|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 13122
|
| Hospital Charge Code |
13122
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$377.55 |
| Rate for Payer: Aetna Commercial |
$104.68
|
| Rate for Payer: Aetna Medicare |
$81.24
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$78.12
|
| Rate for Payer: BCBS Trust/PPO |
$377.55
|
| Rate for Payer: BCN Commercial |
$186.67
|
| Rate for Payer: BCN Medicare Advantage |
$78.12
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$112.49
|
| Rate for Payer: Cofinity Commercial |
$104.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.12
|
| Rate for Payer: Mclaren Medicaid |
$52.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.03
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Nomi Health Commercial |
$93.74
|
| Rate for Payer: PACE SWMI |
$78.12
|
| Rate for Payer: PHP Medicare Advantage |
$78.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health HMO/PPO |
$110.62
|
| Rate for Payer: Priority Health Medicare |
$78.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.12
|
| Rate for Payer: UHC Exchange |
$78.12
|
| Rate for Payer: UHC Medicare Advantage |
$78.12
|
| Rate for Payer: UHCCP Medicaid |
$52.19
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 13122
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$377.55 |
| Rate for Payer: Aetna Commercial |
$104.68
|
| Rate for Payer: Aetna Medicare |
$81.24
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$78.12
|
| Rate for Payer: BCBS Trust/PPO |
$377.55
|
| Rate for Payer: BCN Commercial |
$186.67
|
| Rate for Payer: BCN Medicare Advantage |
$78.12
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$112.49
|
| Rate for Payer: Cofinity Commercial |
$104.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.12
|
| Rate for Payer: Mclaren Medicaid |
$52.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.03
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Nomi Health Commercial |
$93.74
|
| Rate for Payer: PACE SWMI |
$78.12
|
| Rate for Payer: PHP Medicare Advantage |
$78.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health HMO/PPO |
$110.62
|
| Rate for Payer: Priority Health Medicare |
$78.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.12
|
| Rate for Payer: UHC Exchange |
$78.12
|
| Rate for Payer: UHC Medicare Advantage |
$78.12
|
| Rate for Payer: UHCCP Medicaid |
$52.19
|
|
|
PR REPAIR COMPLEX TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
HCPCS 13100
|
| Min. Negotiated Rate |
$128.65 |
| Max. Negotiated Rate |
$501.39 |
| Rate for Payer: Aetna Commercial |
$254.51
|
| Rate for Payer: Aetna Medicare |
$197.53
|
| Rate for Payer: BCBS Complete |
$135.08
|
| Rate for Payer: BCBS MAPPO |
$189.93
|
| Rate for Payer: BCBS Trust/PPO |
$293.06
|
| Rate for Payer: BCN Commercial |
$501.39
|
| Rate for Payer: BCN Medicare Advantage |
$189.93
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cofinity Commercial |
$273.50
|
| Rate for Payer: Cofinity Commercial |
$254.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.93
|
| Rate for Payer: Mclaren Medicaid |
$128.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.43
|
| Rate for Payer: Meridian Medicaid |
$135.08
|
| Rate for Payer: Nomi Health Commercial |
$227.92
|
| Rate for Payer: PACE SWMI |
$189.93
|
| Rate for Payer: PHP Medicare Advantage |
$189.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.80
|
| Rate for Payer: Priority Health HMO/PPO |
$270.01
|
| Rate for Payer: Priority Health Medicare |
$191.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$270.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.93
|
| Rate for Payer: UHC Exchange |
$189.93
|
| Rate for Payer: UHC Medicare Advantage |
$189.93
|
| Rate for Payer: UHCCP Medicaid |
$128.65
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 13101
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$583.97 |
| Rate for Payer: Aetna Commercial |
$310.59
|
| Rate for Payer: Aetna Medicare |
$241.05
|
| Rate for Payer: BCBS Complete |
$165.50
|
| Rate for Payer: BCBS MAPPO |
$231.78
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$583.97
|
| Rate for Payer: BCN Medicare Advantage |
$231.78
