|
PR NEPHRECTOMY W/PRTL URETERECT OPN RIB RESCJ COMPL
|
Professional
|
Both
|
$3,454.00
|
|
|
Service Code
|
HCPCS 50225
|
| Min. Negotiated Rate |
$755.72 |
| Max. Negotiated Rate |
$3,687.01 |
| Rate for Payer: Aetna Commercial |
$1,515.49
|
| Rate for Payer: Aetna Medicare |
$1,176.20
|
| Rate for Payer: BCBS Complete |
$793.51
|
| Rate for Payer: BCBS MAPPO |
$1,130.96
|
| Rate for Payer: BCBS Trust/PPO |
$3,687.01
|
| Rate for Payer: BCN Commercial |
$1,734.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,130.96
|
| Rate for Payer: Cash Price |
$2,763.20
|
| Rate for Payer: Cash Price |
$2,763.20
|
| Rate for Payer: Cofinity Commercial |
$1,628.58
|
| Rate for Payer: Cofinity Commercial |
$1,515.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,130.96
|
| Rate for Payer: Mclaren Medicaid |
$755.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,187.51
|
| Rate for Payer: Meridian Medicaid |
$793.51
|
| Rate for Payer: Nomi Health Commercial |
$1,357.15
|
| Rate for Payer: PACE SWMI |
$1,130.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,130.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$755.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,245.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,921.62
|
| Rate for Payer: Priority Health Medicare |
$1,142.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,921.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,130.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,130.96
|
| Rate for Payer: UHC Exchange |
$1,130.96
|
| Rate for Payer: UHC Medicare Advantage |
$1,130.96
|
| Rate for Payer: UHCCP Medicaid |
$755.72
|
|
|
PR NEPHRECTOMY W/TOT URETERECT&BLDR CUFF SAME INC
|
Professional
|
Both
|
$2,488.00
|
|
|
Service Code
|
HCPCS 50234
|
| Min. Negotiated Rate |
$828.78 |
| Max. Negotiated Rate |
$4,336.29 |
| Rate for Payer: Aetna Commercial |
$1,664.19
|
| Rate for Payer: Aetna Medicare |
$1,291.61
|
| Rate for Payer: BCBS Complete |
$870.22
|
| Rate for Payer: BCBS MAPPO |
$1,241.93
|
| Rate for Payer: BCBS Trust/PPO |
$4,336.29
|
| Rate for Payer: BCN Commercial |
$1,874.08
|
| 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: Mclaren Medicaid |
$828.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,304.03
|
| Rate for Payer: Meridian Medicaid |
$870.22
|
| 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 Choice Medicaid |
$828.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,617.20
|
| Rate for Payer: Priority Health HMO/PPO |
$2,058.50
|
| Rate for Payer: Priority Health Medicare |
$1,254.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,058.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,241.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,241.93
|
| Rate for Payer: UHC Exchange |
$1,241.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,241.93
|
| Rate for Payer: UHCCP Medicaid |
$828.78
|
|
|
PR NEPHROLITHOTOMY REMOVAL CALCULUS
|
Professional
|
Both
|
$2,064.00
|
|
|
Service Code
|
HCPCS 50060
|
| Min. Negotiated Rate |
$725.69 |
| Max. Negotiated Rate |
$2,591.84 |
| Rate for Payer: Aetna Commercial |
$1,454.64
|
| Rate for Payer: Aetna Medicare |
$1,128.97
|
| Rate for Payer: BCBS Complete |
$761.97
|
| Rate for Payer: BCBS MAPPO |
$1,085.55
|
| Rate for Payer: BCBS Trust/PPO |
$2,591.84
|
| Rate for Payer: BCN Commercial |
$1,636.58
|
| 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: Mclaren Medicaid |
$725.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,139.83
|
| Rate for Payer: Meridian Medicaid |
$761.97
|
| 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 Choice Medicaid |
$725.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,341.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,804.45
|
| Rate for Payer: Priority Health Medicare |
$1,096.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,804.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,085.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,085.55
|
| Rate for Payer: UHC Exchange |
$1,085.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,085.55
|
| Rate for Payer: UHCCP Medicaid |
$725.69
|
|
|
PR NEPHROLITHOTOMY RMVL LARGE STAGHORN CALCULUS
|
Professional
|
