|
PR REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT
|
Professional
|
Both
|
$3,157.00
|
|
|
Service Code
|
HCPCS 27138
|
| Min. Negotiated Rate |
$1,262.80 |
| Max. Negotiated Rate |
$2,111.26 |
| Rate for Payer: Aetna Commercial |
$1,964.64
|
| Rate for Payer: Aetna Medicare |
$1,524.80
|
| Rate for Payer: BCBS Complete |
$1,262.80
|
| Rate for Payer: BCBS MAPPO |
$1,466.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,466.15
|
| Rate for Payer: Cash Price |
$2,525.60
|
| Rate for Payer: Cash Price |
$2,525.60
|
| Rate for Payer: Cofinity Commercial |
$2,111.26
|
| Rate for Payer: Cofinity Commercial |
$1,964.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,466.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,539.46
|
| Rate for Payer: Nomi Health Commercial |
$1,759.38
|
| Rate for Payer: PACE SWMI |
$1,466.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,466.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,052.05
|
| Rate for Payer: Priority Health Medicare |
$1,480.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,466.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,466.15
|
| Rate for Payer: UHC Exchange |
$1,466.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,466.15
|
|
|
PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Facility
|
OP
|
$6,003.00
|
|
|
Service Code
|
CPT 27487
|
| Hospital Charge Code |
27487
|
| Min. Negotiated Rate |
$1,425.71 |
| Max. Negotiated Rate |
$5,402.70 |
| Rate for Payer: Aetna Commercial |
$5,102.55
|
| Rate for Payer: Aetna Medicare |
$1,560.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,875.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,875.94
|
| Rate for Payer: BCBS Complete |
$2,401.20
|
| Rate for Payer: BCBS MAPPO |
$1,500.75
|
| Rate for Payer: BCBS Trust/PPO |
$4,935.07
|
| Rate for Payer: BCN Commercial |
$4,667.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,500.75
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cofinity Commercial |
$5,162.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,802.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,500.75
|
| Rate for Payer: Healthscope Commercial |
$5,402.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,502.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,575.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,725.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,102.55
|
| Rate for Payer: Nomi Health Commercial |
$4,922.46
|
| Rate for Payer: PACE Senior Care Partners |
$1,425.71
|
| Rate for Payer: PACE SWMI |
$1,500.75
|
| Rate for Payer: PHP Commercial |
$5,102.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,500.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,901.95
|
| Rate for Payer: Priority Health HMO/PPO |
$5,222.61
|
| Rate for Payer: Priority Health Medicare |
$1,515.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,022.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,500.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,282.64
|
| Rate for Payer: UHC Core |
$5,012.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,500.75
|
| Rate for Payer: UHC Exchange |
$1,500.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,500.75
|
| Rate for Payer: VA VA |
$1,500.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,502.25
|
|
|
PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Professional
|
Both
|
$6,003.00
|
|
|
Service Code
|
HCPCS 27487
|
| Hospital Charge Code |
27487
|
| Min. Negotiated Rate |
$1,686.61 |
| Max. Negotiated Rate |
$3,901.95 |
| Rate for Payer: Aetna Commercial |
$2,260.06
|
| Rate for Payer: Aetna Medicare |
$1,754.07
|
| Rate for Payer: BCBS Complete |
$2,401.20
|
| Rate for Payer: BCBS MAPPO |
$1,686.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,686.61
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cofinity Commercial |
$2,428.72
|
| Rate for Payer: Cofinity Commercial |
$2,260.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,686.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,770.94
|
| Rate for Payer: Nomi Health Commercial |
