|
PR RCNSTJ POLYDACTYLOUS DIGIT SOFT TISSUE & BONE
|
Professional
|
Both
|
$1,739.00
|
|
|
Service Code
|
HCPCS 26587
|
| Min. Negotiated Rate |
$695.60 |
| Max. Negotiated Rate |
$1,451.38 |
| Rate for Payer: Aetna Commercial |
$1,350.59
|
| Rate for Payer: Aetna Medicare |
$1,048.22
|
| Rate for Payer: BCBS Complete |
$695.60
|
| Rate for Payer: BCBS MAPPO |
$1,007.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,007.90
|
| Rate for Payer: Cash Price |
$1,391.20
|
| Rate for Payer: Cash Price |
$1,391.20
|
| Rate for Payer: Cofinity Commercial |
$1,451.38
|
| Rate for Payer: Cofinity Commercial |
$1,350.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,007.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,058.30
|
| Rate for Payer: Nomi Health Commercial |
$1,209.48
|
| Rate for Payer: PACE SWMI |
$1,007.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,007.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,130.35
|
| Rate for Payer: Priority Health Medicare |
$1,017.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,007.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,007.90
|
| Rate for Payer: UHC Exchange |
$1,007.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,007.90
|
|
|
PR RCNSTJ PST TIBL TDN W/EXC ACCESSORY TARSL NAVCLR
|
Professional
|
Both
|
$1,482.00
|
|
|
Service Code
|
HCPCS 28238
|
| Min. Negotiated Rate |
$464.68 |
| Max. Negotiated Rate |
$963.30 |
| Rate for Payer: Aetna Commercial |
$622.67
|
| Rate for Payer: Aetna Medicare |
$483.27
|
| Rate for Payer: BCBS Complete |
$592.80
|
| Rate for Payer: BCBS MAPPO |
$464.68
|
| Rate for Payer: BCN Medicare Advantage |
$464.68
|
| Rate for Payer: Cash Price |
$1,185.60
|
| Rate for Payer: Cash Price |
$1,185.60
|
| Rate for Payer: Cofinity Commercial |
$669.14
|
| Rate for Payer: Cofinity Commercial |
$622.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$464.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$487.91
|
| Rate for Payer: Nomi Health Commercial |
$557.62
|
| Rate for Payer: PACE SWMI |
$464.68
|
| Rate for Payer: PHP Medicare Advantage |
$464.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.30
|
| Rate for Payer: Priority Health Medicare |
$469.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$464.68
|
| Rate for Payer: UHC Exchange |
$464.68
|
| Rate for Payer: UHC Medicare Advantage |
$464.68
|
|
|
PR RCNSTJ STABLJ DSTL U/DSTL JT 2 SOFT TISS STABLJ
|
Professional
|
Both
|
$3,444.00
|
|
|
Service Code
|
HCPCS 25337
|
| Min. Negotiated Rate |
$857.59 |
| Max. Negotiated Rate |
$2,238.60 |
| Rate for Payer: Aetna Commercial |
$1,149.17
|
| Rate for Payer: Aetna Medicare |
$891.89
|
| Rate for Payer: BCBS Complete |
$1,377.60
|
| Rate for Payer: BCBS MAPPO |
$857.59
|
| Rate for Payer: BCN Medicare Advantage |
$857.59
|
| Rate for Payer: Cash Price |
$2,755.20
|
| Rate for Payer: Cash Price |
$2,755.20
|
| Rate for Payer: Cofinity Commercial |
$1,234.93
|
| Rate for Payer: Cofinity Commercial |
$1,149.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$857.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$900.47
|
| Rate for Payer: Nomi Health Commercial |
$1,029.11
|
| Rate for Payer: PACE SWMI |
$857.59
|
| Rate for Payer: PHP Medicare Advantage |
$857.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,238.60
|
| Rate for Payer: Priority Health Medicare |
$866.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$857.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$857.59
|
| Rate for Payer: UHC Exchange |
$857.59
|
| Rate for Payer: UHC Medicare Advantage |
$857.59
|
|
|
PR RCNSTJ SUPERIOR-LATERAL ORBITAL RIM & LOWER FHD
|
Professional
|
Both
|
$4,478.00
|
|
|
Service Code
|
HCPCS 21172
|
| Min. Negotiated Rate |
$1,791.20 |
| Max. Negotiated Rate |
$2,989.05 |
| Rate for Payer: Aetna Commercial |
$2,781.48
|
| Rate for Payer: Aetna Medicare |
$2,158.76
|
| Rate for Payer: BCBS Complete |