Both
|
$3,414.00
|
|
|
Service Code
|
HCPCS 50075
|
| Min. Negotiated Rate |
$926.55 |
| Max. Negotiated Rate |
$2,775.16 |
| Rate for Payer: Aetna Commercial |
$1,859.30
|
| Rate for Payer: Aetna Medicare |
$1,443.04
|
| Rate for Payer: BCBS Complete |
$972.88
|
| Rate for Payer: BCBS MAPPO |
$1,387.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,775.16
|
| Rate for Payer: BCN Commercial |
$2,090.56
|
| 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: Mclaren Medicaid |
$926.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,456.92
|
| Rate for Payer: Meridian Medicaid |
$972.88
|
| 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 Choice Medicaid |
$926.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,219.10
|
| Rate for Payer: Priority Health HMO/PPO |
$2,303.49
|
| Rate for Payer: Priority Health Medicare |
$1,401.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,303.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,387.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,387.54
|
| Rate for Payer: UHC Exchange |
$1,387.54
|
| Rate for Payer: UHC Medicare Advantage |
$1,387.54
|
| Rate for Payer: UHCCP Medicaid |
$926.55
|
|
|
PR NEPHRORRHAPHY SUTURE KIDNEY WOUND/INJURY
|
Professional
|
Both
|
$2,305.00
|
|
|
Service Code
|
HCPCS 50500
|
| Min. Negotiated Rate |
$828.57 |
| Max. Negotiated Rate |
$2,060.62 |
| Rate for Payer: Aetna Commercial |
$1,679.21
|
| Rate for Payer: Aetna Medicare |
$1,303.27
|
| Rate for Payer: BCBS Complete |
$870.00
|
| Rate for Payer: BCBS MAPPO |
$1,253.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,989.58
|
| Rate for Payer: BCN Commercial |
$1,819.35
|
| 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: Mclaren Medicaid |
$828.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,315.80
|
| Rate for Payer: Meridian Medicaid |
$870.00
|
| 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 Choice Medicaid |
$828.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,498.25
|
| Rate for Payer: Priority Health HMO/PPO |
$2,060.62
|
| Rate for Payer: Priority Health Medicare |
$1,265.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,060.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,253.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,253.14
|
| Rate for Payer: UHC Exchange |
$1,253.14
|
| Rate for Payer: UHC Medicare Advantage |
$1,253.14
|
| Rate for Payer: UHCCP Medicaid |
$828.57
|
|
|
PR NEPHROSTOMY NEPHROTOMY W/DRAINAGE
|
Professional
|
Both
|
$1,765.00
|
|
|
Service Code
|
HCPCS 50040
|
| Min. Negotiated Rate |
$591.71 |
| Max. Negotiated Rate |
$3,134.93 |
| Rate for Payer: Aetna Commercial |
$1,184.22
|
| Rate for Payer: Aetna Medicare |
$919.10
|
| Rate for Payer: BCBS Complete |
$621.30
|
| Rate for Payer: BCBS MAPPO |
$883.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,134.93
|
| Rate for Payer: BCN Commercial |
$1,332.14
|
| 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: Mclaren Medicaid |
$591.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$927.94
|
| Rate for Payer: Meridian Medicaid |
$621.30
|
| 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 Choice Medicaid |
$591.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,147.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,469.44
|
| Rate for Payer: Priority Health Medicare |
$892.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,469.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$883.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$883.75
|
| Rate for Payer: UHC Exchange |
$883.75
|
| Rate for Payer: UHC Medicare Advantage |
$883.75
|
| Rate for Payer: UHCCP Medicaid |
$591.71
|
|
|
PR NERVE CONDUCTION STUDIES 11-12 STUDIES
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
HCPCS 95912
|
| Min. Negotiated Rate |
$98.41 |
| Max. Negotiated Rate |
$8,557.53 |
| 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: BCBS Complete |
$103.33
|
| Rate for Payer: BCBS Complete |
$103.33
|
| Rate for Payer: BCBS MAPPO |
$223.84
|
| Rate for Payer: BCBS MAPPO |
$223.84
|
| Rate for Payer: BCBS Trust/PPO |
$8,557.53
|
| Rate for Payer: BCBS Trust/PPO |
$8,557.53
|
| Rate for Payer: BCN Commercial |
$360.16