$2,023.93
|
| Rate for Payer: PACE SWMI |
$1,686.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,686.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,901.95
|
| Rate for Payer: Priority Health Medicare |
$1,703.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,686.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,686.61
|
| Rate for Payer: UHC Exchange |
$1,686.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,686.61
|
|
|
PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Professional
|
Both
|
$6,003.00
|
|
|
Service Code
|
HCPCS 27487
|
| Min. Negotiated Rate |
$1,686.61 |
| Max. Negotiated Rate |
$3,901.95 |
| Rate for Payer: Aetna Commercial |
$2,260.06
|
| Rate for Payer: Aetna Medicare |
$1,754.07
|
| Rate for Payer: BCBS Complete |
$2,401.20
|
| Rate for Payer: BCBS MAPPO |
$1,686.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,686.61
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cofinity Commercial |
$2,428.72
|
| Rate for Payer: Cofinity Commercial |
$2,260.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,686.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,770.94
|
| Rate for Payer: Nomi Health Commercial |
$2,023.93
|
| Rate for Payer: PACE SWMI |
$1,686.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,686.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,901.95
|
| Rate for Payer: Priority Health Medicare |
$1,703.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,686.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,686.61
|
| Rate for Payer: UHC Exchange |
$1,686.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,686.61
|
|
|
PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Facility
|
IP
|
$6,003.00
|
|
|
Service Code
|
CPT 27487
|
| Hospital Charge Code |
27487
|
| Min. Negotiated Rate |
$3,901.95 |
| Max. Negotiated Rate |
$5,402.70 |
| Rate for Payer: Aetna Commercial |
$5,102.55
|
| Rate for Payer: BCBS Trust/PPO |
$4,900.25
|
| Rate for Payer: BCN Commercial |
$4,639.12
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cofinity Commercial |
$5,162.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,802.40
|
| Rate for Payer: Healthscope Commercial |
$5,402.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,502.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,102.55
|
| Rate for Payer: Nomi Health Commercial |
$4,922.46
|
| Rate for Payer: PHP Commercial |
$5,102.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,901.95
|
| Rate for Payer: Priority Health HMO/PPO |
$5,222.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,022.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,282.64
|
| Rate for Payer: UHC Core |
$5,012.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,502.25
|
|
|
PR REVJ UR-CUTAN ANAST RPR FSCAL DFCT & HERNIA
|
Professional
|
Both
|
$1,435.00
|
|
|
Service Code
|
HCPCS 50728
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$963.78 |
| Rate for Payer: Aetna Commercial |
$896.85
|
| Rate for Payer: Aetna Medicare |
$696.06
|
| Rate for Payer: BCBS Complete |
$574.00
|
| Rate for Payer: BCBS MAPPO |
$669.29
|
| Rate for Payer: BCN Medicare Advantage |
$669.29
|
| Rate for Payer: Cash Price |
$1,148.00
|
| Rate for Payer: Cash Price |
$1,148.00
|
| Rate for Payer: Cofinity Commercial |
$963.78
|
| Rate for Payer: Cofinity Commercial |
$896.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$669.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$702.75
|
| Rate for Payer: Nomi Health Commercial |
$803.15
|
| Rate for Payer: PACE SWMI |
$669.29
|
| Rate for Payer: PHP Medicare Advantage |
$669.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$932.75
|
| Rate for Payer: Priority Health Medicare |
$675.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$669.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$669.29
|
| Rate for Payer: UHC Exchange |
$669.29
|
| Rate for Payer: UHC Medicare Advantage |
$669.29
|
|
|
PR REVJ URINARY-CUTANEOUS ANASTAMOSIS
|
Professional
|
Both
|
$1,296.00
|
|
|
Service Code
|
HCPCS 50727
|
| Min. Negotiated Rate |
$487.42 |