$1,791.20
|
| Rate for Payer: BCBS MAPPO |
$2,075.73
|
| Rate for Payer: BCN Medicare Advantage |
$2,075.73
|
| Rate for Payer: Cash Price |
$3,582.40
|
| Rate for Payer: Cash Price |
$3,582.40
|
| Rate for Payer: Cofinity Commercial |
$2,989.05
|
| Rate for Payer: Cofinity Commercial |
$2,781.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,075.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,179.52
|
| Rate for Payer: Nomi Health Commercial |
$2,490.88
|
| Rate for Payer: PACE SWMI |
$2,075.73
|
| Rate for Payer: PHP Medicare Advantage |
$2,075.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,910.70
|
| Rate for Payer: Priority Health Medicare |
$2,096.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,075.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,075.73
|
| Rate for Payer: UHC Exchange |
$2,075.73
|
| Rate for Payer: UHC Medicare Advantage |
$2,075.73
|
|
|
PR RCNSTJ TDN PULLEY EA TDN W/TDN/FSCAL GRF SPX
|
Professional
|
Both
|
$1,434.00
|
|
|
Service Code
|
HCPCS 26502
|
| Min. Negotiated Rate |
$573.60 |
| Max. Negotiated Rate |
$1,019.91 |
| Rate for Payer: Aetna Commercial |
$949.08
|
| Rate for Payer: Aetna Medicare |
$736.60
|
| Rate for Payer: BCBS Complete |
$573.60
|
| Rate for Payer: BCBS MAPPO |
$708.27
|
| Rate for Payer: BCN Medicare Advantage |
$708.27
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Cofinity Commercial |
$949.08
|
| Rate for Payer: Cofinity Commercial |
$1,019.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$708.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$743.68
|
| Rate for Payer: Nomi Health Commercial |
$849.92
|
| Rate for Payer: PACE SWMI |
$708.27
|
| Rate for Payer: PHP Medicare Advantage |
$708.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$932.10
|
| Rate for Payer: Priority Health Medicare |
$715.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$708.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$708.27
|
| Rate for Payer: UHC Exchange |
$708.27
|
| Rate for Payer: UHC Medicare Advantage |
$708.27
|
|
|
PR RCNSTJ TENDON PULLEY EACH W/LOCAL TISSUES SPX
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 26500
|
| Min. Negotiated Rate |
$555.20 |
| Max. Negotiated Rate |
$925.53 |
| Rate for Payer: Aetna Commercial |
$861.26
|
| Rate for Payer: Aetna Medicare |
$668.44
|
| Rate for Payer: BCBS Complete |
$555.20
|
| Rate for Payer: BCBS MAPPO |
$642.73
|
| Rate for Payer: BCN Medicare Advantage |
$642.73
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$925.53
|
| Rate for Payer: Cofinity Commercial |
$861.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$642.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$674.87
|
| Rate for Payer: Nomi Health Commercial |
$771.28
|
| Rate for Payer: PACE SWMI |
$642.73
|
| Rate for Payer: PHP Medicare Advantage |
$642.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health Medicare |
$649.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$642.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$642.73
|
| Rate for Payer: UHC Exchange |
$642.73
|
| Rate for Payer: UHC Medicare Advantage |
$642.73
|
|
|
PR RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
HCPCS 45900
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$296.21 |
| Rate for Payer: Aetna Commercial |
$275.64
|
| Rate for Payer: Aetna Medicare |
$213.93
|
| Rate for Payer: BCBS Complete |
$154.80
|
| Rate for Payer: BCBS MAPPO |
$205.70
|
| Rate for Payer: BCN Medicare Advantage |
$205.70
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cofinity Commercial |
$296.21
|
| Rate for Payer: Cofinity Commercial |
$275.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.99
|
| Rate for Payer: Nomi Health Commercial |
$246.84
|
| Rate for Payer: PACE SWMI |
$205.70
|
| Rate for Payer: PHP Medicare Advantage |
$205.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.55
|
| Rate for Payer: Priority Health Medicare |
