|
PR REPAIR BLOOD VESSEL DIRECT INTRA-ABDOMINAL
|
Professional
|
Both
|
$5,052.00
|
|
|
Service Code
|
HCPCS 35221
|
| Min. Negotiated Rate |
$926.34 |
| Max. Negotiated Rate |
$3,283.80 |
| Rate for Payer: Aetna Commercial |
$1,893.10
|
| Rate for Payer: Aetna Medicare |
$1,469.27
|
| Rate for Payer: BCBS Complete |
$972.66
|
| Rate for Payer: BCBS MAPPO |
$1,412.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,367.77
|
| Rate for Payer: BCN Commercial |
$2,119.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,412.76
|
| Rate for Payer: Cash Price |
$4,041.60
|
| Rate for Payer: Cash Price |
$4,041.60
|
| Rate for Payer: Cofinity Commercial |
$2,034.37
|
| Rate for Payer: Cofinity Commercial |
$1,893.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,412.76
|
| Rate for Payer: Mclaren Medicaid |
$926.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,483.40
|
| Rate for Payer: Meridian Medicaid |
$972.66
|
| Rate for Payer: Nomi Health Commercial |
$1,695.31
|
| Rate for Payer: PACE SWMI |
$1,412.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,412.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$926.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,283.80
|
| Rate for Payer: Priority Health HMO/PPO |
$2,313.97
|
| Rate for Payer: Priority Health Medicare |
$1,426.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,313.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,412.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,412.76
|
| Rate for Payer: UHC Exchange |
$1,412.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,412.76
|
| Rate for Payer: UHCCP Medicaid |
$926.34
|
|
|
PR REPAIR BLOOD VESSEL DIRECT LOWER EXTREMITY
|
Professional
|
Both
|
$2,660.00
|
|
|
Service Code
|
HCPCS 35226
|
| Min. Negotiated Rate |
$519.51 |
| Max. Negotiated Rate |
$2,526.86 |
| Rate for Payer: Aetna Commercial |
$1,063.89
|
| Rate for Payer: Aetna Medicare |
$825.71
|
| Rate for Payer: BCBS Complete |
$545.49
|
| Rate for Payer: BCBS MAPPO |
$793.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,526.86
|
| Rate for Payer: BCN Commercial |
$1,190.91
|
| Rate for Payer: BCN Medicare Advantage |
$793.95
|
| Rate for Payer: Cash Price |
$2,128.00
|
| Rate for Payer: Cash Price |
$2,128.00
|
| Rate for Payer: Cofinity Commercial |
$1,143.29
|
| Rate for Payer: Cofinity Commercial |
$1,063.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$793.95
|
| Rate for Payer: Mclaren Medicaid |
$519.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$833.65
|
| Rate for Payer: Meridian Medicaid |
$545.49
|
| Rate for Payer: Nomi Health Commercial |
$952.74
|
| Rate for Payer: PACE SWMI |
$793.95
|
| Rate for Payer: PHP Medicare Advantage |
$793.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$519.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,729.00
|
| Rate for Payer: Priority Health HMO/PPO |
$1,294.99
|
| Rate for Payer: Priority Health Medicare |
$801.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,294.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$793.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$793.95
|
| Rate for Payer: UHC Exchange |
$793.95
|
| Rate for Payer: UHC Medicare Advantage |
$793.95
|
| Rate for Payer: UHCCP Medicaid |
$519.51
|
|
|
PR REPAIR BLOOD VESSEL DIRECT NECK
|
Professional
|
Both
|
$4,240.00
|
|
|
Service Code
|
HCPCS 35201
|
| Min. Negotiated Rate |
$584.05 |
| Max. Negotiated Rate |
$2,756.00 |
| Rate for Payer: Aetna Commercial |
$1,192.77
|
| Rate for Payer: Aetna Medicare |
$925.74
|
| Rate for Payer: BCBS Complete |
$613.25
|
| Rate for Payer: BCBS MAPPO |
$890.13
|
| Rate for Payer: BCBS Trust/PPO |
$871.17
|
| Rate for Payer: BCN Commercial |
$1,340.94
|
| Rate for Payer: BCN Medicare Advantage |
$890.13
|
| Rate for Payer: Cash Price |
$3,392.00
|
| Rate for Payer: Cash Price |
$3,392.00
|
| Rate for Payer: Cofinity Commercial |
$1,281.79
|
| Rate for Payer: Cofinity Commercial |
$1,192.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$890.13
|
| Rate for Payer: Mclaren Medicaid |
$584.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$934.64
|
| Rate for Payer: Meridian Medicaid |
$613.25
|
| Rate for Payer: Nomi Health Commercial |
$1,068.16
|
| Rate for Payer: PACE SWMI |
$890.13
|
| Rate for Payer: PHP Medicare Advantage |
$890.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,756.00
|
| Rate for Payer: Priority Health HMO/PPO |
$1,463.58
|
| Rate for Payer: Priority Health Medicare |
$899.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,463.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$890.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$890.13