|
| Rate for Payer: BCN Commercial |
$360.16
|
| Rate for Payer: BCN Medicare Advantage |
$223.84
|
| Rate for Payer: BCN Medicare Advantage |
$223.84
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| 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: Mclaren Medicaid |
$98.41
|
| Rate for Payer: Mclaren Medicaid |
$98.41
|
| 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: Meridian Medicaid |
$103.33
|
| Rate for Payer: Meridian Medicaid |
$103.33
|
| 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 Choice Medicaid |
$98.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.41
|
| 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 HMO/PPO |
$208.52
|
| Rate for Payer: Priority Health HMO/PPO |
$208.52
|
| Rate for Payer: Priority Health Medicare |
$226.08
|
| Rate for Payer: Priority Health Medicare |
$226.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.84
|
| Rate for Payer: UHC Exchange |
$223.84
|
| Rate for Payer: UHC Exchange |
$223.84
|
| Rate for Payer: UHC Medicare Advantage |
$223.84
|
| Rate for Payer: UHC Medicare Advantage |
$223.84
|
| Rate for Payer: UHCCP Medicaid |
$98.41
|
| Rate for Payer: UHCCP Medicaid |
$98.41
|
|
|
PR NERVE CONDUCTION STUDIES 1-2 STUDIES
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 95907
|
| Min. Negotiated Rate |
$33.02 |
| Max. Negotiated Rate |
$1,173.88 |
| 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: BCBS Complete |
$34.67
|
| Rate for Payer: BCBS Complete |
$34.67
|
| Rate for Payer: BCBS MAPPO |
$81.39
|
| Rate for Payer: BCBS MAPPO |
$81.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,173.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,173.88
|
| Rate for Payer: BCN Commercial |
$130.48
|
| Rate for Payer: BCN Commercial |
$130.48
|
| Rate for Payer: BCN Medicare Advantage |
$81.39
|
| Rate for Payer: BCN Medicare Advantage |
$81.39
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| 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: Mclaren Medicaid |
$33.02
|
| Rate for Payer: Mclaren Medicaid |
$33.02
|
| 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: Meridian Medicaid |
$34.67
|
| Rate for Payer: Meridian Medicaid |
$34.67
|
| 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 Choice Medicaid |
$33.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.02
|
| 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 HMO/PPO |
$70.11
|
| Rate for Payer: Priority Health HMO/PPO |
$70.11
|
| Rate for Payer: Priority Health Medicare |
$82.20
|
| Rate for Payer: Priority Health Medicare |
$82.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.39
|
| Rate for Payer: UHC Exchange |
$81.39
|
| Rate for Payer: UHC Exchange |
$81.39
|
| Rate for Payer: UHC Medicare Advantage |
$81.39
|
| Rate for Payer: UHC Medicare Advantage |
$81.39
|
| Rate for Payer: UHCCP Medicaid |
$33.02
|
| Rate for Payer: UHCCP Medicaid |
$33.02
|
|
|
PR NERVE CONDUCTION STUDIES 13/> STUDIES
|
Professional
|
Both
|
$877.00
|
|
|
Service Code
|
HCPCS 95913
|
| Min. Negotiated Rate |
$116.72 |
| 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: BCBS Complete |
$122.56
|
| Rate for Payer: BCBS Complete |
$122.56
|
| Rate for Payer: BCBS MAPPO |
$262.16
|
| Rate for Payer: BCBS MAPPO |
$262.16
|
| Rate for Payer: BCBS Trust/PPO |
$214.87
|
| Rate for Payer: BCBS Trust/PPO |
$214.87
|
| Rate for Payer: BCN Commercial |
$415.86
|
| Rate for Payer: BCN Commercial |
$415.86
|
| Rate for Payer: BCN Medicare Advantage |
$262.16
|
| Rate for Payer: BCN Medicare Advantage |
$262.16
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cash Price |
$701.60
|
| Rate for Payer: Cash Price |
$701.60
|
| 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: Mclaren Medicaid |
$116.72
|
| Rate for Payer: Mclaren Medicaid |
$116.72
|
| 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: Meridian Medicaid |
$122.56
|
| Rate for Payer: Meridian Medicaid |
$122.56
|
| 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 Choice Medicaid |
$116.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.72
|
| 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 HMO/PPO |
$246.51
|
| Rate for Payer: Priority Health HMO/PPO |