$207.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.70
|
| Rate for Payer: UHC Exchange |
$205.70
|
| Rate for Payer: UHC Medicare Advantage |
$205.70
|
|
|
PR RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS
|
Professional
|
Both
|
$817.00
|
|
|
Service Code
|
HCPCS 54600
|
| Min. Negotiated Rate |
$326.80 |
| Max. Negotiated Rate |
$624.11 |
| Rate for Payer: Aetna Commercial |
$580.77
|
| Rate for Payer: Aetna Medicare |
$450.75
|
| Rate for Payer: BCBS Complete |
$326.80
|
| Rate for Payer: BCBS MAPPO |
$433.41
|
| Rate for Payer: BCN Medicare Advantage |
$433.41
|
| Rate for Payer: Cash Price |
$653.60
|
| Rate for Payer: Cash Price |
$653.60
|
| Rate for Payer: Cofinity Commercial |
$624.11
|
| Rate for Payer: Cofinity Commercial |
$580.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$455.08
|
| Rate for Payer: Nomi Health Commercial |
$520.09
|
| Rate for Payer: PACE SWMI |
$433.41
|
| Rate for Payer: PHP Medicare Advantage |
$433.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.05
|
| Rate for Payer: Priority Health Medicare |
$437.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.41
|
| Rate for Payer: UHC Exchange |
$433.41
|
| Rate for Payer: UHC Medicare Advantage |
$433.41
|
|
|
PR RDCTJ VOLVULUS INTUSSUSCEPTION INT HRNA LAPT
|
Professional
|
Both
|
$2,376.00
|
|
|
Service Code
|
HCPCS 44050
|
| Min. Negotiated Rate |
$910.06 |
| Max. Negotiated Rate |
$1,544.40 |
| Rate for Payer: Aetna Commercial |
$1,219.48
|
| Rate for Payer: Aetna Medicare |
$946.46
|
| Rate for Payer: BCBS Complete |
$950.40
|
| Rate for Payer: BCBS MAPPO |
$910.06
|
| Rate for Payer: BCN Medicare Advantage |
$910.06
|
| Rate for Payer: Cash Price |
$1,900.80
|
| Rate for Payer: Cash Price |
$1,900.80
|
| Rate for Payer: Cofinity Commercial |
$1,310.49
|
| Rate for Payer: Cofinity Commercial |
$1,219.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$910.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$955.56
|
| Rate for Payer: Nomi Health Commercial |
$1,092.07
|
| Rate for Payer: PACE SWMI |
$910.06
|
| Rate for Payer: PHP Medicare Advantage |
$910.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,544.40
|
| Rate for Payer: Priority Health Medicare |
$919.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$910.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$910.06
|
| Rate for Payer: UHC Exchange |
$910.06
|
| Rate for Payer: UHC Medicare Advantage |
$910.06
|
|
|
PR REALIGNMENT EXTENSOR TENDON HAND EACH TENDON
|
Professional
|
Both
|
$1,586.00
|
|
|
Service Code
|
HCPCS 26437
|
| Min. Negotiated Rate |
$622.95 |
| Max. Negotiated Rate |
$1,030.90 |
| Rate for Payer: Aetna Commercial |
$834.75
|
| Rate for Payer: Aetna Medicare |
$647.87
|
| Rate for Payer: BCBS Complete |
$634.40
|
| Rate for Payer: BCBS MAPPO |
$622.95
|
| Rate for Payer: BCN Medicare Advantage |
$622.95
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cofinity Commercial |
$897.05
|
| Rate for Payer: Cofinity Commercial |
$834.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$622.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$654.10
|
| Rate for Payer: Nomi Health Commercial |
$747.54
|
| Rate for Payer: PACE SWMI |
$622.95
|
| Rate for Payer: PHP Medicare Advantage |
$622.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,030.90
|
| Rate for Payer: Priority Health Medicare |
$629.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$622.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$622.95
|
| Rate for Payer: UHC Exchange |
$622.95
|
| Rate for Payer: UHC Medicare Advantage |
$622.95
|
|
|
PR REAORT VALV W CP BYPASS
|
Professional
|
Both
|
$8,044.00
|
|
|
Service Code
|
HCPCS 33400
|
| Min. Negotiated Rate |
$3,217.60 |
| Max. Negotiated Rate |
$5,228.60 |
| Rate for Payer: Aetna Medicare |
$4,022.00
|
| Rate for Payer: BCBS Complete |
$3,217.60
|
| Rate for Payer: Cash Price |