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$333.76
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.78
|
| Rate for Payer: Mclaren Medicaid |
$157.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.37
|
| Rate for Payer: Meridian Medicaid |
$165.50
|
| Rate for Payer: Nomi Health Commercial |
$278.14
|
| Rate for Payer: PACE SWMI |
$231.78
|
| Rate for Payer: PHP Medicare Advantage |
$231.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health HMO/PPO |
$332.32
|
| Rate for Payer: Priority Health Medicare |
$234.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$332.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.78
|
| Rate for Payer: UHC Exchange |
$231.78
|
| Rate for Payer: UHC Medicare Advantage |
$231.78
|
| Rate for Payer: UHCCP Medicaid |
$157.62
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$583.97 |
| Rate for Payer: Aetna Commercial |
$310.59
|
| Rate for Payer: Aetna Medicare |
$241.05
|
| Rate for Payer: BCBS Complete |
$165.50
|
| Rate for Payer: BCBS MAPPO |
$231.78
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$583.97
|
| Rate for Payer: BCN Medicare Advantage |
$231.78
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$333.76
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.78
|
| Rate for Payer: Mclaren Medicaid |
$157.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.37
|
| Rate for Payer: Meridian Medicaid |
$165.50
|
| Rate for Payer: Nomi Health Commercial |
$278.14
|
| Rate for Payer: PACE SWMI |
$231.78
|
| Rate for Payer: PHP Medicare Advantage |
$231.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health HMO/PPO |
$332.32
|
| Rate for Payer: Priority Health Medicare |
$234.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$332.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.78
|
| Rate for Payer: UHC Exchange |
$231.78
|
| Rate for Payer: UHC Medicare Advantage |
$231.78
|
| Rate for Payer: UHCCP Medicaid |
$157.62
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$432.90 |
| Max. Negotiated Rate |
$599.40 |
| Rate for Payer: Aetna Commercial |
$566.10
|
| Rate for Payer: BCBS Trust/PPO |
$543.66
|
| Rate for Payer: BCN Commercial |
$514.68
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$572.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.80
|
| Rate for Payer: Healthscope Commercial |
$599.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$499.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.10
|
| Rate for Payer: Nomi Health Commercial |
$546.12
|
| Rate for Payer: PHP Commercial |
$566.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health HMO/PPO |
$579.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$446.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$586.08
|
| Rate for Payer: UHC Core |
$556.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$499.50
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$158.18 |
| Max. Negotiated Rate |
$599.40 |
| Rate for Payer: Aetna Commercial |
$566.10
|
| Rate for Payer: Aetna Medicare |
$173.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$208.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$208.12
|
| Rate for Payer: BCBS Complete |
$455.33
|
| Rate for Payer: BCBS MAPPO |
$166.50
|
| Rate for Payer: BCBS Trust/PPO |
$547.52
|
| Rate for Payer: BCN Commercial |
$517.82
|
| Rate for Payer: BCN Medicare Advantage |
$166.50
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$572.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.50
|
| Rate for Payer: Healthscope Commercial |
$599.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$499.50
|
| Rate for Payer: Mclaren Medicaid |
$433.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.82
|
| Rate for Payer: Meridian Medicaid |
$455.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.10
|
| Rate for Payer: Nomi Health Commercial |
$546.12
|
| Rate for Payer: PACE Senior Care Partners |
$158.18
|
| Rate for Payer: PACE SWMI |
$166.50
|
| Rate for Payer: PHP Commercial |
$566.10
|
| Rate for Payer: PHP Medicare Advantage |
$166.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$433.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health HMO/PPO |
$579.42
|
| Rate for Payer: Priority Health Medicare |