$246.51
|
| Rate for Payer: Priority Health Medicare |
$264.78
|
| Rate for Payer: Priority Health Medicare |
$264.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$262.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$262.16
|
| Rate for Payer: UHC Exchange |
$262.16
|
| Rate for Payer: UHC Exchange |
$262.16
|
| Rate for Payer: UHC Medicare Advantage |
$262.16
|
| Rate for Payer: UHC Medicare Advantage |
$262.16
|
| Rate for Payer: UHCCP Medicaid |
$116.72
|
| Rate for Payer: UHCCP Medicaid |
$116.72
|
|
|
PR NERVE CONDUCTION STUDIES 3-4 STUDIES
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
HCPCS 95908
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$1,235.69 |
| 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: BCBS Complete |
$43.17
|
| Rate for Payer: BCBS Complete |
$43.17
|
| Rate for Payer: BCBS MAPPO |
$101.27
|
| Rate for Payer: BCBS MAPPO |
$101.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,235.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,235.69
|
| Rate for Payer: BCN Commercial |
$162.25
|
| Rate for Payer: BCN Commercial |
$162.25
|
| Rate for Payer: BCN Medicare Advantage |
$101.27
|
| Rate for Payer: BCN Medicare Advantage |
$101.27
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| 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: Mclaren Medicaid |
$41.11
|
| Rate for Payer: Mclaren Medicaid |
$41.11
|
| 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: Meridian Medicaid |
$43.17
|
| Rate for Payer: Meridian Medicaid |
$43.17
|
| 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 Choice Medicaid |
$41.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.11
|
| 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 HMO/PPO |
$87.75
|
| Rate for Payer: Priority Health HMO/PPO |
$87.75
|
| Rate for Payer: Priority Health Medicare |
$102.28
|
| Rate for Payer: Priority Health Medicare |
$102.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.27
|
| Rate for Payer: UHC Exchange |
$101.27
|
| Rate for Payer: UHC Exchange |
$101.27
|
| Rate for Payer: UHC Medicare Advantage |
$101.27
|
| Rate for Payer: UHC Medicare Advantage |
$101.27
|
| Rate for Payer: UHCCP Medicaid |
$41.11
|
| Rate for Payer: UHCCP Medicaid |
$41.11
|
|
|
PR NERVE CONDUCTION STUDIES 5-6 STUDIES
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 95909
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$1,003.24 |
| 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: BCBS Complete |
$51.89
|
| Rate for Payer: BCBS Complete |
$51.89
|
| Rate for Payer: BCBS MAPPO |
$121.81
|
| Rate for Payer: BCBS MAPPO |
$121.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,003.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,003.24
|
| Rate for Payer: BCN Commercial |
$194.98
|
| Rate for Payer: BCN Commercial |
$194.98
|
| Rate for Payer: BCN Medicare Advantage |
$121.81
|
| Rate for Payer: BCN Medicare Advantage |
$121.81
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| 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: Mclaren Medicaid |
$49.42
|
| Rate for Payer: Mclaren Medicaid |
$49.42
|
| 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: Meridian Medicaid |
$51.89
|
| Rate for Payer: Meridian Medicaid |
$51.89
|
| 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 Choice Medicaid |
$49.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.42
|
| 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 HMO/PPO |
$104.94
|
| Rate for Payer: Priority Health HMO/PPO |
$104.94
|
| Rate for Payer: Priority Health Medicare |
$123.03
|
| Rate for Payer: Priority Health Medicare |
$123.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.81
|
| Rate for Payer: UHC Exchange |
$121.81
|
| Rate for Payer: UHC Exchange |
$121.81
|
| Rate for Payer: UHC Medicare Advantage |
$121.81
|
| Rate for Payer: UHC Medicare Advantage |
$121.81
|
| Rate for Payer: UHCCP Medicaid |
$49.42
|
| Rate for Payer: UHCCP Medicaid |
$49.42
|
|
|
PR NERVE CONDUCTION STUDIES 7-8 STUDIES
|
Professional
|
Both
|
$534.00
|
|
|
Service Code
|
HCPCS 95910
|
| Min. Negotiated Rate |
$65.82 |
| Max. Negotiated Rate |
$1,982.71 |
| 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: BCBS Complete |