| Max. Negotiated Rate |
$842.40 |
| Rate for Payer: Aetna Commercial |
$653.14
|
| Rate for Payer: Aetna Medicare |
$506.92
|
| Rate for Payer: BCBS Complete |
$518.40
|
| Rate for Payer: BCBS MAPPO |
$487.42
|
| Rate for Payer: BCN Medicare Advantage |
$487.42
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cofinity Commercial |
$701.88
|
| Rate for Payer: Cofinity Commercial |
$653.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$487.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$511.79
|
| Rate for Payer: Nomi Health Commercial |
$584.90
|
| Rate for Payer: PACE SWMI |
$487.42
|
| Rate for Payer: PHP Medicare Advantage |
$487.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$842.40
|
| Rate for Payer: Priority Health Medicare |
$492.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$487.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$487.42
|
| Rate for Payer: UHC Exchange |
$487.42
|
| Rate for Payer: UHC Medicare Advantage |
$487.42
|
|
|
PR REV/RMV PRPH SAC/GSTRC NPG/RCV DTCH CONN ELTR RA
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
HCPCS 64595
|
| Min. Negotiated Rate |
$220.08 |
| Max. Negotiated Rate |
$452.40 |
| Rate for Payer: Aetna Commercial |
$294.91
|
| Rate for Payer: Aetna Medicare |
$228.88
|
| Rate for Payer: BCBS Complete |
$278.40
|
| Rate for Payer: BCBS MAPPO |
$220.08
|
| Rate for Payer: BCN Medicare Advantage |
$220.08
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cofinity Commercial |
$316.92
|
| Rate for Payer: Cofinity Commercial |
$294.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.08
|
| Rate for Payer: Nomi Health Commercial |
$264.10
|
| Rate for Payer: PACE SWMI |
$220.08
|
| Rate for Payer: PHP Medicare Advantage |
$220.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.40
|
| Rate for Payer: Priority Health Medicare |
$222.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.08
|
| Rate for Payer: UHC Exchange |
$220.08
|
| Rate for Payer: UHC Medicare Advantage |
$220.08
|
|
|
PR REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI
|
Professional
|
Both
|
$1,066.00
|
|
|
Service Code
|
HCPCS 37224
|
| Min. Negotiated Rate |
$423.87 |
| Max. Negotiated Rate |
$692.90 |
| Rate for Payer: Aetna Commercial |
$567.99
|
| Rate for Payer: Aetna Medicare |
$440.82
|
| Rate for Payer: BCBS Complete |
$426.40
|
| Rate for Payer: BCBS MAPPO |
$423.87
|
| Rate for Payer: BCN Medicare Advantage |
$423.87
|
| Rate for Payer: Cash Price |
$852.80
|
| Rate for Payer: Cash Price |
$852.80
|
| Rate for Payer: Cofinity Commercial |
$610.37
|
| Rate for Payer: Cofinity Commercial |
$567.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$423.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$445.06
|
| Rate for Payer: Nomi Health Commercial |
$508.64
|
| Rate for Payer: PACE SWMI |
$423.87
|
| Rate for Payer: PHP Medicare Advantage |
$423.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$692.90
|
| Rate for Payer: Priority Health Medicare |
$428.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$423.87
|
| Rate for Payer: UHC Exchange |
$423.87
|
| Rate for Payer: UHC Medicare Advantage |
$423.87
|
|
|
PR REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL
|
Professional
|
Both
|
$2,317.00
|
|
|
Service Code
|
HCPCS 37225
|
| Min. Negotiated Rate |
$567.29 |
| Max. Negotiated Rate |
$1,506.05 |
| Rate for Payer: Aetna Commercial |
$760.17
|
| Rate for Payer: Aetna Medicare |
$589.98
|
| Rate for Payer: BCBS Complete |
$926.80
|
| Rate for Payer: BCBS MAPPO |
$567.29
|
| Rate for Payer: BCN Medicare Advantage |
$567.29
|
| Rate for Payer: Cash Price |
$1,853.60
|
| Rate for Payer: Cash Price |
$1,853.60
|
| Rate for Payer: Cofinity Commercial |
$816.90
|
| Rate for Payer: Cofinity Commercial |
$760.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$567.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$595.65
|
| Rate for Payer: Nomi Health Commercial |
$680.75
|
| Rate for Payer: PACE SWMI |
$567.29
|
| Rate for Payer: PHP Medicare Advantage |
$567.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,506.05