|
| Rate for Payer: UHC Exchange |
$890.13
|
| Rate for Payer: UHC Medicare Advantage |
$890.13
|
| Rate for Payer: UHCCP Medicaid |
$584.05
|
|
|
PR REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY
|
Professional
|
Both
|
$2,790.00
|
|
|
Service Code
|
HCPCS 35206
|
| Min. Negotiated Rate |
$503.53 |
| Max. Negotiated Rate |
$1,959.46 |
| Rate for Payer: Aetna Commercial |
$1,022.62
|
| Rate for Payer: Aetna Medicare |
$793.68
|
| Rate for Payer: BCBS Complete |
$528.71
|
| Rate for Payer: BCBS MAPPO |
$763.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,959.46
|
| Rate for Payer: BCN Commercial |
$1,129.33
|
| Rate for Payer: BCN Medicare Advantage |
$763.15
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Cofinity Commercial |
$1,098.94
|
| Rate for Payer: Cofinity Commercial |
$1,022.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$763.15
|
| Rate for Payer: Mclaren Medicaid |
$503.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$801.31
|
| Rate for Payer: Meridian Medicaid |
$528.71
|
| Rate for Payer: Nomi Health Commercial |
$915.78
|
| Rate for Payer: PACE SWMI |
$763.15
|
| Rate for Payer: PHP Medicare Advantage |
$763.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$503.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,813.50
|
| Rate for Payer: Priority Health HMO/PPO |
$1,243.40
|
| Rate for Payer: Priority Health Medicare |
$770.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,243.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$763.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$763.15
|
| Rate for Payer: UHC Exchange |
$763.15
|
| Rate for Payer: UHC Medicare Advantage |
$763.15
|
| Rate for Payer: UHCCP Medicaid |
$503.53
|
|
|
PR REPAIR BLOOD VESSEL VEIN GRAFT INTRA-ABDOMINAL
|
Professional
|
Both
|
$3,839.00
|
|
|
Service Code
|
HCPCS 35251
|
| Min. Negotiated Rate |
$808.30 |
| Max. Negotiated Rate |
$2,725.59 |
| Rate for Payer: Aetna Commercial |
$2,226.45
|
| Rate for Payer: Aetna Medicare |
$1,727.99
|
| Rate for Payer: BCBS Complete |
$1,141.74
|
| Rate for Payer: BCBS MAPPO |
$1,661.53
|
| Rate for Payer: BCBS Trust/PPO |
$808.30
|
| Rate for Payer: BCN Commercial |
$2,514.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,661.53
|
| Rate for Payer: Cash Price |
$3,071.20
|
| Rate for Payer: Cash Price |
$3,071.20
|
| Rate for Payer: Cofinity Commercial |
$2,392.60
|
| Rate for Payer: Cofinity Commercial |
$2,226.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,661.53
|
| Rate for Payer: Mclaren Medicaid |
$1,087.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,744.61
|
| Rate for Payer: Meridian Medicaid |
$1,141.74
|
| Rate for Payer: Nomi Health Commercial |
$1,993.84
|
| Rate for Payer: PACE SWMI |
$1,661.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,661.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,087.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,495.35
|
| Rate for Payer: Priority Health HMO/PPO |
$2,725.59
|
| Rate for Payer: Priority Health Medicare |
$1,678.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,725.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,661.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,661.53
|
| Rate for Payer: UHC Exchange |
$1,661.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,661.53
|
| Rate for Payer: UHCCP Medicaid |
$1,087.37
|
|
|
PR REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY
|
Professional
|
Both
|
$4,575.00
|
|
|
Service Code
|
HCPCS 35256
|
| Min. Negotiated Rate |
$639.43 |
| Max. Negotiated Rate |
$2,973.75 |
| Rate for Payer: Aetna Commercial |
$1,310.69
|
| Rate for Payer: Aetna Medicare |
$1,017.26
|
| Rate for Payer: BCBS Complete |
$671.40
|
| Rate for Payer: BCBS MAPPO |
$978.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,015.92
|
| Rate for Payer: BCN Commercial |
$1,459.19
|
| Rate for Payer: BCN Medicare Advantage |
$978.13
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cofinity Commercial |
$1,408.51
|
| Rate for Payer: Cofinity Commercial |
$1,310.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$978.13
|
| Rate for Payer: Mclaren Medicaid |
$639.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,027.04
|
| Rate for Payer: Meridian Medicaid |
$671.40
|
| Rate for Payer: Nomi Health Commercial |
$1,173.76
|
| Rate for Payer: PACE SWMI |
$978.13
|
| Rate for Payer: PHP Medicare Advantage |
$978.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$639.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,973.75