$6,435.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,228.60
|
|
|
PR RECMPL WND LID,NOS,EAR <1 CM
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
HCPCS 13150
|
| Min. Negotiated Rate |
$241.20 |
| Max. Negotiated Rate |
$391.95 |
| Rate for Payer: Aetna Medicare |
$301.50
|
| Rate for Payer: BCBS Complete |
$241.20
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.95
|
|
|
PR RECONSTRUCTION EXTERNAL AUDITORY CANAL SPX
|
Professional
|
Both
|
$3,465.00
|
|
|
Service Code
|
HCPCS 69310
|
| Min. Negotiated Rate |
$1,033.61 |
| Max. Negotiated Rate |
$2,252.25 |
| Rate for Payer: Aetna Commercial |
$1,385.04
|
| Rate for Payer: Aetna Medicare |
$1,074.95
|
| Rate for Payer: BCBS Complete |
$1,386.00
|
| Rate for Payer: BCBS MAPPO |
$1,033.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,033.61
|
| Rate for Payer: Cash Price |
$2,772.00
|
| Rate for Payer: Cash Price |
$2,772.00
|
| Rate for Payer: Cofinity Commercial |
$1,385.04
|
| Rate for Payer: Cofinity Commercial |
$1,488.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,033.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,085.29
|
| Rate for Payer: Nomi Health Commercial |
$1,240.33
|
| Rate for Payer: PACE SWMI |
$1,033.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,033.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,252.25
|
| Rate for Payer: Priority Health Medicare |
$1,043.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,033.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,033.61
|
| Rate for Payer: UHC Exchange |
$1,033.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,033.61
|
|
|
PR RECONSTRUCTION NAIL BED W/GRAFT
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
HCPCS 11762
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$290.55 |
| Rate for Payer: Aetna Commercial |
$239.89
|
| Rate for Payer: Aetna Medicare |
$186.18
|
| Rate for Payer: BCBS Complete |
$178.80
|
| Rate for Payer: BCBS MAPPO |
$179.02
|
| Rate for Payer: BCN Medicare Advantage |
$179.02
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cofinity Commercial |
$257.79
|
| Rate for Payer: Cofinity Commercial |
$239.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.97
|
| Rate for Payer: Nomi Health Commercial |
$214.82
|
| Rate for Payer: PACE SWMI |
$179.02
|
| Rate for Payer: PHP Medicare Advantage |
$179.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.55
|
| Rate for Payer: Priority Health Medicare |
$180.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.02
|
| Rate for Payer: UHC Exchange |
$179.02
|
| Rate for Payer: UHC Medicare Advantage |
$179.02
|
|
|
PR RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC
|
Facility
|
OP
|
$3,986.00
|
|
|
Service Code
|
CPT 23420
|
| Hospital Charge Code |
23420
|
| Min. Negotiated Rate |
$946.67 |
| Max. Negotiated Rate |
$5,423.52 |
| Rate for Payer: Aetna Commercial |
$3,388.10
|
| Rate for Payer: Aetna Medicare |
$1,036.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,245.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,245.62
|
| Rate for Payer: BCBS Complete |
$5,423.52
|
| Rate for Payer: BCBS MAPPO |
$996.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,276.89
|
| Rate for Payer: BCN Commercial |
$3,099.11
|
| Rate for Payer: BCN Medicare Advantage |
$996.50
|
| Rate for Payer: Cash Price |
$3,188.80
|
| Rate for Payer: Cash Price |
$3,188.80
|
| Rate for Payer: Cofinity Commercial |
$3,427.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,188.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$996.50
|
| Rate for Payer: Healthscope Commercial |
$3,587.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,989.50
|
| Rate for Payer: Mclaren Medicaid |
$5,164.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,046.33
|
| Rate for Payer: Meridian Medicaid |
$5,423.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,145.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,388.10
