|
PR RPR AA HERNIA RECR 3-10 CM REDUCIBLE
|
Facility
|
OP
|
$1,589.00
|
|
|
Service Code
|
CPT 49615
|
| Hospital Charge Code |
49615
|
| Min. Negotiated Rate |
$377.39 |
| Max. Negotiated Rate |
$4,737.22 |
| Rate for Payer: Aetna Commercial |
$1,350.65
|
| Rate for Payer: Aetna Medicare |
$413.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$496.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$496.56
|
| Rate for Payer: BCBS Complete |
$4,737.22
|
| Rate for Payer: BCBS MAPPO |
$397.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,306.32
|
| Rate for Payer: BCN Commercial |
$1,235.45
|
| Rate for Payer: BCN Medicare Advantage |
$397.25
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cofinity Commercial |
$1,366.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,271.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$397.25
|
| Rate for Payer: Healthscope Commercial |
$1,430.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,191.75
|
| Rate for Payer: Mclaren Medicaid |
$4,511.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$417.11
|
| Rate for Payer: Meridian Medicaid |
$4,737.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$456.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,350.65
|
| Rate for Payer: Nomi Health Commercial |
$1,302.98
|
| Rate for Payer: PACE Senior Care Partners |
$377.39
|
| Rate for Payer: PACE SWMI |
$397.25
|
| Rate for Payer: PHP Commercial |
$1,350.65
|
| Rate for Payer: PHP Medicare Advantage |
$397.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,511.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,032.85
|
| Rate for Payer: Priority Health HMO/PPO |
$1,382.43
|
| Rate for Payer: Priority Health Medicare |
$401.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,064.63
|
| Rate for Payer: Railroad Medicare Medicare |
$397.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,398.32
|
| Rate for Payer: UHC Core |
$1,326.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$397.25
|
| Rate for Payer: UHC Exchange |
$397.25
|
| Rate for Payer: UHC Medicare Advantage |
$397.25
|
| Rate for Payer: UHCCP Medicaid |
$4,511.34
|
| Rate for Payer: VA VA |
$397.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,191.75
|
|
|
PR RPR AA HERNIA RECR 3-10 CM REDUCIBLE
|
Professional
|
Both
|
$1,589.00
|
|
|
Service Code
|
HCPCS 49615
|
| Hospital Charge Code |
49615
|
| Min. Negotiated Rate |
$623.55 |
| Max. Negotiated Rate |
$1,032.85 |
| Rate for Payer: Aetna Commercial |
$835.56
|
| Rate for Payer: Aetna Medicare |
$648.49
|
| Rate for Payer: BCBS Complete |
$635.60
|
| Rate for Payer: BCBS MAPPO |
$623.55
|
| Rate for Payer: BCN Medicare Advantage |
$623.55
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cofinity Commercial |
$897.91
|
| Rate for Payer: Cofinity Commercial |
$835.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$623.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$654.73
|
| Rate for Payer: Nomi Health Commercial |
$748.26
|
| Rate for Payer: PACE SWMI |
$623.55
|
| Rate for Payer: PHP Medicare Advantage |
$623.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,032.85
|
| Rate for Payer: Priority Health Medicare |
$629.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$623.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$623.55
|
| Rate for Payer: UHC Exchange |
$623.55
|
| Rate for Payer: UHC Medicare Advantage |
$623.55
|
|
|
PR RPR AA HERNIA RECR 3-10 CM REDUCIBLE
|
Professional
|
Both
|
$1,589.00
|
|
|
Service Code
|
HCPCS 49615
|
| Min. Negotiated Rate |
$623.55 |
| Max. Negotiated Rate |
$1,032.85 |
| Rate for Payer: Aetna Commercial |
$835.56
|
| Rate for Payer: Aetna Medicare |
$648.49
|
| Rate for Payer: BCBS Complete |
$635.60
|
| Rate for Payer: BCBS MAPPO |
$623.55
|
| Rate for Payer: BCN Medicare Advantage |
$623.55
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cofinity Commercial |