|
| Rate for Payer: Priority Health HMO/PPO |
$1,578.99
|
| Rate for Payer: Priority Health Medicare |
$987.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,578.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$978.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$978.13
|
| Rate for Payer: UHC Exchange |
$978.13
|
| Rate for Payer: UHC Medicare Advantage |
$978.13
|
| Rate for Payer: UHCCP Medicaid |
$639.43
|
|
|
PR REPAIR BLOOD VESSEL W/GRAFT OTHER/THAN VEIN NECK
|
Professional
|
Both
|
$4,692.00
|
|
|
Service Code
|
HCPCS 35261
|
| Min. Negotiated Rate |
$615.36 |
| Max. Negotiated Rate |
$3,049.80 |
| Rate for Payer: Aetna Commercial |
$1,266.84
|
| Rate for Payer: Aetna Medicare |
$983.22
|
| Rate for Payer: BCBS Complete |
$646.13
|
| Rate for Payer: BCBS MAPPO |
$945.40
|
| Rate for Payer: BCBS Trust/PPO |
$773.96
|
| Rate for Payer: BCN Commercial |
$1,398.59
|
| Rate for Payer: BCN Medicare Advantage |
$945.40
|
| Rate for Payer: Cash Price |
$3,753.60
|
| Rate for Payer: Cash Price |
$3,753.60
|
| Rate for Payer: Cofinity Commercial |
$1,361.38
|
| Rate for Payer: Cofinity Commercial |
$1,266.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$945.40
|
| Rate for Payer: Mclaren Medicaid |
$615.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$992.67
|
| Rate for Payer: Meridian Medicaid |
$646.13
|
| Rate for Payer: Nomi Health Commercial |
$1,134.48
|
| Rate for Payer: PACE SWMI |
$945.40
|
| Rate for Payer: PHP Medicare Advantage |
$945.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$615.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,049.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,531.13
|
| Rate for Payer: Priority Health Medicare |
$954.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,531.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$945.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$945.40
|
| Rate for Payer: UHC Exchange |
$945.40
|
| Rate for Payer: UHC Medicare Advantage |
$945.40
|
| Rate for Payer: UHCCP Medicaid |
$615.36
|
|
|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT NECK
|
Professional
|
Both
|
$1,896.00
|
|
|
Service Code
|
HCPCS 35231
|
| Min. Negotiated Rate |
$794.92 |
| Max. Negotiated Rate |
$2,591.31 |
| Rate for Payer: Aetna Commercial |
$1,599.79
|
| Rate for Payer: Aetna Medicare |
$1,241.62
|
| Rate for Payer: BCBS Complete |
$834.67
|
| Rate for Payer: BCBS MAPPO |
$1,193.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,591.31
|
| Rate for Payer: BCN Commercial |
$1,810.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,193.87
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cofinity Commercial |
$1,719.17
|
| Rate for Payer: Cofinity Commercial |
$1,599.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,193.87
|
| Rate for Payer: Mclaren Medicaid |
$794.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,253.56
|
| Rate for Payer: Meridian Medicaid |
$834.67
|
| Rate for Payer: Nomi Health Commercial |
$1,432.64
|
| Rate for Payer: PACE SWMI |
$1,193.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,193.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$794.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,232.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,969.88
|
| Rate for Payer: Priority Health Medicare |
$1,205.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,969.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,193.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,193.87
|
| Rate for Payer: UHC Exchange |
$1,193.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,193.87
|
| Rate for Payer: UHCCP Medicaid |
$794.92
|
|
|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY
|
Professional
|
Both
|
$3,698.00
|
|
|
Service Code
|
HCPCS 35236
|
| Min. Negotiated Rate |
$636.02 |
| Max. Negotiated Rate |
$2,563.84 |
| Rate for Payer: Aetna Commercial |
$1,295.15
|
| Rate for Payer: Aetna Medicare |
$1,005.19
|
| Rate for Payer: BCBS Complete |
$667.82
|
| Rate for Payer: BCBS MAPPO |
$966.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,563.84
|
| Rate for Payer: BCN Commercial |
$1,427.91
|
| Rate for Payer: BCN Medicare Advantage |
$966.53
|
| Rate for Payer: Cash Price |
$2,958.40
|
| Rate for Payer: Cash Price |
$2,958.40
|
| Rate for Payer: Cofinity Commercial |
$1,391.80
|
| Rate for Payer: Cofinity Commercial |
$1,295.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$966.53
|
| Rate for Payer: Mclaren Medicaid |
$636.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,014.86
|
| Rate for Payer: Meridian Medicaid |
