|
PR REPAIR BIFID EARLOBES - UNILATERAL
|
Professional
|
Both
|
$901.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$360.40 |
| Max. Negotiated Rate |
$675.75 |
| Rate for Payer: Aetna Medicare |
$450.50
|
| Rate for Payer: BCBS Complete |
$360.40
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$675.75
|
| Rate for Payer: UMR Bronson Commercial |
$414.46
|
|
|
PR REPAIR BLOOD VESSEL DIRECT HAND FINGER
|
Professional
|
Both
|
$1,394.00
|
|
|
Service Code
|
HCPCS 35207
|
| Min. Negotiated Rate |
$435.80 |
| Max. Negotiated Rate |
$1,319.02 |
| Rate for Payer: Aetna Commercial |
$897.53
|
| Rate for Payer: Aetna Medicare |
$696.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$964.51
|
| Rate for Payer: BCBS Complete |
$457.59
|
| Rate for Payer: BCBS MAPPO |
$669.80
|
| Rate for Payer: BCN Commercial |
$1,144.86
|
| Rate for Payer: BCN Medicare Advantage |
$669.80
|
| Rate for Payer: Cash Price |
$1,115.20
|
| Rate for Payer: Cash Price |
$1,115.20
|
| Rate for Payer: Cofinity Commercial |
$897.53
|
| Rate for Payer: Cofinity Commercial |
$964.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$669.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$703.29
|
| Rate for Payer: Meridian Medicaid |
$457.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$736.78
|
| Rate for Payer: Nomi Health Commercial |
$803.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,045.50
|
| Rate for Payer: PACE SWMI |
$669.80
|
| Rate for Payer: PHP Commercial |
$937.72
|
| Rate for Payer: PHP Medicare Advantage |
$669.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$435.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,231.16
|
| Rate for Payer: Priority Health Medicare |
$669.80
|
| Rate for Payer: Priority Health SBD |
$1,231.16
|
| Rate for Payer: Priority Health Tiered Network |
$1,231.16
|
| Rate for Payer: Railroad Medicare Medicare |
$669.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,319.02
|
| Rate for Payer: UHC Core |
$1,319.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$669.80
|
| Rate for Payer: UHC Exchange |
$1,319.02
|
| Rate for Payer: UHC Medicaid |
$435.80
|
| Rate for Payer: UHCCP Medicaid |
$435.80
|
| Rate for Payer: UMR Bronson Commercial |
$641.24
|
|
|
PR REPAIR BLOOD VESSEL DIRECT INTRA-ABDOMINAL
|
Professional
|
Both
|
$5,204.00
|
|
|
Service Code
|
HCPCS 35221
|
| Min. Negotiated Rate |
$853.49 |
| Max. Negotiated Rate |
$3,903.00 |
| Rate for Payer: Aetna Commercial |
$1,801.67
|
| Rate for Payer: Aetna Medicare |
$1,398.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,801.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,936.12
|
| Rate for Payer: BCBS Complete |
$896.16
|
| Rate for Payer: BCBS MAPPO |
$1,344.53
|
| Rate for Payer: BCN Commercial |
$2,165.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,344.53
|
| Rate for Payer: Cash Price |
$4,163.20
|
| Rate for Payer: Cash Price |
$4,163.20
|
| Rate for Payer: Cofinity Commercial |
$1,801.67
|
| Rate for Payer: Cofinity Commercial |
$1,936.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,344.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,411.76
|
| Rate for Payer: Meridian Medicaid |
$896.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,478.98
|
| Rate for Payer: Nomi Health Commercial |
$1,613.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,903.00
|
| Rate for Payer: PACE SWMI |
$1,344.53
|
| Rate for Payer: PHP Commercial |
$1,882.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,344.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$853.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,328.96
|
| Rate for Payer: Priority Health Medicare |
$1,344.53
|
| Rate for Payer: Priority Health SBD |
$2,328.96
|
| Rate for Payer: Priority Health Tiered Network |
$2,328.96
|
| Rate for Payer: Railroad Medicare Medicare |
$1,344.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,624.91
|
| Rate for Payer: UHC Core |
$2,624.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,344.53
|
| Rate for Payer: UHC Exchange |
$2,624.91
|
| Rate for Payer: UHC Medicaid |
$853.49
|
| Rate for Payer: UHCCP Medicaid |
$853.49
|
| Rate for Payer: UMR Bronson Commercial |
$2,393.84
|
|
|
PR REPAIR BLOOD VESSEL DIRECT LOWER EXTREMITY
|
Professional
|
Both
|
$2,740.00
|
|
|
Service Code
|
HCPCS 35226
|
| Min. Negotiated Rate |
$482.45 |
| Max. Negotiated Rate |
$2,055.00 |
| Rate for Payer: Aetna Commercial |
$1,019.90
|
| Rate for Payer: Aetna Medicare |
$791.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,019.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,096.01
|
| Rate for Payer: BCBS Complete |
$506.57
|
| Rate for Payer: BCBS MAPPO |
$761.12
|
| Rate for Payer: BCN Commercial |
$1,214.57
|
| Rate for Payer: BCN Medicare Advantage |
$761.12
|
| Rate for Payer: Cash Price |
$2,192.00
|
| Rate for Payer: Cash Price |
$2,192.00
|
| Rate for Payer: Cofinity Commercial |
$1,019.90
|
| Rate for Payer: Cofinity Commercial |