|
| Rate for Payer: Nomi Health Commercial |
$3,268.52
|
| Rate for Payer: PACE Senior Care Partners |
$946.67
|
| Rate for Payer: PACE SWMI |
$996.50
|
| Rate for Payer: PHP Commercial |
$3,388.10
|
| Rate for Payer: PHP Medicare Advantage |
$996.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,164.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,590.90
|
| Rate for Payer: Priority Health HMO/PPO |
$3,467.82
|
| Rate for Payer: Priority Health Medicare |
$1,006.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,670.62
|
| Rate for Payer: Railroad Medicare Medicare |
$996.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,507.68
|
| Rate for Payer: UHC Core |
$3,328.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$996.50
|
| Rate for Payer: UHC Exchange |
$996.50
|
| Rate for Payer: UHC Medicare Advantage |
$996.50
|
| Rate for Payer: UHCCP Medicaid |
$5,164.92
|
| Rate for Payer: VA VA |
$996.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,989.50
|
|
|
PR RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC
|
Professional
|
Both
|
$3,986.00
|
|
|
Service Code
|
HCPCS 23420
|
| Min. Negotiated Rate |
$940.72 |
| Max. Negotiated Rate |
$2,590.90 |
| Rate for Payer: Aetna Commercial |
$1,260.56
|
| Rate for Payer: Aetna Medicare |
$978.35
|
| Rate for Payer: BCBS Complete |
$1,594.40
|
| Rate for Payer: BCBS MAPPO |
$940.72
|
| Rate for Payer: BCN Medicare Advantage |
$940.72
|
| Rate for Payer: Cash Price |
$3,188.80
|
| Rate for Payer: Cash Price |
$3,188.80
|
| Rate for Payer: Cofinity Commercial |
$1,354.64
|
| Rate for Payer: Cofinity Commercial |
$1,260.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$940.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$987.76
|
| Rate for Payer: Nomi Health Commercial |
$1,128.86
|
| Rate for Payer: PACE SWMI |
$940.72
|
| Rate for Payer: PHP Medicare Advantage |
$940.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,590.90
|
| Rate for Payer: Priority Health Medicare |
$950.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$940.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$940.72
|
| Rate for Payer: UHC Exchange |
$940.72
|
| Rate for Payer: UHC Medicare Advantage |
$940.72
|
|
|
PR RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC
|
Professional
|
Both
|
$3,986.00
|
|
|
Service Code
|
HCPCS 23420
|
| Hospital Charge Code |
23420
|
| Min. Negotiated Rate |
$940.72 |
| Max. Negotiated Rate |
$2,590.90 |
| Rate for Payer: Aetna Commercial |
$1,260.56
|
| Rate for Payer: Aetna Medicare |
$978.35
|
| Rate for Payer: BCBS Complete |
$1,594.40
|
| Rate for Payer: BCBS MAPPO |
$940.72
|
| Rate for Payer: BCN Medicare Advantage |
$940.72
|
| Rate for Payer: Cash Price |
$3,188.80
|
| Rate for Payer: Cash Price |
$3,188.80
|
| Rate for Payer: Cofinity Commercial |
$1,354.64
|
| Rate for Payer: Cofinity Commercial |
$1,260.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$940.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$987.76
|
| Rate for Payer: Nomi Health Commercial |
$1,128.86
|
| Rate for Payer: PACE SWMI |
$940.72
|
| Rate for Payer: PHP Medicare Advantage |
$940.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,590.90
|
| Rate for Payer: Priority Health Medicare |
$950.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$940.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$940.72
|
| Rate for Payer: UHC Exchange |
$940.72
|
| Rate for Payer: UHC Medicare Advantage |
$940.72
|
|
|
PR RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC
|
Facility
|
IP
|
$3,986.00
|
|
|
Service Code
|
CPT 23420
|
| Hospital Charge Code |
23420
|
| Min. Negotiated Rate |
$2,590.90 |
| Max. Negotiated Rate |
$3,587.40 |
| Rate for Payer: Aetna Commercial |
$3,388.10
|
| Rate for Payer: BCBS Trust/PPO |
$3,253.77
|
| Rate for Payer: BCN Commercial |
$3,080.38
|
| Rate for Payer: Cash Price |
$3,188.80
|