$667.82
|
| Rate for Payer: Nomi Health Commercial |
$1,159.84
|
| Rate for Payer: PACE SWMI |
$966.53
|
| Rate for Payer: PHP Medicare Advantage |
$966.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$636.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,403.70
|
| Rate for Payer: Priority Health HMO/PPO |
$1,565.69
|
| Rate for Payer: Priority Health Medicare |
$976.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,565.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$966.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$966.53
|
| Rate for Payer: UHC Exchange |
$966.53
|
| Rate for Payer: UHC Medicare Advantage |
$966.53
|
| Rate for Payer: UHCCP Medicaid |
$636.02
|
|
|
PR REPAIR BROW PTOSIS
|
Professional
|
Both
|
$1,326.00
|
|
|
Service Code
|
HCPCS 67900
|
| Min. Negotiated Rate |
$183.32 |
| Max. Negotiated Rate |
$944.61 |
| Rate for Payer: Aetna Commercial |
$627.51
|
| Rate for Payer: Aetna Medicare |
$487.02
|
| Rate for Payer: BCBS Complete |
$336.60
|
| Rate for Payer: BCBS MAPPO |
$468.29
|
| Rate for Payer: BCBS Trust/PPO |
$183.32
|
| Rate for Payer: BCN Commercial |
$944.61
|
| Rate for Payer: BCN Medicare Advantage |
$468.29
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cofinity Commercial |
$674.34
|
| Rate for Payer: Cofinity Commercial |
$627.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$468.29
|
| Rate for Payer: Mclaren Medicaid |
$320.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$491.70
|
| Rate for Payer: Meridian Medicaid |
$336.60
|
| Rate for Payer: Nomi Health Commercial |
$561.95
|
| Rate for Payer: PACE SWMI |
$468.29
|
| Rate for Payer: PHP Medicare Advantage |
$468.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$320.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.90
|
| Rate for Payer: Priority Health HMO/PPO |
$878.53
|
| Rate for Payer: Priority Health Medicare |
$472.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$878.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$468.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$468.29
|
| Rate for Payer: UHC Exchange |
$468.29
|
| Rate for Payer: UHC Medicare Advantage |
$468.29
|
| Rate for Payer: UHCCP Medicaid |
$320.57
|
|
|
PR REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS
|
Professional
|
Both
|
$7,686.00
|
|
|
Service Code
|
HCPCS 33305
|
| Min. Negotiated Rate |
$786.64 |
| Max. Negotiated Rate |
$6,391.47 |
| Rate for Payer: Aetna Commercial |
$5,250.48
|
| Rate for Payer: Aetna Medicare |
$4,075.00
|
| Rate for Payer: BCBS Complete |
$2,688.94
|
| Rate for Payer: BCBS MAPPO |
$3,918.27
|
| Rate for Payer: BCBS Trust/PPO |
$786.64
|
| Rate for Payer: BCN Commercial |
$5,839.21
|
| Rate for Payer: BCN Medicare Advantage |
$3,918.27
|
| Rate for Payer: Cash Price |
$6,148.80
|
| Rate for Payer: Cash Price |
$6,148.80
|
| Rate for Payer: Cofinity Commercial |
$5,642.31
|
| Rate for Payer: Cofinity Commercial |
$5,250.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,918.27
|
| Rate for Payer: Mclaren Medicaid |
$2,560.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,114.18
|
| Rate for Payer: Meridian Medicaid |
$2,688.94
|
| Rate for Payer: Nomi Health Commercial |
$4,701.92
|
| Rate for Payer: PACE SWMI |
$3,918.27
|
| Rate for Payer: PHP Medicare Advantage |
$3,918.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,560.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,995.90
|
| Rate for Payer: Priority Health HMO/PPO |
$6,391.47
|
| Rate for Payer: Priority Health Medicare |
$3,957.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,391.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,918.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,918.27
|
| Rate for Payer: UHC Exchange |
$3,918.27
|
| Rate for Payer: UHC Medicare Advantage |
$3,918.27
|
| Rate for Payer: UHCCP Medicaid |
$2,560.90
|
|
|
PR REPAIR CARDIAC WOUND W/O BYPASS
|
Professional
|
Both
|
$4,597.00
|
|
|
Service Code
|
HCPCS 33300
|
| Min. Negotiated Rate |
$1,537.22 |
| Max. Negotiated Rate |
$3,818.50 |
| Rate for Payer: Aetna Commercial |
$3,144.97
|
| Rate for Payer: Aetna Medicare |
$2,440.87
|
| Rate for Payer: BCBS Complete |
$1,614.08
|
| Rate for Payer: BCBS MAPPO |
$2,346.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,283.84
|
| Rate for Payer: BCN Commercial |
$3,485.73
|
| Rate for Payer: BCN Medicare Advantage |
$2,346.99
|
| Rate for Payer: Cash Price |
$3,677.60
|
| Rate for Payer: Cash Price |
$3,677.60
|
| Rate for Payer: Cofinity Commercial |
$3,379.67
|
| Rate for Payer: Cofinity Commercial |