$69.11
|
| Rate for Payer: BCBS Complete |
$69.11
|
| Rate for Payer: BCBS MAPPO |
$159.37
|
| Rate for Payer: BCBS MAPPO |
$159.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,982.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,982.71
|
| Rate for Payer: BCN Commercial |
$255.09
|
| Rate for Payer: BCN Commercial |
$255.09
|
| Rate for Payer: BCN Medicare Advantage |
$159.37
|
| Rate for Payer: BCN Medicare Advantage |
$159.37
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cash Price |
$427.20
|
| 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: Mclaren Medicaid |
$65.82
|
| Rate for Payer: Mclaren Medicaid |
$65.82
|
| 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: Meridian Medicaid |
$69.11
|
| Rate for Payer: Meridian Medicaid |
$69.11
|
| 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 Choice Medicaid |
$65.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.82
|
| 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 HMO/PPO |
$139.77
|
| Rate for Payer: Priority Health HMO/PPO |
$139.77
|
| Rate for Payer: Priority Health Medicare |
$160.96
|
| Rate for Payer: Priority Health Medicare |
$160.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.37
|
| Rate for Payer: UHC Exchange |
$159.37
|
| Rate for Payer: UHC Exchange |
$159.37
|
| Rate for Payer: UHC Medicare Advantage |
$159.37
|
| Rate for Payer: UHC Medicare Advantage |
$159.37
|
| Rate for Payer: UHCCP Medicaid |
$65.82
|
| Rate for Payer: UHCCP Medicaid |
$65.82
|
|
|
PR NERVE CONDUCTION STUDIES 9-10 STUDIES
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
HCPCS 95911
|
| Min. Negotiated Rate |
$82.22 |
| Max. Negotiated Rate |
$640.30 |
| 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: BCBS Complete |
$86.33
|
| Rate for Payer: BCBS Complete |
$86.33
|
| Rate for Payer: BCBS MAPPO |
$191.71
|
| Rate for Payer: BCBS MAPPO |
$191.71
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: BCN Commercial |
$307.87
|
| Rate for Payer: BCN Commercial |
$307.87
|
| Rate for Payer: BCN Medicare Advantage |
$191.71
|
| Rate for Payer: BCN Medicare Advantage |
$191.71
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cash Price |
$517.60
|
| Rate for Payer: Cash Price |
$517.60
|
| 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: Mclaren Medicaid |
$82.22
|
| Rate for Payer: Mclaren Medicaid |
$82.22
|
| 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: Meridian Medicaid |
$86.33
|
| Rate for Payer: Meridian Medicaid |
$86.33
|
| 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 Choice Medicaid |
$82.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.22
|
| 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 HMO/PPO |
$174.59
|
| Rate for Payer: Priority Health HMO/PPO |
$174.59
|
| Rate for Payer: Priority Health Medicare |
$193.63
|
| Rate for Payer: Priority Health Medicare |
$193.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.71
|
| Rate for Payer: UHC Exchange |
$191.71
|
| Rate for Payer: UHC Exchange |
$191.71
|
| Rate for Payer: UHC Medicare Advantage |
$191.71
|
| Rate for Payer: UHC Medicare Advantage |
$191.71
|
| Rate for Payer: UHCCP Medicaid |
$82.22
|
| Rate for Payer: UHCCP Medicaid |
$82.22
|
|
|
PR NERVE GRAFT 1 STRAND ARM/LEG <4 CM
|
Professional
|
Both
|
$2,147.00
|
|
|
Service Code
|
HCPCS 64892
|
| Min. Negotiated Rate |
$214.49 |
| Max. Negotiated Rate |
$1,797.71 |
| Rate for Payer: Aetna Commercial |
$1,353.92
|
| Rate for Payer: Aetna Medicare |
$1,050.81
|
| Rate for Payer: BCBS Complete |
$711.88
|
| Rate for Payer: BCBS MAPPO |
$1,010.39
|
| Rate for Payer: BCBS Trust/PPO |
$214.49
|
| Rate for Payer: BCN Commercial |
$1,535.43
|
| 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: Mclaren Medicaid |
$677.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,060.91
|
| Rate for Payer: Meridian Medicaid |
$711.88
|
| 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 Choice Medicaid |
$677.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.55
|
| Rate for Payer: Priority Health HMO/PPO |
$1,797.71
|
| Rate for Payer: Priority Health Medicare |