| Rate for Payer: Cofinity Commercial |
$3,427.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,188.80
|
| Rate for Payer: Healthscope Commercial |
$3,587.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,989.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,388.10
|
| Rate for Payer: Nomi Health Commercial |
$3,268.52
|
| Rate for Payer: PHP Commercial |
$3,388.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,590.90
|
| Rate for Payer: Priority Health HMO/PPO |
$3,467.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,670.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,507.68
|
| Rate for Payer: UHC Core |
$3,328.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,989.50
|
|
|
PR RECONSTRUCTION TOE POLYDACTYLY
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 28344
|
| Min. Negotiated Rate |
$266.99 |
| Max. Negotiated Rate |
$536.25 |
| Rate for Payer: Aetna Commercial |
$357.77
|
| Rate for Payer: Aetna Medicare |
$277.67
|
| Rate for Payer: BCBS Complete |
$330.00
|
| Rate for Payer: BCBS MAPPO |
$266.99
|
| Rate for Payer: BCN Medicare Advantage |
$266.99
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$384.47
|
| Rate for Payer: Cofinity Commercial |
$357.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$266.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$280.34
|
| Rate for Payer: Nomi Health Commercial |
$320.39
|
| Rate for Payer: PACE SWMI |
$266.99
|
| Rate for Payer: PHP Medicare Advantage |
$266.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.25
|
| Rate for Payer: Priority Health Medicare |
$269.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$266.99
|
| Rate for Payer: UHC Exchange |
$266.99
|
| Rate for Payer: UHC Medicare Advantage |
$266.99
|
|
|
PR RECONSTRUCTION VENA CAVA ANY METHOD
|
Professional
|
Both
|
$2,399.00
|
|
|
Service Code
|
HCPCS 34502
|
| Min. Negotiated Rate |
$959.60 |
| Max. Negotiated Rate |
$2,130.94 |
| Rate for Payer: Aetna Commercial |
$1,982.96
|
| Rate for Payer: Aetna Medicare |
$1,539.01
|
| Rate for Payer: BCBS Complete |
$959.60
|
| Rate for Payer: BCBS MAPPO |
$1,479.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,479.82
|
| Rate for Payer: Cash Price |
$1,919.20
|
| Rate for Payer: Cash Price |
$1,919.20
|
| Rate for Payer: Cofinity Commercial |
$2,130.94
|
| Rate for Payer: Cofinity Commercial |
$1,982.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,479.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,553.81
|
| Rate for Payer: Nomi Health Commercial |
$1,775.78
|
| Rate for Payer: PACE SWMI |
$1,479.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,479.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,559.35
|
| Rate for Payer: Priority Health Medicare |
$1,494.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,479.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,479.82
|
| Rate for Payer: UHC Exchange |
$1,479.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,479.82
|
|
|
PR RECTAL SESATION TONE & COMPLIANCE TEST
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 91120
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$612.27 |
| Rate for Payer: Aetna Commercial |
$569.75
|
| Rate for Payer: Aetna Commercial |
$569.75
|
| Rate for Payer: Aetna Medicare |
$442.20
|
| Rate for Payer: Aetna Medicare |
$442.20
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: BCBS Complete |
$284.00
|
| Rate for Payer: BCBS MAPPO |
$425.19
|
| Rate for Payer: BCBS MAPPO |
$425.19
|
| Rate for Payer: BCN Medicare Advantage |
$425.19
|
| Rate for Payer: BCN Medicare Advantage |
$425.19
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$612.27
|
| Rate for Payer: Cofinity Commercial |
$612.27
|
| Rate for Payer: Cofinity Commercial |
$569.75
|
| Rate for Payer: Cofinity Commercial |
$569.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$425.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$425.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$446.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$446.45