$3,144.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,346.99
|
| Rate for Payer: Mclaren Medicaid |
$1,537.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,464.34
|
| Rate for Payer: Meridian Medicaid |
$1,614.08
|
| Rate for Payer: Nomi Health Commercial |
$2,816.39
|
| Rate for Payer: PACE SWMI |
$2,346.99
|
| Rate for Payer: PHP Medicare Advantage |
$2,346.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,537.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,988.05
|
| Rate for Payer: Priority Health HMO/PPO |
$3,818.50
|
| Rate for Payer: Priority Health Medicare |
$2,370.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,818.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,346.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,346.99
|
| Rate for Payer: UHC Exchange |
$2,346.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,346.99
|
| Rate for Payer: UHCCP Medicaid |
$1,537.22
|
|
|
PR REPAIR CHOANAL ATRESIA INTRANASAL
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
HCPCS 30540
|
| Min. Negotiated Rate |
$472.43 |
| Max. Negotiated Rate |
$1,096.60 |
| Rate for Payer: Aetna Commercial |
$919.43
|
| Rate for Payer: Aetna Medicare |
$713.59
|
| Rate for Payer: BCBS Complete |
$496.05
|
| Rate for Payer: BCBS MAPPO |
$686.14
|
| Rate for Payer: BCBS Trust/PPO |
$614.94
|
| Rate for Payer: BCN Commercial |
$1,096.60
|
| Rate for Payer: BCN Medicare Advantage |
$686.14
|
| Rate for Payer: Cash Price |
$981.60
|
| Rate for Payer: Cash Price |
$981.60
|
| Rate for Payer: Cofinity Commercial |
$988.04
|
| Rate for Payer: Cofinity Commercial |
$919.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.14
|
| Rate for Payer: Mclaren Medicaid |
$472.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.45
|
| Rate for Payer: Meridian Medicaid |
$496.05
|
| Rate for Payer: Nomi Health Commercial |
$823.37
|
| Rate for Payer: PACE SWMI |
$686.14
|
| Rate for Payer: PHP Medicare Advantage |
$686.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.55
|
| Rate for Payer: Priority Health HMO/PPO |
$1,036.31
|
| Rate for Payer: Priority Health Medicare |
$693.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,036.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$686.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.14
|
| Rate for Payer: UHC Exchange |
$686.14
|
| Rate for Payer: UHC Medicare Advantage |
$686.14
|
| Rate for Payer: UHCCP Medicaid |
$472.43
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 13151
|
| Min. Negotiated Rate |
$177.86 |
| Max. Negotiated Rate |
$1,139.30 |
| Rate for Payer: Aetna Commercial |
$352.70
|
| Rate for Payer: Aetna Medicare |
$273.74
|
| Rate for Payer: BCBS Complete |
$186.75
|
| Rate for Payer: BCBS MAPPO |
$263.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,139.30
|
| Rate for Payer: BCN Commercial |
$622.09
|
| Rate for Payer: BCN Medicare Advantage |
$263.21
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cofinity Commercial |
$379.02
|
| Rate for Payer: Cofinity Commercial |
$352.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.21
|
| Rate for Payer: Mclaren Medicaid |
$177.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.37
|
| Rate for Payer: Meridian Medicaid |
$186.75
|
| Rate for Payer: Nomi Health Commercial |
$315.85
|
| Rate for Payer: PACE SWMI |
$263.21
|
| Rate for Payer: PHP Medicare Advantage |
$263.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$177.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.20
|
| Rate for Payer: Priority Health HMO/PPO |
$373.86
|
| Rate for Payer: Priority Health Medicare |
$265.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$373.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.21
|
| Rate for Payer: UHC Exchange |
$263.21
|
| Rate for Payer: UHC Medicare Advantage |
$263.21
|
| Rate for Payer: UHCCP Medicaid |
$177.86
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Professional
|
Both
|
$1,232.00
|
|
|
Service Code
|
HCPCS 13152
|
| Min. Negotiated Rate |
$213.64 |
| Max. Negotiated Rate |
$2,272.50 |
| Rate for Payer: Aetna Commercial |
$423.92
|
| Rate for Payer: Aetna Medicare |
$329.01
|
| Rate for Payer: BCBS Complete |
$224.32
|
| Rate for Payer: BCBS MAPPO |
$316.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,272.50
|
| Rate for Payer: BCN Commercial |
$729.10
|
| Rate for Payer: BCN Medicare Advantage |
$316.36
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cofinity Commercial |
$455.56
|
| Rate for Payer: Cofinity Commercial |
$423.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.36
|
| Rate for Payer: Mclaren Medicaid |