|
| Rate for Payer: Priority Health Medicare |
$572.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$567.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$567.29
|
| Rate for Payer: UHC Exchange |
$567.29
|
| Rate for Payer: UHC Medicare Advantage |
$567.29
|
|
|
PR REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 37226
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$750.75 |
| Rate for Payer: Aetna Commercial |
$663.39
|
| Rate for Payer: Aetna Medicare |
$514.87
|
| Rate for Payer: BCBS Complete |
$462.00
|
| Rate for Payer: BCBS MAPPO |
$495.07
|
| Rate for Payer: BCN Medicare Advantage |
$495.07
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$712.90
|
| Rate for Payer: Cofinity Commercial |
$663.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$495.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$519.82
|
| Rate for Payer: Nomi Health Commercial |
$594.08
|
| Rate for Payer: PACE SWMI |
$495.07
|
| Rate for Payer: PHP Medicare Advantage |
$495.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health Medicare |
$500.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$495.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$495.07
|
| Rate for Payer: UHC Exchange |
$495.07
|
| Rate for Payer: UHC Medicare Advantage |
$495.07
|
|
|
PR REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL
|
Professional
|
Both
|
$1,967.00
|
|
|
Service Code
|
HCPCS 37227
|
| Min. Negotiated Rate |
$681.48 |
| Max. Negotiated Rate |
$1,278.55 |
| Rate for Payer: Aetna Commercial |
$913.18
|
| Rate for Payer: Aetna Medicare |
$708.74
|
| Rate for Payer: BCBS Complete |
$786.80
|
| Rate for Payer: BCBS MAPPO |
$681.48
|
| Rate for Payer: BCN Medicare Advantage |
$681.48
|
| Rate for Payer: Cash Price |
$1,573.60
|
| Rate for Payer: Cash Price |
$1,573.60
|
| Rate for Payer: Cofinity Commercial |
$981.33
|
| Rate for Payer: Cofinity Commercial |
$913.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$681.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$715.55
|
| Rate for Payer: Nomi Health Commercial |
$817.78
|
| Rate for Payer: PACE SWMI |
$681.48
|
| Rate for Payer: PHP Medicare Advantage |
$681.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,278.55
|
| Rate for Payer: Priority Health Medicare |
$688.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$681.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$681.48
|
| Rate for Payer: UHC Exchange |
$681.48
|
| Rate for Payer: UHC Medicare Advantage |
$681.48
|
|
|
PR REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSILATL
|
Professional
|
Both
|
$499.00
|
|
|
Service Code
|
HCPCS 37223
|
| Min. Negotiated Rate |
$199.60 |
| Max. Negotiated Rate |
$324.35 |
| Rate for Payer: Aetna Commercial |
$271.55
|
| Rate for Payer: Aetna Medicare |
$210.76
|
| Rate for Payer: BCBS Complete |
$199.60
|
| Rate for Payer: BCBS MAPPO |
$202.65
|
| Rate for Payer: BCN Medicare Advantage |
$202.65
|
| Rate for Payer: Cash Price |
$399.20
|
| Rate for Payer: Cash Price |
$399.20
|
| Rate for Payer: Cofinity Commercial |
$291.82
|
| Rate for Payer: Cofinity Commercial |
$271.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.78
|
| Rate for Payer: Nomi Health Commercial |
$243.18
|
| Rate for Payer: PACE SWMI |
$202.65
|
| Rate for Payer: PHP Medicare Advantage |
$202.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.35
|
| Rate for Payer: Priority Health Medicare |
$204.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.65
|
| Rate for Payer: UHC Exchange |
$202.65
|
| Rate for Payer: UHC Medicare Advantage |
$202.65
|
|
|
PR REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY
|
Professional
|
Both
|
$2,022.00
|
|
|
Service Code
|
HCPCS 37221
|
| Min. Negotiated Rate |
$470.25 |
| Max. Negotiated Rate |
$1,314.30 |
| Rate for Payer: Aetna Commercial |
$630.13
|
| Rate for Payer: Aetna Medicare |
$489.06
|
| Rate for Payer: BCBS Complete |
$808.80
|
| Rate for Payer: BCBS MAPPO |
$470.25
|
| Rate for Payer: BCN Medicare Advantage |
$470.25
|
| Rate for Payer: Cash Price |
$1,617.60
|
| Rate for Payer: Cash Price |