$1,020.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,797.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,010.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,010.39
|
| Rate for Payer: UHC Exchange |
$1,010.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,010.39
|
| Rate for Payer: UHCCP Medicaid |
$677.98
|
|
|
PR NERVE GRAFT 1 STRAND ARM/LEG >4 CM
|
Professional
|
Both
|
$1,734.00
|
|
|
Service Code
|
HCPCS 64893
|
| Min. Negotiated Rate |
$605.43 |
| Max. Negotiated Rate |
$1,916.01 |
| Rate for Payer: Aetna Commercial |
$1,444.32
|
| Rate for Payer: Aetna Medicare |
$1,120.96
|
| Rate for Payer: BCBS Complete |
$759.07
|
| Rate for Payer: BCBS MAPPO |
$1,077.85
|
| Rate for Payer: BCBS Trust/PPO |
$605.43
|
| Rate for Payer: BCN Commercial |
$1,636.09
|
| 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: Mclaren Medicaid |
$722.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,131.74
|
| Rate for Payer: Meridian Medicaid |
$759.07
|
| 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 Choice Medicaid |
$722.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,916.01
|
| Rate for Payer: Priority Health Medicare |
$1,088.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,916.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,077.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,077.85
|
| Rate for Payer: UHC Exchange |
$1,077.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,077.85
|
| Rate for Payer: UHCCP Medicaid |
$722.92
|
|
|
PR NERVE GRAFT 1 STRAND HAND/FOOT <4 CM
|
Professional
|
Both
|
$3,711.00
|
|
|
Service Code
|
HCPCS 64890
|
| Min. Negotiated Rate |
$359.24 |
| 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: BCBS Complete |
$731.56
|
| Rate for Payer: BCBS MAPPO |
$1,038.69
|
| Rate for Payer: BCBS Trust/PPO |
$359.24
|
| Rate for Payer: BCN Commercial |
$1,576.96
|
| 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: Mclaren Medicaid |
$696.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,090.62
|
| Rate for Payer: Meridian Medicaid |
$731.56
|
| 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 Choice Medicaid |
$696.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,412.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,846.63
|
| Rate for Payer: Priority Health Medicare |
$1,049.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,846.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,038.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,038.69
|
| Rate for Payer: UHC Exchange |
$1,038.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,038.69
|
| Rate for Payer: UHCCP Medicaid |
$696.72
|
|
|
PR NERVE GRAFT EACH NERVE MULTIPLE STRANDS
|
Professional
|
Both
|
$2,944.00
|
|
|
Service Code
|
HCPCS 64902
|
| Min. Negotiated Rate |
$379.32 |
| Max. Negotiated Rate |
$1,913.60 |
| Rate for Payer: Aetna Commercial |
$881.61
|
| Rate for Payer: Aetna Medicare |
$684.24
|
| Rate for Payer: BCBS Complete |
$458.03
|
| Rate for Payer: BCBS MAPPO |
$657.92
|
| Rate for Payer: BCBS Trust/PPO |
$379.32
|
| Rate for Payer: BCN Commercial |
$993.00
|
| 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: Mclaren Medicaid |
$436.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$690.82
|
| Rate for Payer: Meridian Medicaid |
$458.03
|
| 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 Choice Medicaid |
$436.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,913.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,156.77
|
| Rate for Payer: Priority Health Medicare |
$664.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,156.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$657.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$657.92
|
| Rate for Payer: UHC Exchange |
$657.92
|
| Rate for Payer: UHC Medicare Advantage |
$657.92
|
| Rate for Payer: UHCCP Medicaid |
$436.22
|
|
|
PR NERVE GRAFT MLT STRANDS ARM/LEG <4 CM
|
Professional
|
Both
|
$2,622.00
|
|
|
Service Code
|
HCPCS 64897
|
| Min. Negotiated Rate |
$407.32 |
| Max. Negotiated Rate |
$2,161.69 |
| Rate for Payer: Aetna Commercial |
$1,632.58
|
| Rate for Payer: Aetna Medicare |
$1,267.07
|
| Rate for Payer: BCBS Complete |
$856.80
|
| Rate for Payer: BCBS MAPPO |
$1,218.34
|