$213.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.18
|
| Rate for Payer: Meridian Medicaid |
$224.32
|
| Rate for Payer: Nomi Health Commercial |
$379.63
|
| Rate for Payer: PACE SWMI |
$316.36
|
| Rate for Payer: PHP Medicare Advantage |
$316.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$800.80
|
| Rate for Payer: Priority Health HMO/PPO |
$450.61
|
| Rate for Payer: Priority Health Medicare |
$319.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$450.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.36
|
| Rate for Payer: UHC Exchange |
$316.36
|
| Rate for Payer: UHC Medicare Advantage |
$316.36
|
| Rate for Payer: UHCCP Medicaid |
$213.64
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 13131
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$570.29 |
| Rate for Payer: Aetna Commercial |
$307.30
|
| Rate for Payer: Aetna Medicare |
$238.50
|
| Rate for Payer: BCBS Complete |
$162.81
|
| Rate for Payer: BCBS MAPPO |
$229.33
|
| Rate for Payer: BCBS Trust/PPO |
$5.64
|
| Rate for Payer: BCN Commercial |
$570.29
|
| Rate for Payer: BCN Medicare Advantage |
$229.33
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cofinity Commercial |
$330.24
|
| Rate for Payer: Cofinity Commercial |
$307.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.33
|
| Rate for Payer: Mclaren Medicaid |
$155.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.80
|
| Rate for Payer: Meridian Medicaid |
$162.81
|
| Rate for Payer: Nomi Health Commercial |
$275.20
|
| Rate for Payer: PACE SWMI |
$229.33
|
| Rate for Payer: PHP Medicare Advantage |
$229.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.25
|
| Rate for Payer: Priority Health HMO/PPO |
$325.54
|
| Rate for Payer: Priority Health Medicare |
$231.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.33
|
| Rate for Payer: UHC Exchange |
$229.33
|
| Rate for Payer: UHC Medicare Advantage |
$229.33
|
| Rate for Payer: UHCCP Medicaid |
$155.06
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Professional
|
Both
|
$1,306.00
|
|
|
Service Code
|
HCPCS 13132
|
| Min. Negotiated Rate |
$192.98 |
| Max. Negotiated Rate |
$848.90 |
| Rate for Payer: Aetna Commercial |
$382.44
|
| Rate for Payer: Aetna Medicare |
$296.82
|
| Rate for Payer: BCBS Complete |
$202.63
|
| Rate for Payer: BCBS MAPPO |
$285.40
|
| Rate for Payer: BCBS Trust/PPO |
$349.63
|
| Rate for Payer: BCN Commercial |
$691.96
|
| Rate for Payer: BCN Medicare Advantage |
$285.40
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Cofinity Commercial |
$410.98
|
| Rate for Payer: Cofinity Commercial |
$382.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.40
|
| Rate for Payer: Mclaren Medicaid |
$192.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$299.67
|
| Rate for Payer: Meridian Medicaid |
$202.63
|
| Rate for Payer: Nomi Health Commercial |
$342.48
|
| Rate for Payer: PACE SWMI |
$285.40
|
| Rate for Payer: PHP Medicare Advantage |
$285.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.90
|
| Rate for Payer: Priority Health HMO/PPO |
$406.37
|
| Rate for Payer: Priority Health Medicare |
$288.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$406.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.40
|
| Rate for Payer: UHC Exchange |
$285.40
|
| Rate for Payer: UHC Medicare Advantage |
$285.40
|
| Rate for Payer: UHCCP Medicaid |
$192.98
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 13133
|
| Min. Negotiated Rate |
$79.45 |
| Max. Negotiated Rate |
$1,316.25 |
| Rate for Payer: Aetna Commercial |
$158.91
|
| Rate for Payer: Aetna Medicare |
$123.33
|
| Rate for Payer: BCBS Complete |
$83.42
|
| Rate for Payer: BCBS MAPPO |
$118.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,316.25
|
| Rate for Payer: BCN Commercial |
$245.80
|
| Rate for Payer: BCN Medicare Advantage |
$118.59
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$170.77
|
| Rate for Payer: Cofinity Commercial |
$158.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.59
|
| Rate for Payer: Mclaren Medicaid |
$79.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.52
|
| Rate for Payer: Meridian Medicaid |
$83.42
|
| Rate for Payer: Nomi Health Commercial |
$142.31
|
| Rate for Payer: PACE SWMI |
$118.59
|
| Rate for Payer: PHP Medicare Advantage |
$118.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health HMO/PPO |
$167.96
|
| Rate for Payer: Priority Health Medicare |
$119.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.59
|
| Rate for Payer: UHC Exchange |
$118.59
|
| Rate for Payer: UHC Medicare Advantage |