$897.91
|
| Rate for Payer: Cofinity Commercial |
$835.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$623.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$654.73
|
| Rate for Payer: Nomi Health Commercial |
$748.26
|
| Rate for Payer: PACE SWMI |
$623.55
|
| Rate for Payer: PHP Medicare Advantage |
$623.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,032.85
|
| Rate for Payer: Priority Health Medicare |
$629.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$623.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$623.55
|
| Rate for Payer: UHC Exchange |
$623.55
|
| Rate for Payer: UHC Medicare Advantage |
$623.55
|
|
|
PR RPR AA HERNIA RECR 3-10 CM REDUCIBLE
|
Facility
|
IP
|
$1,589.00
|
|
|
Service Code
|
CPT 49615
|
| Hospital Charge Code |
49615
|
| Min. Negotiated Rate |
$1,032.85 |
| Max. Negotiated Rate |
$1,430.10 |
| Rate for Payer: Aetna Commercial |
$1,350.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,297.10
|
| Rate for Payer: BCN Commercial |
$1,227.98
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cofinity Commercial |
$1,366.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,271.20
|
| Rate for Payer: Healthscope Commercial |
$1,430.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,191.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,350.65
|
| Rate for Payer: Nomi Health Commercial |
$1,302.98
|
| Rate for Payer: PHP Commercial |
$1,350.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,032.85
|
| Rate for Payer: Priority Health HMO/PPO |
$1,382.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,064.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,398.32
|
| Rate for Payer: UHC Core |
$1,326.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,191.75
|
|
|
PR RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED
|
Facility
|
IP
|
$1,165.00
|
|
|
Service Code
|
CPT 49614
|
| Hospital Charge Code |
49614
|
| Min. Negotiated Rate |
$757.25 |
| Max. Negotiated Rate |
$1,048.50 |
| Rate for Payer: Aetna Commercial |
$990.25
|
| Rate for Payer: BCBS Trust/PPO |
$950.99
|
| Rate for Payer: BCN Commercial |
$900.31
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cofinity Commercial |
$1,001.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$932.00
|
| Rate for Payer: Healthscope Commercial |
$1,048.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$873.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$990.25
|
| Rate for Payer: Nomi Health Commercial |
$955.30
|
| Rate for Payer: PHP Commercial |
$990.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,013.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$780.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,025.20
|
| Rate for Payer: UHC Core |
$972.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$873.75
|
|
|
PR RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED
|
Facility
|
OP
|
$1,165.00
|
|
|
Service Code
|
CPT 49614
|
| Hospital Charge Code |
49614
|
| Min. Negotiated Rate |
$276.69 |
| Max. Negotiated Rate |
$4,429.45 |
| Rate for Payer: Aetna Commercial |
$990.25
|
| Rate for Payer: Aetna Medicare |
$302.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$364.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$364.06
|
| Rate for Payer: BCBS Complete |
$4,429.45
|
| Rate for Payer: BCBS MAPPO |
$291.25
|
| Rate for Payer: BCBS Trust/PPO |
$957.75
|
| Rate for Payer: BCN Commercial |
$905.79
|
| Rate for Payer: BCN Medicare Advantage |
$291.25
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cofinity Commercial |
$1,001.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$932.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$291.25
|
| Rate for Payer: Healthscope Commercial |
$1,048.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$873.75
|
| Rate for Payer: Mclaren Medicaid |