$1,617.60
|
| Rate for Payer: Cofinity Commercial |
$677.16
|
| Rate for Payer: Cofinity Commercial |
$630.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$470.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$493.76
|
| Rate for Payer: Nomi Health Commercial |
$564.30
|
| Rate for Payer: PACE SWMI |
$470.25
|
| Rate for Payer: PHP Medicare Advantage |
$470.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,314.30
|
| Rate for Payer: Priority Health Medicare |
$474.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$470.25
|
| Rate for Payer: UHC Exchange |
$470.25
|
| Rate for Payer: UHC Medicare Advantage |
$470.25
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI
|
Professional
|
Both
|
$1,305.00
|
|
|
Service Code
|
HCPCS 37228
|
| Min. Negotiated Rate |
$516.20 |
| Max. Negotiated Rate |
$848.25 |
| Rate for Payer: Aetna Commercial |
$691.71
|
| Rate for Payer: Aetna Medicare |
$536.85
|
| Rate for Payer: BCBS Complete |
$522.00
|
| Rate for Payer: BCBS MAPPO |
$516.20
|
| Rate for Payer: BCN Medicare Advantage |
$516.20
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cofinity Commercial |
$743.33
|
| Rate for Payer: Cofinity Commercial |
$691.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$516.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$542.01
|
| Rate for Payer: Nomi Health Commercial |
$619.44
|
| Rate for Payer: PACE SWMI |
$516.20
|
| Rate for Payer: PHP Medicare Advantage |
$516.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.25
|
| Rate for Payer: Priority Health Medicare |
$521.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$516.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$516.20
|
| Rate for Payer: UHC Exchange |
$516.20
|
| Rate for Payer: UHC Medicare Advantage |
$516.20
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL
|
Professional
|
Both
|
$4,351.00
|
|
|
Service Code
|
HCPCS 37232
|
| Min. Negotiated Rate |
$189.38 |
| Max. Negotiated Rate |
$2,828.15 |
| Rate for Payer: Aetna Commercial |
$253.77
|
| Rate for Payer: Aetna Medicare |
$196.96
|
| Rate for Payer: BCBS Complete |
$1,740.40
|
| Rate for Payer: BCBS MAPPO |
$189.38
|
| Rate for Payer: BCN Medicare Advantage |
$189.38
|
| Rate for Payer: Cash Price |
$3,480.80
|
| Rate for Payer: Cash Price |
$3,480.80
|
| Rate for Payer: Cofinity Commercial |
$272.71
|
| Rate for Payer: Cofinity Commercial |
$253.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.85
|
| Rate for Payer: Nomi Health Commercial |
$227.26
|
| Rate for Payer: PACE SWMI |
$189.38
|
| Rate for Payer: PHP Medicare Advantage |
$189.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,828.15
|
| Rate for Payer: Priority Health Medicare |
$191.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.38
|
| Rate for Payer: UHC Exchange |
$189.38
|
| Rate for Payer: UHC Medicare Advantage |
$189.38
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL
|
Professional
|
Both
|
$2,733.00
|
|
|
Service Code
|
HCPCS 37229
|
| Min. Negotiated Rate |
$657.99 |
| Max. Negotiated Rate |
$1,776.45 |
| Rate for Payer: Aetna Commercial |
$881.71
|
| Rate for Payer: Aetna Medicare |
$684.31
|
| Rate for Payer: BCBS Complete |
$1,093.20
|
| Rate for Payer: BCBS MAPPO |
$657.99
|
| Rate for Payer: BCN Medicare Advantage |
$657.99
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cofinity Commercial |
$947.51
|
| Rate for Payer: Cofinity Commercial |
$881.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$657.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$690.89
|
| Rate for Payer: Nomi Health Commercial |
$789.59
|
| Rate for Payer: PACE SWMI |
$657.99
|
| Rate for Payer: PHP Medicare Advantage |
$657.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,776.45
|
| Rate for Payer: Priority Health Medicare |
$664.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$657.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$657.99
|
| Rate for Payer: UHC Exchange |
$657.99
|
| Rate for Payer: UHC Medicare Advantage |
$657.99
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL
|
Professional