$118.59
|
| Rate for Payer: UHCCP Medicaid |
$79.45
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
HCPCS 13120
|
| Min. Negotiated Rate |
$84.02 |
| Max. Negotiated Rate |
$522.88 |
| Rate for Payer: Aetna Commercial |
$290.65
|
| Rate for Payer: Aetna Medicare |
$225.58
|
| Rate for Payer: BCBS Complete |
$154.99
|
| Rate for Payer: BCBS MAPPO |
$216.90
|
| Rate for Payer: BCBS Trust/PPO |
$84.02
|
| Rate for Payer: BCN Commercial |
$522.88
|
| Rate for Payer: BCN Medicare Advantage |
$216.90
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cofinity Commercial |
$312.34
|
| Rate for Payer: Cofinity Commercial |
$290.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.90
|
| Rate for Payer: Mclaren Medicaid |
$147.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.74
|
| Rate for Payer: Meridian Medicaid |
$154.99
|
| Rate for Payer: Nomi Health Commercial |
$260.28
|
| Rate for Payer: PACE SWMI |
$216.90
|
| Rate for Payer: PHP Medicare Advantage |
$216.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.55
|
| Rate for Payer: Priority Health HMO/PPO |
$312.00
|
| Rate for Payer: Priority Health Medicare |
$219.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$312.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.90
|
| Rate for Payer: UHC Exchange |
$216.90
|
| Rate for Payer: UHC Medicare Advantage |
$216.90
|
| Rate for Payer: UHCCP Medicaid |
$147.61
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
HCPCS 13121
|
| Min. Negotiated Rate |
$165.08 |
| Max. Negotiated Rate |
$624.53 |
| Rate for Payer: Aetna Commercial |
$327.01
|
| Rate for Payer: Aetna Medicare |
$253.80
|
| Rate for Payer: BCBS Complete |
$173.33
|
| Rate for Payer: BCBS MAPPO |
$244.04
|
| Rate for Payer: BCBS Trust/PPO |
$347.82
|
| Rate for Payer: BCN Commercial |
$624.53
|
| Rate for Payer: BCN Medicare Advantage |
$244.04
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$351.42
|
| Rate for Payer: Cofinity Commercial |
$327.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.04
|
| Rate for Payer: Mclaren Medicaid |
$165.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.24
|
| Rate for Payer: Meridian Medicaid |
$173.33
|
| Rate for Payer: Nomi Health Commercial |
$292.85
|
| Rate for Payer: PACE SWMI |
$244.04
|
| Rate for Payer: PHP Medicare Advantage |
$244.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health HMO/PPO |
$346.77
|
| Rate for Payer: Priority Health Medicare |
$246.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$346.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.04
|
| Rate for Payer: UHC Exchange |
$244.04
|
| Rate for Payer: UHC Medicare Advantage |
$244.04
|
| Rate for Payer: UHCCP Medicaid |
$165.08
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
13121
|
| Min. Negotiated Rate |
$165.08 |
| Max. Negotiated Rate |
$624.53 |
| Rate for Payer: Aetna Commercial |
$327.01
|
| Rate for Payer: Aetna Medicare |
$253.80
|
| Rate for Payer: BCBS Complete |
$173.33
|
| Rate for Payer: BCBS MAPPO |
$244.04
|
| Rate for Payer: BCBS Trust/PPO |
$347.82
|
| Rate for Payer: BCN Commercial |
$624.53
|
| Rate for Payer: BCN Medicare Advantage |
$244.04
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$351.42
|
| Rate for Payer: Cofinity Commercial |
$327.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.04
|
| Rate for Payer: Mclaren Medicaid |
$165.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.24
|
| Rate for Payer: Meridian Medicaid |
$173.33
|
| Rate for Payer: Nomi Health Commercial |
$292.85
|
| Rate for Payer: PACE SWMI |
$244.04
|
| Rate for Payer: PHP Medicare Advantage |
$244.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health HMO/PPO |
$346.77
|
| Rate for Payer: Priority Health Medicare |
$246.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$346.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.04
|
| Rate for Payer: UHC Exchange |
$244.04
|
| Rate for Payer: UHC Medicare Advantage |
$244.04
|
| Rate for Payer: UHCCP Medicaid |
$165.08
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$583.70 |
| Max. Negotiated Rate |
$808.20 |
| Rate for Payer: Aetna Commercial |
$763.30
|
| Rate for Payer: BCBS Trust/PPO |
$733.04
|
| Rate for Payer: BCN Commercial |
$693.97
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$772.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$718.40
|
| Rate for Payer: Healthscope Commercial |
$808.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$673.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$763.30
|
| Rate for Payer: Nomi Health Commercial |
$736.36
|
