR DCMPRN FASCT LEG POST COMPARTMENT ONLY
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 27601
|
| Min. Negotiated Rate |
$421.44 |
| Max. Negotiated Rate |
$902.20 |
| Rate for Payer: Aetna Commercial |
$564.73
|
| Rate for Payer: Aetna Medicare |
$438.30
|
| Rate for Payer: BCBS Complete |
$555.20
|
| Rate for Payer: BCBS MAPPO |
$421.44
|
| Rate for Payer: BCN Medicare Advantage |
$421.44
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$606.87
|
| Rate for Payer: Cofinity Commercial |
$564.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.51
|
| Rate for Payer: Nomi Health Commercial |
$505.73
|
| Rate for Payer: PACE SWMI |
$421.44
|
| Rate for Payer: PHP Medicare Advantage |
$421.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health Medicare |
$425.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$421.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$421.44
|
| Rate for Payer: UHC Exchange |
$421.44
|
| Rate for Payer: UHC Medicare Advantage |
$421.44
|
|
|
PR DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&NRVE
|
Professional
|
Both
|
$1,156.00
|
|
|
Service Code
|
HCPCS 27499
|
| Min. Negotiated Rate |
$462.40 |
| Max. Negotiated Rate |
$977.82 |
| Rate for Payer: Aetna Commercial |
$909.91
|
| Rate for Payer: Aetna Medicare |
$706.20
|
| Rate for Payer: BCBS Complete |
$462.40
|
| Rate for Payer: BCBS MAPPO |
$679.04
|
| Rate for Payer: BCN Medicare Advantage |
$679.04
|
| Rate for Payer: Cash Price |
$924.80
|
| Rate for Payer: Cash Price |
$924.80
|
| Rate for Payer: Cofinity Commercial |
$977.82
|
| Rate for Payer: Cofinity Commercial |
$909.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$679.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.99
|
| Rate for Payer: Nomi Health Commercial |
$814.85
|
| Rate for Payer: PACE SWMI |
$679.04
|
| Rate for Payer: PHP Medicare Advantage |
$679.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$751.40
|
| Rate for Payer: Priority Health Medicare |
$685.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$679.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$679.04
|
| Rate for Payer: UHC Exchange |
$679.04
|
| Rate for Payer: UHC Medicare Advantage |
$679.04
|
|