$4,218.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$305.81
|
| Rate for Payer: Meridian Medicaid |
$4,429.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$334.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$990.25
|
| Rate for Payer: Nomi Health Commercial |
$955.30
|
| Rate for Payer: PACE Senior Care Partners |
$276.69
|
| Rate for Payer: PACE SWMI |
$291.25
|
| Rate for Payer: PHP Commercial |
$990.25
|
| Rate for Payer: PHP Medicare Advantage |
$291.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,218.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,013.55
|
| Rate for Payer: Priority Health Medicare |
$294.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$780.55
|
| Rate for Payer: Railroad Medicare Medicare |
$291.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,025.20
|
| Rate for Payer: UHC Core |
$972.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$291.25
|
| Rate for Payer: UHC Exchange |
$291.25
|
| Rate for Payer: UHC Medicare Advantage |
$291.25
|
| Rate for Payer: UHCCP Medicaid |
$4,218.24
|
| Rate for Payer: VA VA |
$291.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$873.75
|
|
|
PR RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 49614
|
| Hospital Charge Code |
49614
|
| Min. Negotiated Rate |
$466.00 |
| Max. Negotiated Rate |
$803.22 |
| Rate for Payer: Aetna Commercial |
$747.44
|
| Rate for Payer: Aetna Medicare |
$580.10
|
| Rate for Payer: BCBS Complete |
$466.00
|
| Rate for Payer: BCBS MAPPO |
$557.79
|
| Rate for Payer: BCN Medicare Advantage |
$557.79
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cofinity Commercial |
$803.22
|
| Rate for Payer: Cofinity Commercial |
$747.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$585.68
|
| Rate for Payer: Nomi Health Commercial |
$669.35
|
| Rate for Payer: PACE SWMI |
$557.79
|
| Rate for Payer: PHP Medicare Advantage |
$557.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.25
|
| Rate for Payer: Priority Health Medicare |
$563.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$557.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.79
|
| Rate for Payer: UHC Exchange |
$557.79
|
| Rate for Payer: UHC Medicare Advantage |
$557.79
|
|
|
PR RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 49614
|
| Min. Negotiated Rate |
$466.00 |
| Max. Negotiated Rate |
$803.22 |
| Rate for Payer: Aetna Commercial |
$747.44
|
| Rate for Payer: Aetna Medicare |
$580.10
|
| Rate for Payer: BCBS Complete |
$466.00
|
| Rate for Payer: BCBS MAPPO |
$557.79
|
| Rate for Payer: BCN Medicare Advantage |
$557.79
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cofinity Commercial |
$803.22
|
| Rate for Payer: Cofinity Commercial |
$747.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$585.68
|
| Rate for Payer: Nomi Health Commercial |
$669.35
|
| Rate for Payer: PACE SWMI |
$557.79
|
| Rate for Payer: PHP Medicare Advantage |
$557.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.25
|
| Rate for Payer: Priority Health Medicare |
$563.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$557.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.79
|
| Rate for Payer: UHC Exchange |
$557.79
|
| Rate for Payer: UHC Medicare Advantage |
$557.79
|
|
|
PR RPR AA HERNIA RECR < 3 CM REDUCIBLE
|
Professional
|
Both
|
$857.00
|
|
|
Service Code
|
HCPCS 49613
|
| Min. Negotiated Rate |
$342.80 |
| Max. Negotiated Rate |
$590.79 |
| Rate for Payer: Aetna Commercial |
$549.76
|
| Rate for Payer: Aetna Medicare |
$426.68
|
| Rate for Payer: BCBS Complete |
$342.80
|
| Rate for Payer: BCBS MAPPO |
$410.27
|
| Rate for Payer: BCN Medicare Advantage |
$410.27
|
| Rate for Payer: Cash Price |
$685.60
|
| Rate for Payer: Cash Price |
$685.60
|
| Rate for Payer: Cofinity Commercial |
$590.79
|
| Rate for Payer: Cofinity Commercial |
$549.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$410.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$430.78