$168.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$446.22
|
| Rate for Payer: Railroad Medicare Medicare |
$166.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$586.08
|
| Rate for Payer: UHC Core |
$556.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.50
|
| Rate for Payer: UHC Exchange |
$166.50
|
| Rate for Payer: UHC Medicare Advantage |
$166.50
|
| Rate for Payer: UHCCP Medicaid |
$433.62
|
| Rate for Payer: VA VA |
$166.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$499.50
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$49.64 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Medicare |
$54.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.31
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS MAPPO |
$52.25
|
| Rate for Payer: BCBS Trust/PPO |
$171.82
|
| Rate for Payer: BCN Commercial |
$162.50
|
| Rate for Payer: BCN Medicare Advantage |
$52.25
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.25
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: Nomi Health Commercial |
$171.38
|
| Rate for Payer: PACE Senior Care Partners |
$49.64
|
| Rate for Payer: PACE SWMI |
$52.25
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: PHP Medicare Advantage |
$52.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO |
$181.83
|
| Rate for Payer: Priority Health Medicare |
$52.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.03
|
| Rate for Payer: Railroad Medicare Medicare |
$52.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.92
|
| Rate for Payer: UHC Core |
$174.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.25
|
| Rate for Payer: UHC Exchange |
$52.25
|
| Rate for Payer: UHC Medicare Advantage |
$52.25
|
| Rate for Payer: VA VA |
$52.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$483.39 |
| Rate for Payer: Aetna Commercial |
$91.56
|
| Rate for Payer: Aetna Medicare |
$71.06
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS MAPPO |
$68.33
|
| Rate for Payer: BCBS Trust/PPO |
$483.39
|
| Rate for Payer: BCN Commercial |
$171.04
|
| Rate for Payer: BCN Medicare Advantage |
$68.33
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$91.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.33
|
| Rate for Payer: Mclaren Medicaid |
$45.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.75
|
| Rate for Payer: Meridian Medicaid |
$47.86
|
| Rate for Payer: Nomi Health Commercial |
$82.00
|
| Rate for Payer: PACE SWMI |
$68.33
|
| Rate for Payer: PHP Medicare Advantage |
$68.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO |
$96.17
|
| Rate for Payer: Priority Health Medicare |
$69.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.33
|
| Rate for Payer: UHC Exchange |
$68.33
|
| Rate for Payer: UHC Medicare Advantage |
$68.33
|
| Rate for Payer: UHCCP Medicaid |
$45.58
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 13102
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$483.39 |
| Rate for Payer: Aetna Commercial |
$91.56
|
| Rate for Payer: Aetna Medicare |
$71.06
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS MAPPO |
$68.33
|
| Rate for Payer: BCBS Trust/PPO |
$483.39
|
| Rate for Payer: BCN Commercial |
$171.04
|
| Rate for Payer: BCN Medicare Advantage |
$68.33
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$91.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.33
|
| Rate for Payer: Mclaren Medicaid |
$45.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.75
|
| Rate for Payer: Meridian Medicaid |
$47.86
|
| Rate for Payer: Nomi Health Commercial |
$82.00
|
| Rate for Payer: PACE SWMI |
$68.33
|
| Rate for Payer: PHP Medicare Advantage |
$68.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO |
$96.17
|
| Rate for Payer: Priority Health Medicare |
$69.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.33
|
| Rate for Payer: UHC Exchange |
$68.33
|
| Rate for Payer: UHC Medicare Advantage |
$68.33
|
| Rate for Payer: UHCCP Medicaid |
$45.58
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$135.85 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: BCBS Trust/PPO |
$170.61
|
| Rate for Payer: BCN Commercial |
$161.52
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: Nomi Health Commercial |