| Rate for Payer: BCBS Trust/PPO |
$407.32
|
| Rate for Payer: BCN Commercial |
$1,846.72
|
| 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: Mclaren Medicaid |
$816.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,279.26
|
| Rate for Payer: Meridian Medicaid |
$856.80
|
| 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 Choice Medicaid |
$816.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,704.30
|
| Rate for Payer: Priority Health HMO/PPO |
$2,161.69
|
| Rate for Payer: Priority Health Medicare |
$1,230.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,161.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,218.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,218.34
|
| Rate for Payer: UHC Exchange |
$1,218.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,218.34
|
| Rate for Payer: UHCCP Medicaid |
$816.00
|
|
|
PR NERVE GRAFT MLT STRANDS ARM/LEG >4 CM
|
Professional
|
Both
|
$3,191.00
|
|
|
Service Code
|
HCPCS 64898
|
| Min. Negotiated Rate |
$367.70 |
| Max. Negotiated Rate |
$2,340.83 |
| Rate for Payer: Aetna Commercial |
$1,768.02
|
| Rate for Payer: Aetna Medicare |
$1,372.20
|
| Rate for Payer: BCBS Complete |
$927.93
|
| Rate for Payer: BCBS MAPPO |
$1,319.42
|
| Rate for Payer: BCBS Trust/PPO |
$367.70
|
| Rate for Payer: BCN Commercial |
$1,999.18
|
| 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: Mclaren Medicaid |
$883.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,385.39
|
| Rate for Payer: Meridian Medicaid |
$927.93
|
| 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 Choice Medicaid |
$883.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.15
|
| Rate for Payer: Priority Health HMO/PPO |
$2,340.83
|
| Rate for Payer: Priority Health Medicare |
$1,332.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,340.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,319.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,319.42
|
| Rate for Payer: UHC Exchange |
$1,319.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,319.42
|
| Rate for Payer: UHCCP Medicaid |
$883.74
|
|
|
PR NERVE GRAFT MLT STRANDS HAND/FOOT <4 CM
|
Professional
|
Both
|
$3,215.00
|
|
|
Service Code
|
HCPCS 64895
|
| Min. Negotiated Rate |
$219.77 |
| Max. Negotiated Rate |
$2,260.08 |
| Rate for Payer: Aetna Commercial |
$1,707.33
|
| Rate for Payer: Aetna Medicare |
$1,325.10
|
| Rate for Payer: BCBS Complete |
$895.72
|
| Rate for Payer: BCBS MAPPO |
$1,274.13
|
| Rate for Payer: BCBS Trust/PPO |
$219.77
|
| Rate for Payer: BCN Commercial |
$1,932.72
|
| 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 |
$1,707.33
|
| Rate for Payer: Cofinity Commercial |
$1,834.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,274.13
|
| Rate for Payer: Mclaren Medicaid |
$853.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,337.84
|
| Rate for Payer: Meridian Medicaid |
$895.72
|
| 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 Choice Medicaid |
$853.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,089.75
|
| Rate for Payer: Priority Health HMO/PPO |
$2,260.08
|
| Rate for Payer: Priority Health Medicare |
$1,286.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,260.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,274.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,274.13
|
| Rate for Payer: UHC Exchange |
$1,274.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,274.13
|
| Rate for Payer: UHCCP Medicaid |
$853.07
|
|
|
PR NERVE PEDICLE TRANSFER FIRST STAGE
|
Professional
|
Both
|
$2,227.00
|
|
|
Service Code
|
HCPCS 64905
|
| Min. Negotiated Rate |
$641.34 |
| Max. Negotiated Rate |
$1,712.41 |
| Rate for Payer: Aetna Commercial |
$1,281.52
|
| Rate for Payer: Aetna Medicare |
$994.61
|
| Rate for Payer: BCBS Complete |
$673.41
|
| Rate for Payer: BCBS MAPPO |
$956.36
|
| Rate for Payer: BCN Commercial |
$1,469.46
|
| 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: Mclaren Medicaid |
$641.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,004.18
|
| Rate for Payer: Meridian Medicaid |
$673.41
|
| 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 Choice Medicaid |
$641.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,447.55