|
| Rate for Payer: Nomi Health Commercial |
$492.32
|
| Rate for Payer: PACE SWMI |
$410.27
|
| Rate for Payer: PHP Medicare Advantage |
$410.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$557.05
|
| Rate for Payer: Priority Health Medicare |
$414.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$410.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$410.27
|
| Rate for Payer: UHC Exchange |
$410.27
|
| Rate for Payer: UHC Medicare Advantage |
$410.27
|
|
|
PR RPR ACQUIRED/TRAUMATIC AV FISTULA EXTREMITIES
|
Professional
|
Both
|
$1,541.00
|
|
|
Service Code
|
HCPCS 35190
|
| Min. Negotiated Rate |
$616.40 |
| Max. Negotiated Rate |
$1,040.60 |
| Rate for Payer: Aetna Commercial |
$968.34
|
| Rate for Payer: Aetna Medicare |
$751.55
|
| Rate for Payer: BCBS Complete |
$616.40
|
| Rate for Payer: BCBS MAPPO |
$722.64
|
| Rate for Payer: BCN Medicare Advantage |
$722.64
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cofinity Commercial |
$968.34
|
| Rate for Payer: Cofinity Commercial |
$1,040.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$758.77
|
| Rate for Payer: Nomi Health Commercial |
$867.17
|
| Rate for Payer: PACE SWMI |
$722.64
|
| Rate for Payer: PHP Medicare Advantage |
$722.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.65
|
| Rate for Payer: Priority Health Medicare |
$729.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$722.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$722.64
|
| Rate for Payer: UHC Exchange |
$722.64
|
| Rate for Payer: UHC Medicare Advantage |
$722.64
|
|
|
PR RPR ACQUIRED/TRAUMATIC AV FISTULA HEAD & NECK
|
Professional
|
Both
|
$4,240.00
|
|
|
Service Code
|
HCPCS 35188
|
| Min. Negotiated Rate |
$1,272.15 |
| Max. Negotiated Rate |
$2,756.00 |
| Rate for Payer: Aetna Commercial |
$1,704.68
|
| Rate for Payer: Aetna Medicare |
$1,323.04
|
| Rate for Payer: BCBS Complete |
$1,696.00
|
| Rate for Payer: BCBS MAPPO |
$1,272.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,272.15
|
| Rate for Payer: Cash Price |
$3,392.00
|
| Rate for Payer: Cash Price |
$3,392.00
|
| Rate for Payer: Cofinity Commercial |
$1,831.90
|
| Rate for Payer: Cofinity Commercial |
$1,704.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,272.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,335.76
|
| Rate for Payer: Nomi Health Commercial |
$1,526.58
|
| Rate for Payer: PACE SWMI |
$1,272.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,272.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,756.00
|
| Rate for Payer: Priority Health Medicare |
$1,284.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,272.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,272.15
|
| Rate for Payer: UHC Exchange |
$1,272.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,272.15
|
|
|
PR RPR/ADVMNT FLXR TDN N/Z/2 W/O FR GRAFT EA TENDON
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 26350
|
| Min. Negotiated Rate |
$693.38 |
| Max. Negotiated Rate |
$1,288.95 |
| Rate for Payer: Aetna Commercial |
$929.13
|
| Rate for Payer: Aetna Medicare |
$721.12
|
| Rate for Payer: BCBS Complete |
$793.20
|
| Rate for Payer: BCBS MAPPO |
$693.38
|
| Rate for Payer: BCN Medicare Advantage |
$693.38
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Commercial |
$998.47
|
| Rate for Payer: Cofinity Commercial |
$929.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$693.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$728.05
|
| Rate for Payer: Nomi Health Commercial |
$832.06
|
| Rate for Payer: PACE SWMI |
$693.38
|
| Rate for Payer: PHP Medicare Advantage |
$693.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.95
|
| Rate for Payer: Priority Health Medicare |
$700.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$693.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$693.38
|