$171.38
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO |
$181.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.92
|
| Rate for Payer: UHC Core |
$174.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
PR REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS 13153
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$307.45 |
| Rate for Payer: Aetna Commercial |
$175.39
|
| Rate for Payer: Aetna Medicare |
$136.13
|
| Rate for Payer: BCBS Complete |
$91.70
|
| Rate for Payer: BCBS MAPPO |
$130.89
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$271.70
|
| Rate for Payer: BCN Medicare Advantage |
$130.89
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cofinity Commercial |
$188.48
|
| Rate for Payer: Cofinity Commercial |
$175.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.89
|
| Rate for Payer: Mclaren Medicaid |
$87.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.43
|
| Rate for Payer: Meridian Medicaid |
$91.70
|
| Rate for Payer: Nomi Health Commercial |
$157.07
|
| Rate for Payer: PACE SWMI |
$130.89
|
| Rate for Payer: PHP Medicare Advantage |
$130.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.45
|
| Rate for Payer: Priority Health HMO/PPO |
$182.86
|
| Rate for Payer: Priority Health Medicare |
$132.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.89
|
| Rate for Payer: UHC Exchange |
$130.89
|
| Rate for Payer: UHC Medicare Advantage |
$130.89
|
| Rate for Payer: UHCCP Medicaid |
$87.33
|
|
|
PR REPAIR CONGENITAL AV FISTULA EXTREMITIES
|
Professional
|
Both
|
$4,223.00
|
|
|
Service Code
|
HCPCS 35184
|
| Min. Negotiated Rate |
$604.49 |
| Max. Negotiated Rate |
$2,744.95 |
| Rate for Payer: Aetna Commercial |
$1,245.81
|
| Rate for Payer: Aetna Medicare |
$966.90
|
| Rate for Payer: BCBS Complete |
$634.71
|
| Rate for Payer: BCBS MAPPO |
$929.71
|
| Rate for Payer: BCBS Trust/PPO |
$669.36
|
| Rate for Payer: BCN Commercial |
$1,376.60
|
| Rate for Payer: BCN Medicare Advantage |
$929.71
|
| Rate for Payer: Cash Price |
$3,378.40
|
| Rate for Payer: Cash Price |
$3,378.40
|
| Rate for Payer: Cofinity Commercial |
$1,338.78
|
| Rate for Payer: Cofinity Commercial |
$1,245.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$929.71
|
| Rate for Payer: Mclaren Medicaid |
$604.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$976.20
|
| Rate for Payer: Meridian Medicaid |
$634.71
|
| Rate for Payer: Nomi Health Commercial |
$1,115.65
|
| Rate for Payer: PACE SWMI |
$929.71
|
| Rate for Payer: PHP Medicare Advantage |
$929.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$604.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,744.95
|
| Rate for Payer: Priority Health HMO/PPO |
$1,505.07
|
| Rate for Payer: Priority Health Medicare |
$939.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,505.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$929.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$929.71
|
| Rate for Payer: UHC Exchange |
$929.71
|
| Rate for Payer: UHC Medicare Advantage |
$929.71
|
| Rate for Payer: UHCCP Medicaid |
$604.49
|
|
|
PR REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA
|
Professional
|
Both
|
$1,951.00
|
|
|
Service Code
|
HCPCS 25425
|
| Min. Negotiated Rate |
$517.47 |
| Max. Negotiated Rate |
$1,484.86 |
| Rate for Payer: Aetna Commercial |
$1,245.92
|
| Rate for Payer: Aetna Medicare |
$966.98
|
| Rate for Payer: BCBS Complete |
$657.75
|
| Rate for Payer: BCBS MAPPO |
$929.79
|
| Rate for Payer: BCBS Trust/PPO |
$517.47
|
| Rate for Payer: BCN Commercial |
$1,415.70
|
| Rate for Payer: BCN Medicare Advantage |
$929.79
|
| Rate for Payer: Cash Price |
$1,560.80
|
| Rate for Payer: Cash Price |
$1,560.80
|
| Rate for Payer: Cofinity Commercial |
$1,338.90
|
| Rate for Payer: Cofinity Commercial |
$1,245.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$929.79
|
| Rate for Payer: Mclaren Medicaid |
$626.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$976.28
|
| Rate for Payer: Meridian Medicaid |
$657.75
|
| Rate for Payer: Nomi Health Commercial |
$1,115.75
|
| Rate for Payer: PACE SWMI |
$929.79
|
| Rate for Payer: PHP Medicare Advantage |