|
Both
|
$1,141.00
|
|
|
Service Code
|
HCPCS 37233
|
| Min. Negotiated Rate |
$305.92 |
| Max. Negotiated Rate |
$741.65 |
| Rate for Payer: Aetna Commercial |
$409.93
|
| Rate for Payer: Aetna Medicare |
$318.16
|
| Rate for Payer: BCBS Complete |
$456.40
|
| Rate for Payer: BCBS MAPPO |
$305.92
|
| Rate for Payer: BCN Medicare Advantage |
$305.92
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Cofinity Commercial |
$440.52
|
| Rate for Payer: Cofinity Commercial |
$409.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.22
|
| Rate for Payer: Nomi Health Commercial |
$367.10
|
| Rate for Payer: PACE SWMI |
$305.92
|
| Rate for Payer: PHP Medicare Advantage |
$305.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$741.65
|
| Rate for Payer: Priority Health Medicare |
$308.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.92
|
| Rate for Payer: UHC Exchange |
$305.92
|
| Rate for Payer: UHC Medicare Advantage |
$305.92
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL
|
Professional
|
Both
|
$2,739.00
|
|
|
Service Code
|
HCPCS 37230
|
| Min. Negotiated Rate |
$661.66 |
| Max. Negotiated Rate |
$1,780.35 |
| Rate for Payer: Aetna Commercial |
$886.62
|
| Rate for Payer: Aetna Medicare |
$688.13
|
| Rate for Payer: BCBS Complete |
$1,095.60
|
| Rate for Payer: BCBS MAPPO |
$661.66
|
| Rate for Payer: BCN Medicare Advantage |
$661.66
|
| Rate for Payer: Cash Price |
$2,191.20
|
| Rate for Payer: Cash Price |
$2,191.20
|
| Rate for Payer: Cofinity Commercial |
$952.79
|
| Rate for Payer: Cofinity Commercial |
$886.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$661.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$694.74
|
| Rate for Payer: Nomi Health Commercial |
$793.99
|
| Rate for Payer: PACE SWMI |
$661.66
|
| Rate for Payer: PHP Medicare Advantage |
$661.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,780.35
|
| Rate for Payer: Priority Health Medicare |
$668.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$661.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$661.66
|
| Rate for Payer: UHC Exchange |
$661.66
|
| Rate for Payer: UHC Medicare Advantage |
$661.66
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 37234
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$385.33 |
| Rate for Payer: Aetna Commercial |
$358.57
|
| Rate for Payer: Aetna Medicare |
$278.29
|
| Rate for Payer: BCBS Complete |
$208.00
|
| Rate for Payer: BCBS MAPPO |
$267.59
|
| Rate for Payer: BCN Medicare Advantage |
$267.59
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cofinity Commercial |
$385.33
|
| Rate for Payer: Cofinity Commercial |
$358.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$280.97
|
| Rate for Payer: Nomi Health Commercial |
$321.11
|
| Rate for Payer: PACE SWMI |
$267.59
|
| Rate for Payer: PHP Medicare Advantage |
$267.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.00
|
| Rate for Payer: Priority Health Medicare |
$270.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.59
|
| Rate for Payer: UHC Exchange |
$267.59
|
| Rate for Payer: UHC Medicare Advantage |
$267.59
|
|
|
PR RHINOPLASTY EXTERNAL
|
Professional
|
Both
|
$3,162.00
|
|
|
Service Code
|
HCPCS 00536
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,264.80 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Medicare |
$1,581.00
|
| Rate for Payer: BCBS Complete |
$1,264.80
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,055.30
|
|
|
PR RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR
|
Professional
|
Both
|
$2,464.00
|
|
|
Service Code
|
HCPCS 30420
|
| Min. Negotiated Rate |
$985.60 |
| Max. Negotiated Rate |
$1,935.88 |
| Rate for Payer: Aetna Commercial |
$1,801.44
|
| Rate for Payer: Aetna Medicare |
$1,398.13
|
| Rate for Payer: BCBS Complete |
$985.60
|
| Rate for Payer: BCBS MAPPO |
$1,344.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,344.36
|
| Rate for Payer: Cash Price |
$1,971.20
|
| Rate for Payer: Cash Price |
$1,971.20
|
| Rate for Payer: Cofinity Commercial |
$1,935.88
|
| Rate for Payer: Cofinity Commercial |