| Rate for Payer: UHC Exchange |
$693.38
|
| Rate for Payer: UHC Medicare Advantage |
$693.38
|
|
|
PR RPR/ADVMNT FLXR TDN ZONE 2 W/FR GRAFT EA TENDON
|
Professional
|
Both
|
$2,709.00
|
|
|
Service Code
|
HCPCS 26358
|
| Min. Negotiated Rate |
$945.32 |
| Max. Negotiated Rate |
$1,760.85 |
| Rate for Payer: Aetna Commercial |
$1,266.73
|
| Rate for Payer: Aetna Medicare |
$983.13
|
| Rate for Payer: BCBS Complete |
$1,083.60
|
| Rate for Payer: BCBS MAPPO |
$945.32
|
| Rate for Payer: BCN Medicare Advantage |
$945.32
|
| Rate for Payer: Cash Price |
$2,167.20
|
| Rate for Payer: Cash Price |
$2,167.20
|
| Rate for Payer: Cofinity Commercial |
$1,361.26
|
| Rate for Payer: Cofinity Commercial |
$1,266.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$945.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$992.59
|
| Rate for Payer: Nomi Health Commercial |
$1,134.38
|
| Rate for Payer: PACE SWMI |
$945.32
|
| Rate for Payer: PHP Medicare Advantage |
$945.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,760.85
|
| Rate for Payer: Priority Health Medicare |
$954.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$945.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$945.32
|
| Rate for Payer: UHC Exchange |
$945.32
|
| Rate for Payer: UHC Medicare Advantage |
$945.32
|
|
|
PR RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON
|
Professional
|
Both
|
$2,657.00
|
|
|
Service Code
|
HCPCS 26356
|
| Min. Negotiated Rate |
$763.85 |
| Max. Negotiated Rate |
$1,727.05 |
| Rate for Payer: Aetna Commercial |
$1,023.56
|
| Rate for Payer: Aetna Medicare |
$794.40
|
| Rate for Payer: BCBS Complete |
$1,062.80
|
| Rate for Payer: BCBS MAPPO |
$763.85
|
| Rate for Payer: BCN Medicare Advantage |
$763.85
|
| Rate for Payer: Cash Price |
$2,125.60
|
| Rate for Payer: Cash Price |
$2,125.60
|
| Rate for Payer: Cofinity Commercial |
$1,099.94
|
| Rate for Payer: Cofinity Commercial |
$1,023.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$763.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$802.04
|
| Rate for Payer: Nomi Health Commercial |
$916.62
|
| Rate for Payer: PACE SWMI |
$763.85
|
| Rate for Payer: PHP Medicare Advantage |
$763.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,727.05
|
| Rate for Payer: Priority Health Medicare |
$771.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$763.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$763.85
|
| Rate for Payer: UHC Exchange |
$763.85
|
| Rate for Payer: UHC Medicare Advantage |
$763.85
|
|
|
PR RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON
|
Professional
|
Both
|
$2,775.00
|
|
|
Service Code
|
HCPCS 26357
|
| Min. Negotiated Rate |
$856.00 |
| Max. Negotiated Rate |
$1,803.75 |
| Rate for Payer: Aetna Commercial |
$1,147.04
|
| Rate for Payer: Aetna Medicare |
$890.24
|
| Rate for Payer: BCBS Complete |
$1,110.00
|
| Rate for Payer: BCBS MAPPO |
$856.00
|
| Rate for Payer: BCN Medicare Advantage |
$856.00
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cofinity Commercial |
$1,232.64
|
| Rate for Payer: Cofinity Commercial |
$1,147.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$856.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$898.80
|
| Rate for Payer: Nomi Health Commercial |
$1,027.20
|
| Rate for Payer: PACE SWMI |
$856.00
|
| Rate for Payer: PHP Medicare Advantage |
$856.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.75
|
| Rate for Payer: Priority Health Medicare |
$864.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$856.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$856.00
|
| Rate for Payer: UHC Exchange |
$856.00
|
| Rate for Payer: UHC Medicare Advantage |
$856.00
|
|
|
PR RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN
|
Professional
|
Both
|
$2,340.00
|
|
|
Service Code
|
HCPCS 26370
|
| Min. Negotiated Rate |
$731.54 |
| Max. Negotiated Rate |
$1,521.00 |