$929.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$626.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,268.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,484.86
|
| Rate for Payer: Priority Health Medicare |
$939.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,484.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$929.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$929.79
|
| Rate for Payer: UHC Exchange |
$929.79
|
| Rate for Payer: UHC Medicare Advantage |
$929.79
|
| Rate for Payer: UHCCP Medicaid |
$626.43
|
|
|
PR REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT
|
Professional
|
Both
|
$2,169.00
|
|
|
Service Code
|
HCPCS 27676
|
| Min. Negotiated Rate |
$397.67 |
| Max. Negotiated Rate |
$3,872.44 |
| Rate for Payer: Aetna Commercial |
$787.58
|
| Rate for Payer: Aetna Medicare |
$611.26
|
| Rate for Payer: BCBS Complete |
$417.55
|
| Rate for Payer: BCBS MAPPO |
$587.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,872.44
|
| Rate for Payer: BCN Commercial |
$889.88
|
| Rate for Payer: BCN Medicare Advantage |
$587.75
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cofinity Commercial |
$846.36
|
| Rate for Payer: Cofinity Commercial |
$787.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$587.75
|
| Rate for Payer: Mclaren Medicaid |
$397.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$617.14
|
| Rate for Payer: Meridian Medicaid |
$417.55
|
| Rate for Payer: Nomi Health Commercial |
$705.30
|
| Rate for Payer: PACE SWMI |
$587.75
|
| Rate for Payer: PHP Medicare Advantage |
$587.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$397.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,409.85
|
| Rate for Payer: Priority Health HMO/PPO |
$941.39
|
| Rate for Payer: Priority Health Medicare |
$593.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$941.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$587.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$587.75
|
| Rate for Payer: UHC Exchange |
$587.75
|
| Rate for Payer: UHC Medicare Advantage |
$587.75
|
| Rate for Payer: UHCCP Medicaid |
$397.67
|
|
|
PR REPAIR ECTROPION EXTENSIVE
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 67917
|
| Min. Negotiated Rate |
$289.47 |
| Max. Negotiated Rate |
$908.94 |
| Rate for Payer: Aetna Commercial |
$565.17
|
| Rate for Payer: Aetna Medicare |
$438.64
|
| Rate for Payer: BCBS Complete |
$303.94
|
| Rate for Payer: BCBS MAPPO |
$421.77
|
| Rate for Payer: BCBS Trust/PPO |
$744.37
|
| Rate for Payer: BCN Commercial |
$908.94
|
| Rate for Payer: BCN Medicare Advantage |
$421.77
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cofinity Commercial |
$607.35
|
| Rate for Payer: Cofinity Commercial |
$565.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.77
|
| Rate for Payer: Mclaren Medicaid |
$289.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.86
|
| Rate for Payer: Meridian Medicaid |
$303.94
|
| Rate for Payer: Nomi Health Commercial |
$506.12
|
| Rate for Payer: PACE SWMI |
$421.77
|
| Rate for Payer: PHP Medicare Advantage |
$421.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$289.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$812.50
|
| Rate for Payer: Priority Health HMO/PPO |
$793.13
|
| Rate for Payer: Priority Health Medicare |
$425.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$793.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$421.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$421.77
|
| Rate for Payer: UHC Exchange |
$421.77
|
| Rate for Payer: UHC Medicare Advantage |
$421.77
|
| Rate for Payer: UHCCP Medicaid |
$289.47
|
|
|
PR REPAIR ENTEROCELE ABDOMINAL APPROACH SPX
|
Professional
|
Both
|
$2,063.00
|
|
|
Service Code
|
HCPCS 57270
|
| Min. Negotiated Rate |
$520.57 |
| Max. Negotiated Rate |
$2,459.24 |
| Rate for Payer: Aetna Commercial |
$1,042.55
|
| Rate for Payer: Aetna Medicare |
$809.14
|
| Rate for Payer: BCBS Complete |
$546.60
|
| Rate for Payer: BCBS MAPPO |
$778.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,459.24
|
| Rate for Payer: BCN Commercial |
$1,193.84
|
| Rate for Payer: BCN Medicare Advantage |
$778.02
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Cofinity Commercial |