$1,801.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,344.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,411.58
|
| Rate for Payer: Nomi Health Commercial |
$1,613.23
|
| Rate for Payer: PACE SWMI |
$1,344.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,344.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,601.60
|
| Rate for Payer: Priority Health Medicare |
$1,357.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,344.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,344.36
|
| Rate for Payer: UHC Exchange |
$1,344.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,344.36
|
|
|
PR RHINOPLASTY SECONDARY INTERMEDIATE REVISION
|
Professional
|
Both
|
$2,030.00
|
|
|
Service Code
|
HCPCS 30435
|
| Min. Negotiated Rate |
$812.00 |
| Max. Negotiated Rate |
$1,785.34 |
| Rate for Payer: Aetna Commercial |
$1,661.36
|
| Rate for Payer: Aetna Medicare |
$1,289.41
|
| Rate for Payer: BCBS Complete |
$812.00
|
| Rate for Payer: BCBS MAPPO |
$1,239.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,239.82
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Cofinity Commercial |
$1,661.36
|
| Rate for Payer: Cofinity Commercial |
$1,785.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,239.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,301.81
|
| Rate for Payer: Nomi Health Commercial |
$1,487.78
|
| Rate for Payer: PACE SWMI |
$1,239.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,239.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,319.50
|
| Rate for Payer: Priority Health Medicare |
$1,252.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,239.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,239.82
|
| Rate for Payer: UHC Exchange |
$1,239.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,239.82
|
|
|
PR RHINOPLASTY SECONDARY MAJOR REVISION
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 30450
|
| Min. Negotiated Rate |
$1,400.00 |
| Max. Negotiated Rate |
$2,355.31 |
| Rate for Payer: Aetna Commercial |
$2,191.74
|
| Rate for Payer: Aetna Medicare |
$1,701.06
|
| Rate for Payer: BCBS Complete |
$1,400.00
|
| Rate for Payer: BCBS MAPPO |
$1,635.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,635.63
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cofinity Commercial |
$2,355.31
|
| Rate for Payer: Cofinity Commercial |
$2,191.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,635.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,717.41
|
| Rate for Payer: Nomi Health Commercial |
$1,962.76
|
| Rate for Payer: PACE SWMI |
$1,635.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,635.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,275.00
|
| Rate for Payer: Priority Health Medicare |
$1,651.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,635.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,635.63
|
| Rate for Payer: UHC Exchange |
$1,635.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,635.63
|
|
|
PR RHINP DFRM W/COLUM LNGTH TIP ONLY
|
Professional
|
Both
|
$1,370.00
|
|
|
Service Code
|
HCPCS 30460
|
| Min. Negotiated Rate |
$548.00 |
| Max. Negotiated Rate |
$1,127.23 |
| Rate for Payer: Aetna Commercial |
$1,048.95
|
| Rate for Payer: Aetna Medicare |
$814.11
|
| Rate for Payer: BCBS Complete |
$548.00
|
| Rate for Payer: BCBS MAPPO |
$782.80
|
| Rate for Payer: BCN Medicare Advantage |
$782.80
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cofinity Commercial |
$1,127.23
|
| Rate for Payer: Cofinity Commercial |
$1,048.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$782.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$821.94
|
| Rate for Payer: Nomi Health Commercial |
$939.36
|
| Rate for Payer: PACE SWMI |
$782.80
|
| Rate for Payer: PHP Medicare Advantage |
$782.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.50
|
| Rate for Payer: Priority Health Medicare |
$790.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$782.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$782.80
|
| Rate for Payer: UHC Exchange |
$782.80
|
| Rate for Payer: UHC Medicare Advantage |
$782.80
|
|