| Rate for Payer: Aetna Commercial |
$980.26
|
| Rate for Payer: Aetna Medicare |
$760.80
|
| Rate for Payer: BCBS Complete |
$936.00
|
| Rate for Payer: BCBS MAPPO |
$731.54
|
| Rate for Payer: BCN Medicare Advantage |
$731.54
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Cofinity Commercial |
$980.26
|
| Rate for Payer: Cofinity Commercial |
$1,053.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$731.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$768.12
|
| Rate for Payer: Nomi Health Commercial |
$877.85
|
| Rate for Payer: PACE SWMI |
$731.54
|
| Rate for Payer: PHP Medicare Advantage |
$731.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,521.00
|
| Rate for Payer: Priority Health Medicare |
$738.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$731.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$731.54
|
| Rate for Payer: UHC Exchange |
$731.54
|
| Rate for Payer: UHC Medicare Advantage |
$731.54
|
|
|
PR RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/FREE GRAFT EA
|
Professional
|
Both
|
$3,106.00
|
|
|
Service Code
|
HCPCS 26372
|
| Min. Negotiated Rate |
$856.02 |
| Max. Negotiated Rate |
$2,018.90 |
| Rate for Payer: Aetna Commercial |
$1,147.07
|
| Rate for Payer: Aetna Medicare |
$890.26
|
| Rate for Payer: BCBS Complete |
$1,242.40
|
| Rate for Payer: BCBS MAPPO |
$856.02
|
| Rate for Payer: BCN Medicare Advantage |
$856.02
|
| Rate for Payer: Cash Price |
$2,484.80
|
| Rate for Payer: Cash Price |
$2,484.80
|
| Rate for Payer: Cofinity Commercial |
$1,232.67
|
| Rate for Payer: Cofinity Commercial |
$1,147.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$856.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$898.82
|
| Rate for Payer: Nomi Health Commercial |
$1,027.22
|
| Rate for Payer: PACE SWMI |
$856.02
|
| Rate for Payer: PHP Medicare Advantage |
$856.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,018.90
|
| Rate for Payer: Priority Health Medicare |
$864.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$856.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$856.02
|
| Rate for Payer: UHC Exchange |
$856.02
|
| Rate for Payer: UHC Medicare Advantage |
$856.02
|
|
|
PR RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/O FREE GRF EA
|
Professional
|
Both
|
$2,854.00
|
|
|
Service Code
|
HCPCS 26373
|
| Min. Negotiated Rate |
$822.63 |
| Max. Negotiated Rate |
$1,855.10 |
| Rate for Payer: Aetna Commercial |
$1,102.32
|
| Rate for Payer: Aetna Medicare |
$855.54
|
| Rate for Payer: BCBS Complete |
$1,141.60
|
| Rate for Payer: BCBS MAPPO |
$822.63
|
| Rate for Payer: BCN Medicare Advantage |
$822.63
|
| Rate for Payer: Cash Price |
$2,283.20
|
| Rate for Payer: Cash Price |
$2,283.20
|
| Rate for Payer: Cofinity Commercial |
$1,184.59
|
| Rate for Payer: Cofinity Commercial |
$1,102.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$822.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$863.76
|
| Rate for Payer: Nomi Health Commercial |
$987.16
|
| Rate for Payer: PACE SWMI |
$822.63
|
| Rate for Payer: PHP Medicare Advantage |
$822.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,855.10
|
| Rate for Payer: Priority Health Medicare |
$830.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$822.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$822.63
|
| Rate for Payer: UHC Exchange |
$822.63
|
| Rate for Payer: UHC Medicare Advantage |
$822.63
|
|
|
PR RPR ANOM AORTIC ORIGIN CORONARY ART UNROOF/TLCJ
|
Professional
|
Both
|
$3,602.00
|
|
|
Service Code
|
HCPCS 33507
|
| Min. Negotiated Rate |
$1,440.80 |
| Max. Negotiated Rate |
$2,380.06 |
| Rate for Payer: Aetna Commercial |
$2,214.78
|
| Rate for Payer: Aetna Medicare |
$1,718.93
|
| Rate for Payer: BCBS Complete |
$1,440.80
|
| Rate for Payer: BCBS MAPPO |
$1,652.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,652.82
|
| Rate for Payer: Cash Price |