$1,120.35
|
| Rate for Payer: Cofinity Commercial |
$1,042.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$778.02
|
| Rate for Payer: Mclaren Medicaid |
$520.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$816.92
|
| Rate for Payer: Meridian Medicaid |
$546.60
|
| Rate for Payer: Nomi Health Commercial |
$933.62
|
| Rate for Payer: PACE SWMI |
$778.02
|
| Rate for Payer: PHP Medicare Advantage |
$778.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$520.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,340.95
|
| Rate for Payer: Priority Health HMO/PPO |
$1,216.31
|
| Rate for Payer: Priority Health Medicare |
$785.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,216.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$778.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$778.02
|
| Rate for Payer: UHC Exchange |
$778.02
|
| Rate for Payer: UHC Medicare Advantage |
$778.02
|
| Rate for Payer: UHCCP Medicaid |
$520.57
|
|
|
PR REPAIR ENTEROCELE VAGINAL APPROACH SPX
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 57268
|
| Min. Negotiated Rate |
$325.89 |
| Max. Negotiated Rate |
$2,026.03 |
| Rate for Payer: Aetna Commercial |
$647.09
|
| Rate for Payer: Aetna Medicare |
$502.22
|
| Rate for Payer: BCBS Complete |
$342.18
|
| Rate for Payer: BCBS MAPPO |
$482.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,026.03
|
| Rate for Payer: BCN Commercial |
$744.75
|
| Rate for Payer: BCN Medicare Advantage |
$482.90
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$695.38
|
| Rate for Payer: Cofinity Commercial |
$647.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$482.90
|
| Rate for Payer: Mclaren Medicaid |
$325.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$507.04
|
| Rate for Payer: Meridian Medicaid |
$342.18
|
| Rate for Payer: Nomi Health Commercial |
$579.48
|
| Rate for Payer: PACE SWMI |
$482.90
|
| Rate for Payer: PHP Medicare Advantage |
$482.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health HMO/PPO |
$760.44
|
| Rate for Payer: Priority Health Medicare |
$487.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$760.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$482.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$482.90
|
| Rate for Payer: UHC Exchange |
$482.90
|
| Rate for Payer: UHC Medicare Advantage |
$482.90
|
| Rate for Payer: UHCCP Medicaid |
$325.89
|
|
|
PR REPAIR ENTROPION SUTURE
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
HCPCS 67921
|
| Min. Negotiated Rate |
$198.94 |
| Max. Negotiated Rate |
$697.83 |
| Rate for Payer: Aetna Commercial |
$385.37
|
| Rate for Payer: Aetna Medicare |
$299.09
|
| Rate for Payer: BCBS Complete |
$208.89
|
| Rate for Payer: BCBS MAPPO |
$287.59
|
| Rate for Payer: BCBS Trust/PPO |
$584.83
|
| Rate for Payer: BCN Commercial |
$697.83
|
| Rate for Payer: BCN Medicare Advantage |
$287.59
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cofinity Commercial |
$414.13
|
| Rate for Payer: Cofinity Commercial |
$385.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.59
|
| Rate for Payer: Mclaren Medicaid |
$198.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$301.97
|
| Rate for Payer: Meridian Medicaid |
$208.89
|
| Rate for Payer: Nomi Health Commercial |
$345.11
|
| Rate for Payer: PACE SWMI |
$287.59
|
| Rate for Payer: PHP Medicare Advantage |
$287.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.10
|
| Rate for Payer: Priority Health HMO/PPO |
$545.71
|
| Rate for Payer: Priority Health Medicare |
$290.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$545.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.59
|
| Rate for Payer: UHC Exchange |
$287.59
|
| Rate for Payer: UHC Medicare Advantage |
$287.59
|
| Rate for Payer: UHCCP Medicaid |
$198.94
|
|
|
PR REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 26433
|
| Min. Negotiated Rate |
$330.19 |
| Max. Negotiated Rate |
$902.20 |
| Rate for Payer: Aetna Commercial |
$710.45
|
| Rate for Payer: Aetna Medicare |
$551.40
|
| Rate for Payer: BCBS Complete |
$386.46
|
| Rate for Payer: BCBS MAPPO |
$530.19
|
| Rate for Payer: BCBS Trust/PPO |
$330.19
|
| Rate for Payer: BCN Commercial |
$854.70
|