| Rate for Payer: PHP Commercial |
$763.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health HMO/PPO |
$781.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$601.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$790.24
|
| Rate for Payer: UHC Core |
$749.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$673.50
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$213.28 |
| Max. Negotiated Rate |
$808.20 |
| Rate for Payer: Aetna Commercial |
$763.30
|
| Rate for Payer: Aetna Medicare |
$233.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$280.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$280.62
|
| Rate for Payer: BCBS Complete |
$455.33
|
| Rate for Payer: BCBS MAPPO |
$224.50
|
| Rate for Payer: BCBS Trust/PPO |
$738.25
|
| Rate for Payer: BCN Commercial |
$698.20
|
| Rate for Payer: BCN Medicare Advantage |
$224.50
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$772.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$718.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$224.50
|
| Rate for Payer: Healthscope Commercial |
$808.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$673.50
|
| Rate for Payer: Mclaren Medicaid |
$433.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$235.72
|
| Rate for Payer: Meridian Medicaid |
$455.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$258.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$763.30
|
| Rate for Payer: Nomi Health Commercial |
$736.36
|
| Rate for Payer: PACE Senior Care Partners |
$213.28
|
| Rate for Payer: PACE SWMI |
$224.50
|
| Rate for Payer: PHP Commercial |
$763.30
|
| Rate for Payer: PHP Medicare Advantage |
$224.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$433.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health HMO/PPO |
$781.26
|
| Rate for Payer: Priority Health Medicare |
$226.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$601.66
|
| Rate for Payer: Railroad Medicare Medicare |
$224.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$790.24
|
| Rate for Payer: UHC Core |
$749.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$224.50
|
| Rate for Payer: UHC Exchange |
$224.50
|
| Rate for Payer: UHC Medicare Advantage |
$224.50
|
| Rate for Payer: UHCCP Medicaid |
$433.62
|
| Rate for Payer: VA VA |
$224.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$673.50
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$66.74 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna Commercial |
$238.85
|
| Rate for Payer: Aetna Medicare |
$73.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.81
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS MAPPO |
$70.25
|
| Rate for Payer: BCBS Trust/PPO |
$231.01
|
| Rate for Payer: BCN Commercial |
$218.48
|
| Rate for Payer: BCN Medicare Advantage |
$70.25
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$241.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.25
|
| Rate for Payer: Healthscope Commercial |
$252.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.85
|
| Rate for Payer: Nomi Health Commercial |
$230.42
|
| Rate for Payer: PACE Senior Care Partners |
$66.74
|
| Rate for Payer: PACE SWMI |
$70.25
|
| Rate for Payer: PHP Commercial |
$238.85
|
| Rate for Payer: PHP Medicare Advantage |
$70.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health HMO/PPO |
$244.47
|
| Rate for Payer: Priority Health Medicare |
$70.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.27
|
| Rate for Payer: Railroad Medicare Medicare |
$70.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.28
|
| Rate for Payer: UHC Core |
$234.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.25
|
| Rate for Payer: UHC Exchange |
$70.25
|
| Rate for Payer: UHC Medicare Advantage |
$70.25
|
| Rate for Payer: VA VA |
$70.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.75
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$182.65 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna Commercial |
$238.85
|
| Rate for Payer: BCBS Trust/PPO |
$229.38
|
| Rate for Payer: BCN Commercial |
$217.16
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$241.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Healthscope Commercial |
$252.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.85
|
| Rate for Payer: Nomi Health Commercial |
$230.42
|
| Rate for Payer: PHP Commercial |
$238.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health HMO/PPO |
$244.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.28
|
| Rate for Payer: UHC Core |
$234.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.75
|
|