$2,881.60
|
| Rate for Payer: Cash Price |
$2,881.60
|
| Rate for Payer: Cofinity Commercial |
$2,380.06
|
| Rate for Payer: Cofinity Commercial |
$2,214.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,652.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,735.46
|
| Rate for Payer: Nomi Health Commercial |
$1,983.38
|
| Rate for Payer: PACE SWMI |
$1,652.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,652.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,341.30
|
| Rate for Payer: Priority Health Medicare |
$1,669.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,652.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,652.82
|
| Rate for Payer: UHC Exchange |
$1,652.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,652.82
|
|
|
PR RPR ANOM CORONARY ART PULM ART ORIGIN GRF W/BYP
|
Professional
|
Both
|
$5,041.00
|
|
|
Service Code
|
HCPCS 33504
|
| Min. Negotiated Rate |
$1,411.26 |
| Max. Negotiated Rate |
$3,276.65 |
| Rate for Payer: Aetna Commercial |
$1,891.09
|
| Rate for Payer: Aetna Medicare |
$1,467.71
|
| Rate for Payer: BCBS Complete |
$2,016.40
|
| Rate for Payer: BCBS MAPPO |
$1,411.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,411.26
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Cofinity Commercial |
$2,032.21
|
| Rate for Payer: Cofinity Commercial |
$1,891.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,411.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,481.82
|
| Rate for Payer: Nomi Health Commercial |
$1,693.51
|
| Rate for Payer: PACE SWMI |
$1,411.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,411.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,276.65
|
| Rate for Payer: Priority Health Medicare |
$1,425.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,411.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,411.26
|
| Rate for Payer: UHC Exchange |
$1,411.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,411.26
|
|
|
PR RPR ATRIAL SEPTAL DFCT SECUNDUM W/BYP W/WO PATCH
|
Professional
|
Both
|
$5,071.00
|
|
|
Service Code
|
HCPCS 33641
|
| Min. Negotiated Rate |
$1,574.01 |
| Max. Negotiated Rate |
$3,296.15 |
| Rate for Payer: Aetna Commercial |
$2,109.17
|
| Rate for Payer: Aetna Medicare |
$1,636.97
|
| Rate for Payer: BCBS Complete |
$2,028.40
|
| Rate for Payer: BCBS MAPPO |
$1,574.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,574.01
|
| Rate for Payer: Cash Price |
$4,056.80
|
| Rate for Payer: Cash Price |
$4,056.80
|
| Rate for Payer: Cofinity Commercial |
$2,266.57
|
| Rate for Payer: Cofinity Commercial |
$2,109.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,574.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,652.71
|
| Rate for Payer: Nomi Health Commercial |
$1,888.81
|
| Rate for Payer: PACE SWMI |
$1,574.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,574.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,296.15
|
| Rate for Payer: Priority Health Medicare |
$1,589.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,574.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,574.01
|
| Rate for Payer: UHC Exchange |
$1,574.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,574.01
|
|
|
PR RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL
|
Professional
|
Both
|
$1,139.00
|
|
|
Service Code
|
HCPCS 67903
|
| Min. Negotiated Rate |
$444.24 |
| Max. Negotiated Rate |
$740.35 |
| Rate for Payer: Aetna Commercial |
$595.28
|
| Rate for Payer: Aetna Medicare |
$462.01
|
| Rate for Payer: BCBS Complete |
$455.60
|
| Rate for Payer: BCBS MAPPO |
$444.24
|
| Rate for Payer: BCN Medicare Advantage |
$444.24
|
| Rate for Payer: Cash Price |
$911.20
|
| Rate for Payer: Cash Price |
$911.20
|
| Rate for Payer: Cofinity Commercial |
$639.71
|
| Rate for Payer: Cofinity Commercial |
$595.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$466.45
|