| Rate for Payer: BCN Medicare Advantage |
$530.19
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$763.47
|
| Rate for Payer: Cofinity Commercial |
$710.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.19
|
| Rate for Payer: Mclaren Medicaid |
$368.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$556.70
|
| Rate for Payer: Meridian Medicaid |
$386.46
|
| Rate for Payer: Nomi Health Commercial |
$636.23
|
| Rate for Payer: PACE SWMI |
$530.19
|
| Rate for Payer: PHP Medicare Advantage |
$530.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health HMO/PPO |
$885.93
|
| Rate for Payer: Priority Health Medicare |
$535.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$885.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$530.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$530.19
|
| Rate for Payer: UHC Exchange |
$530.19
|
| Rate for Payer: UHC Medicare Advantage |
$530.19
|
| Rate for Payer: UHCCP Medicaid |
$368.06
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH
|
Professional
|
Both
|
$1,788.00
|
|
|
Service Code
|
HCPCS 26420
|
| Min. Negotiated Rate |
$66.57 |
| Max. Negotiated Rate |
$1,162.20 |
| Rate for Payer: Aetna Commercial |
$925.65
|
| Rate for Payer: Aetna Medicare |
$718.41
|
| Rate for Payer: BCBS Complete |
$500.76
|
| Rate for Payer: BCBS MAPPO |
$690.78
|
| Rate for Payer: BCBS Trust/PPO |
$66.57
|
| Rate for Payer: BCN Commercial |
$1,105.38
|
| Rate for Payer: BCN Medicare Advantage |
$690.78
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cofinity Commercial |
$994.72
|
| Rate for Payer: Cofinity Commercial |
$925.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$690.78
|
| Rate for Payer: Mclaren Medicaid |
$476.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$725.32
|
| Rate for Payer: Meridian Medicaid |
$500.76
|
| Rate for Payer: Nomi Health Commercial |
$828.94
|
| Rate for Payer: PACE SWMI |
$690.78
|
| Rate for Payer: PHP Medicare Advantage |
$690.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,162.20
|
| Rate for Payer: Priority Health HMO/PPO |
$1,149.00
|
| Rate for Payer: Priority Health Medicare |
$697.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,149.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$690.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$690.78
|
| Rate for Payer: UHC Exchange |
$690.78
|
| Rate for Payer: UHC Medicare Advantage |
$690.78
|
| Rate for Payer: UHCCP Medicaid |
$476.91
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH
|
Professional
|
Both
|
$1,309.00
|
|
|
Service Code
|
HCPCS 26418
|
| Min. Negotiated Rate |
$132.08 |
| Max. Negotiated Rate |
$968.86 |
| Rate for Payer: Aetna Commercial |
$772.68
|
| Rate for Payer: Aetna Medicare |
$599.70
|
| Rate for Payer: BCBS Complete |
$422.48
|
| Rate for Payer: BCBS MAPPO |
$576.63
|
| Rate for Payer: BCBS Trust/PPO |
$132.08
|
| Rate for Payer: BCN Commercial |
$930.93
|
| Rate for Payer: BCN Medicare Advantage |
$576.63
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cofinity Commercial |
$830.35
|
| Rate for Payer: Cofinity Commercial |
$772.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$576.63
|
| Rate for Payer: Mclaren Medicaid |
$402.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$605.46
|
| Rate for Payer: Meridian Medicaid |
$422.48
|
| Rate for Payer: Nomi Health Commercial |
$691.96
|
| Rate for Payer: PACE SWMI |
$576.63
|
| Rate for Payer: PHP Medicare Advantage |
$576.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$402.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.85
|
| Rate for Payer: Priority Health HMO/PPO |
$968.86
|
| Rate for Payer: Priority Health Medicare |
$582.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$968.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$576.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$576.63
|
| Rate for Payer: UHC Exchange |
$576.63
|
| Rate for Payer: UHC Medicare Advantage |
$576.63
|
| Rate for Payer: UHCCP Medicaid |
$402.36
|
|
|
PR REPAIR EXTENSOR TENDON HAND W/GRAFT EACH
|
Professional
|
Both
|
$1,933.00
|
|
|
Service Code
|
HCPCS 26412
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$1,256.45 |
| Rate for Payer: Aetna Commercial |