|
| Rate for Payer: Nomi Health Commercial |
$510.23
|
| Rate for Payer: Nomi Health Commercial |
$510.23
|
| Rate for Payer: PACE SWMI |
$425.19
|
| Rate for Payer: PACE SWMI |
$425.19
|
| Rate for Payer: PHP Medicare Advantage |
$425.19
|
| Rate for Payer: PHP Medicare Advantage |
$425.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: Priority Health Medicare |
$429.44
|
| Rate for Payer: Priority Health Medicare |
$429.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$425.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$425.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$425.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$425.19
|
| Rate for Payer: UHC Exchange |
$425.19
|
| Rate for Payer: UHC Exchange |
$425.19
|
| Rate for Payer: UHC Medicare Advantage |
$425.19
|
| Rate for Payer: UHC Medicare Advantage |
$425.19
|
|
|
PR RECTAL TUMOR EXCISION TRANSANAL ENDOSCOPIC
|
Professional
|
Both
|
$1,793.00
|
|
|
Service Code
|
HCPCS 0184T
|
| Min. Negotiated Rate |
$717.20 |
| Max. Negotiated Rate |
$1,165.45 |
| Rate for Payer: Aetna Medicare |
$896.50
|
| Rate for Payer: BCBS Complete |
$717.20
|
| Rate for Payer: Cash Price |
$1,434.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.45
|
|
|
PR REGION IV LOCAL ANESTH,UPPER/LOWER EXT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS 01995
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
|
|
PR REIMPLANTATION ANOMALOUS PULMONARY ARTERY
|
Professional
|
Both
|
$6,703.00
|
|
|
Service Code
|
HCPCS 33788
|
| Min. Negotiated Rate |
$1,472.16 |
| Max. Negotiated Rate |
$4,356.95 |
| Rate for Payer: Aetna Commercial |
$1,972.69
|
| Rate for Payer: Aetna Medicare |
$1,531.05
|
| Rate for Payer: BCBS Complete |
$2,681.20
|
| Rate for Payer: BCBS MAPPO |
$1,472.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,472.16
|
| Rate for Payer: Cash Price |
$5,362.40
|
| Rate for Payer: Cash Price |
$5,362.40
|
| Rate for Payer: Cofinity Commercial |
$1,972.69
|
| Rate for Payer: Cofinity Commercial |
$2,119.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,472.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,545.77
|
| Rate for Payer: Nomi Health Commercial |
$1,766.59
|
| Rate for Payer: PACE SWMI |
$1,472.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,472.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,356.95
|
| Rate for Payer: Priority Health Medicare |
$1,486.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,472.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,472.16
|
| Rate for Payer: UHC Exchange |
$1,472.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,472.16
|
|
|
PR REINSERTION SPINAL FIXATION DEVICE
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 22849
|
| Min. Negotiated Rate |
$1,275.97 |
| Max. Negotiated Rate |
$3,250.00 |
| Rate for Payer: Aetna Commercial |
$1,709.80
|
| Rate for Payer: Aetna Medicare |
$1,327.01
|
| Rate for Payer: BCBS Complete |
$2,000.00
|
| Rate for Payer: BCBS MAPPO |
$1,275.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,275.97
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cofinity Commercial |
$1,837.40
|
| Rate for Payer: Cofinity Commercial |
$1,709.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,275.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,339.77
|
| Rate for Payer: Nomi Health Commercial |
$1,531.16
|
| Rate for Payer: PACE SWMI |
$1,275.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,275.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,250.00
|
| Rate for Payer: Priority Health Medicare |
$1,288.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,275.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,275.97
|
| Rate for Payer: UHC Exchange |
$1,275.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,275.97
|
|