| Rate for Payer: Nomi Health Commercial |
$533.09
|
| Rate for Payer: PACE SWMI |
$444.24
|
| Rate for Payer: PHP Medicare Advantage |
$444.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$740.35
|
| Rate for Payer: Priority Health Medicare |
$448.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$444.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$444.24
|
| Rate for Payer: UHC Exchange |
$444.24
|
| Rate for Payer: UHC Medicare Advantage |
$444.24
|
|
|
PR RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 67904
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$792.17 |
| Rate for Payer: Aetna Commercial |
$737.16
|
| Rate for Payer: Aetna Medicare |
$572.12
|
| Rate for Payer: BCBS Complete |
$387.60
|
| Rate for Payer: BCBS MAPPO |
$550.12
|
| Rate for Payer: BCN Medicare Advantage |
$550.12
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$792.17
|
| Rate for Payer: Cofinity Commercial |
$737.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$577.63
|
| Rate for Payer: Nomi Health Commercial |
$660.14
|
| Rate for Payer: PACE SWMI |
$550.12
|
| Rate for Payer: PHP Medicare Advantage |
$550.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health Medicare |
$555.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$550.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$550.12
|
| Rate for Payer: UHC Exchange |
$550.12
|
| Rate for Payer: UHC Medicare Advantage |
$550.12
|
|
|
PR RPR BLOOD VESSEL DIRECT INTRATHORACIC W/BYPASS
|
Professional
|
Both
|
$2,893.00
|
|
|
Service Code
|
HCPCS 35211
|
| Min. Negotiated Rate |
$1,157.20 |
| Max. Negotiated Rate |
$1,920.14 |
| Rate for Payer: Aetna Commercial |
$1,786.80
|
| Rate for Payer: Aetna Medicare |
$1,386.77
|
| Rate for Payer: BCBS Complete |
$1,157.20
|
| Rate for Payer: BCBS MAPPO |
$1,333.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,333.43
|
| Rate for Payer: Cash Price |
$2,314.40
|
| Rate for Payer: Cash Price |
$2,314.40
|
| Rate for Payer: Cofinity Commercial |
$1,920.14
|
| Rate for Payer: Cofinity Commercial |
$1,786.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,333.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,400.10
|
| Rate for Payer: Nomi Health Commercial |
$1,600.12
|
| Rate for Payer: PACE SWMI |
$1,333.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,333.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,880.45
|
| Rate for Payer: Priority Health Medicare |
$1,346.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,333.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,333.43
|
| Rate for Payer: UHC Exchange |
$1,333.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,333.43
|
|
|
PR RPR BLOOD VESSEL DIRECT INTRATHORACIC W/O BYPASS
|
Professional
|
Both
|
$5,326.00
|
|
|
Service Code
|
HCPCS 35216
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$3,461.90 |
| Rate for Payer: Aetna Commercial |
$2,673.30
|
| Rate for Payer: Aetna Medicare |
$2,074.80
|
| Rate for Payer: BCBS Complete |
$2,130.40
|
| Rate for Payer: BCBS MAPPO |
$1,995.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,995.00
|
| Rate for Payer: Cash Price |
$4,260.80
|
| Rate for Payer: Cash Price |
$4,260.80
|
| Rate for Payer: Cofinity Commercial |
$2,872.80
|
| Rate for Payer: Cofinity Commercial |
$2,673.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,995.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,094.75
|
| Rate for Payer: Nomi Health Commercial |
$2,394.00
|
| Rate for Payer: PACE SWMI |
$1,995.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,995.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,461.90
|
| Rate for Payer: Priority Health Medicare |
$2,014.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,995.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,995.00
|
| Rate for Payer: UHC Exchange |
$1,995.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,995.00
|
|