$892.28
|
| Rate for Payer: Aetna Medicare |
$692.52
|
| Rate for Payer: BCBS Complete |
$483.30
|
| Rate for Payer: BCBS MAPPO |
$665.88
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: BCN Commercial |
$1,067.76
|
| Rate for Payer: BCN Medicare Advantage |
$665.88
|
| Rate for Payer: Cash Price |
$1,546.40
|
| Rate for Payer: Cash Price |
$1,546.40
|
| Rate for Payer: Cofinity Commercial |
$958.87
|
| Rate for Payer: Cofinity Commercial |
$892.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$665.88
|
| Rate for Payer: Mclaren Medicaid |
$460.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$699.17
|
| Rate for Payer: Meridian Medicaid |
$483.30
|
| Rate for Payer: Nomi Health Commercial |
$799.06
|
| Rate for Payer: PACE SWMI |
$665.88
|
| Rate for Payer: PHP Medicare Advantage |
$665.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,256.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,107.29
|
| Rate for Payer: Priority Health Medicare |
$672.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,107.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$665.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$665.88
|
| Rate for Payer: UHC Exchange |
$665.88
|
| Rate for Payer: UHC Medicare Advantage |
$665.88
|
| Rate for Payer: UHCCP Medicaid |
$460.29
|
|
|
PR REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH
|
Professional
|
Both
|
$1,257.00
|
|
|
Service Code
|
HCPCS 26410
|
| Min. Negotiated Rate |
$154.79 |
| Max. Negotiated Rate |
$931.72 |
| Rate for Payer: Aetna Commercial |
$745.98
|
| Rate for Payer: Aetna Medicare |
$578.97
|
| Rate for Payer: BCBS Complete |
$406.37
|
| Rate for Payer: BCBS MAPPO |
$556.70
|
| Rate for Payer: BCBS Trust/PPO |
$154.79
|
| Rate for Payer: BCN Commercial |
$897.21
|
| Rate for Payer: BCN Medicare Advantage |
$556.70
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Cofinity Commercial |
$801.65
|
| Rate for Payer: Cofinity Commercial |
$745.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$556.70
|
| Rate for Payer: Mclaren Medicaid |
$387.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$584.54
|
| Rate for Payer: Meridian Medicaid |
$406.37
|
| Rate for Payer: Nomi Health Commercial |
$668.04
|
| Rate for Payer: PACE SWMI |
$556.70
|
| Rate for Payer: PHP Medicare Advantage |
$556.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.05
|
| Rate for Payer: Priority Health HMO/PPO |
$931.72
|
| Rate for Payer: Priority Health Medicare |
$562.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$931.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$556.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$556.70
|
| Rate for Payer: UHC Exchange |
$556.70
|
| Rate for Payer: UHC Medicare Advantage |
$556.70
|
| Rate for Payer: UHCCP Medicaid |
$387.02
|
|
|
PR REPAIR FASCIAL DEFECT LEG
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 27656
|
| Min. Negotiated Rate |
$220.88 |
| Max. Negotiated Rate |
$1,234.11 |
| Rate for Payer: Aetna Commercial |
$434.35
|
| Rate for Payer: Aetna Medicare |
$337.11
|
| Rate for Payer: BCBS Complete |
$231.92
|
| Rate for Payer: BCBS MAPPO |
$324.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,234.11
|
| Rate for Payer: BCN Commercial |
$789.70
|
| Rate for Payer: BCN Medicare Advantage |
$324.14
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cofinity Commercial |
$466.76
|
| Rate for Payer: Cofinity Commercial |
$434.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.14
|
| Rate for Payer: Mclaren Medicaid |
$220.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$340.35
|
| Rate for Payer: Meridian Medicaid |
$231.92
|
| Rate for Payer: Nomi Health Commercial |
$388.97
|
| Rate for Payer: PACE SWMI |
$324.14
|
| Rate for Payer: PHP Medicare Advantage |
$324.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.25
|
| Rate for Payer: Priority Health HMO/PPO |
$528.19
|
| Rate for Payer: Priority Health Medicare |
$327.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$528.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.14
|
| Rate for Payer: UHC Exchange |
$324.14
|
| Rate for Payer: UHC Medicare Advantage |
$324.14
|
| Rate for Payer: UHCCP Medicaid |
$220.88
|
|