|
| Rate for Payer: Priority Health HMO/PPO |
$1,712.41
|
| Rate for Payer: Priority Health Medicare |
$965.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,712.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$956.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$956.36
|
| Rate for Payer: UHC Exchange |
$956.36
|
| Rate for Payer: UHC Medicare Advantage |
$956.36
|
| Rate for Payer: UHCCP Medicaid |
$641.34
|
|
|
PR NERVE REPAIR W/CONDUIT EACH NERVE
|
Professional
|
Both
|
$2,621.00
|
|
|
Service Code
|
HCPCS 64910
|
| Min. Negotiated Rate |
$272.60 |
| Max. Negotiated Rate |
$1,703.65 |
| Rate for Payer: Aetna Commercial |
$974.74
|
| Rate for Payer: Aetna Medicare |
$756.52
|
| Rate for Payer: BCBS Complete |
$517.52
|
| Rate for Payer: BCBS MAPPO |
$727.42
|
| Rate for Payer: BCBS Trust/PPO |
$272.60
|
| Rate for Payer: BCN Commercial |
$1,113.21
|
| 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: Mclaren Medicaid |
$492.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$763.79
|
| Rate for Payer: Meridian Medicaid |
$517.52
|
| 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 Choice Medicaid |
$492.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,703.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,306.91
|
| Rate for Payer: Priority Health Medicare |
$734.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,306.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$727.42
|
| Rate for Payer: UHC Exchange |
$727.42
|
| Rate for Payer: UHC Medicare Advantage |
$727.42
|
| Rate for Payer: UHCCP Medicaid |
$492.88
|
|
|
PR NERVE REPAIR W/NERVE ALLOGRAFT EA ADDL STRAND
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 64913
|
| Min. Negotiated Rate |
$108.84 |
| Max. Negotiated Rate |
$291.18 |
| Rate for Payer: Aetna Commercial |
$219.37
|
| Rate for Payer: Aetna Medicare |
$170.26
|
| Rate for Payer: BCBS Complete |
$114.28
|
| Rate for Payer: BCBS MAPPO |
$163.71
|
| Rate for Payer: BCBS Trust/PPO |
$274.19
|
| Rate for Payer: BCN Commercial |
$250.69
|
| 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: Mclaren Medicaid |
$108.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.90
|
| Rate for Payer: Meridian Medicaid |
$114.28
|
| 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 Choice Medicaid |
$108.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.25
|
| Rate for Payer: Priority Health HMO/PPO |
$291.18
|
| Rate for Payer: Priority Health Medicare |
$165.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$291.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.71
|
| Rate for Payer: UHC Exchange |
$163.71
|
| Rate for Payer: UHC Medicare Advantage |
$163.71
|
| Rate for Payer: UHCCP Medicaid |
$108.84
|
|
|
PR NERVE REPAIR W/NERVE ALLOGRAFT FIRST STRAND
|
Professional
|
Both
|
$1,592.00
|
|
|
Service Code
|
HCPCS 64912
|
| Min. Negotiated Rate |
$311.17 |
| Max. Negotiated Rate |
$1,533.25 |
| Rate for Payer: Aetna Commercial |
$1,141.37
|
| Rate for Payer: Aetna Medicare |
$885.84
|
| Rate for Payer: BCBS Complete |
$605.64
|
| Rate for Payer: BCBS MAPPO |
$851.77
|
| Rate for Payer: BCBS Trust/PPO |
$311.17
|
| Rate for Payer: BCN Commercial |
$1,309.17
|
| 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: Mclaren Medicaid |
$576.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$894.36
|
| Rate for Payer: Meridian Medicaid |
$605.64
|
| 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 Choice Medicaid |
$576.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,533.25
|
| Rate for Payer: Priority Health Medicare |
$860.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,533.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$851.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$851.77
|
| Rate for Payer: UHC Exchange |
$851.77
|
| Rate for Payer: UHC Medicare Advantage |
$851.77
|
| Rate for Payer: UHCCP Medicaid |
$576.80
|
|
|
PR NEURAXIAL LABOR ANALG/ANES PLND VAGINAL DELIVERY
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS 01967
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: Priority Health HMO/PPO |
$650.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$650.00
|
|