$1,096.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$761.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$799.18
|
| Rate for Payer: Meridian Medicaid |
$506.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$837.23
|
| Rate for Payer: Nomi Health Commercial |
$913.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,055.00
|
| Rate for Payer: PACE SWMI |
$761.12
|
| Rate for Payer: PHP Commercial |
$1,065.57
|
| Rate for Payer: PHP Medicare Advantage |
$761.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$482.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,306.12
|
| Rate for Payer: Priority Health Medicare |
$761.12
|
| Rate for Payer: Priority Health SBD |
$1,306.12
|
| Rate for Payer: Priority Health Tiered Network |
$1,306.12
|
| Rate for Payer: Railroad Medicare Medicare |
$761.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,489.21
|
| Rate for Payer: UHC Core |
$1,489.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$761.12
|
| Rate for Payer: UHC Exchange |
$1,489.21
|
| Rate for Payer: UHC Medicaid |
$482.45
|
| Rate for Payer: UHCCP Medicaid |
$482.45
|
| Rate for Payer: UMR Bronson Commercial |
$1,260.40
|
|
|
PR REPAIR BLOOD VESSEL DIRECT NECK
|
Professional
|
Both
|
$4,367.00
|
|
|
Service Code
|
HCPCS 35201
|
| Min. Negotiated Rate |
$539.32 |
| Max. Negotiated Rate |
$3,275.25 |
| Rate for Payer: Aetna Commercial |
$1,137.81
|
| Rate for Payer: Aetna Medicare |
$883.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,137.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,222.72
|
| Rate for Payer: BCBS Complete |
$566.29
|
| Rate for Payer: BCBS MAPPO |
$849.11
|
| Rate for Payer: BCN Commercial |
$1,365.46
|
| Rate for Payer: BCN Medicare Advantage |
$849.11
|
| Rate for Payer: Cash Price |
$3,493.60
|
| Rate for Payer: Cash Price |
$3,493.60
|
| Rate for Payer: Cofinity Commercial |
$1,137.81
|
| Rate for Payer: Cofinity Commercial |
$1,222.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$849.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$891.57
|
| Rate for Payer: Meridian Medicaid |
$566.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$934.02
|
| Rate for Payer: Nomi Health Commercial |
$1,018.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,275.25
|
| Rate for Payer: PACE SWMI |
$849.11
|
| Rate for Payer: PHP Commercial |
$1,188.75
|
| Rate for Payer: PHP Medicare Advantage |
$849.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$539.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,468.38
|
| Rate for Payer: Priority Health Medicare |
$849.11
|
| Rate for Payer: Priority Health SBD |
$1,468.38
|
| Rate for Payer: Priority Health Tiered Network |
$1,468.38
|
| Rate for Payer: Railroad Medicare Medicare |
$849.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,681.59
|
| Rate for Payer: UHC Core |
$1,681.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$849.11
|
| Rate for Payer: UHC Exchange |
$1,681.59
|
| Rate for Payer: UHC Medicaid |
$539.32
|
| Rate for Payer: UHCCP Medicaid |
$539.32
|
| Rate for Payer: UMR Bronson Commercial |
$2,008.82
|
|
|
PR REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY
|
Professional
|
Both
|
$2,874.00
|
|
|
Service Code
|
HCPCS 35206
|
| Min. Negotiated Rate |
$461.78 |
| Max. Negotiated Rate |
$2,155.50 |
| Rate for Payer: Aetna Commercial |
$968.70
|
| Rate for Payer: Aetna Medicare |
$751.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,040.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$968.70
|
| Rate for Payer: BCBS Complete |
$484.87
|
| Rate for Payer: BCBS MAPPO |
$722.91
|
| Rate for Payer: BCN Commercial |
$1,177.23
|
| Rate for Payer: BCN Medicare Advantage |
$722.91
|
| Rate for Payer: Cash Price |
$2,299.20
|
| Rate for Payer: Cash Price |
$2,299.20
|
| Rate for Payer: Cofinity Commercial |
$1,040.99
|
| Rate for Payer: Cofinity Commercial |
$968.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$759.06
|
| Rate for Payer: Meridian Medicaid |
$484.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$795.20
|
| Rate for Payer: Nomi Health Commercial |
$867.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,155.50
|
| Rate for Payer: PACE SWMI |
$722.91
|
| Rate for Payer: PHP Commercial |
$1,012.07
|
| Rate for Payer: PHP Medicare Advantage |
$722.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$461.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,265.96
|
| Rate for Payer: Priority Health Medicare |
$722.91
|
| Rate for Payer: Priority Health SBD |
$1,265.96
|
| Rate for Payer: Priority Health Tiered Network |
$1,265.96
|
| Rate for Payer: Railroad Medicare Medicare |
$722.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,393.48
|
| Rate for Payer: UHC Core |
$1,393.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$722.91
|
| Rate for Payer: UHC Exchange |
$1,393.48
|
| Rate for Payer: UHC Medicaid |
$461.78
|
| Rate for Payer: UHCCP Medicaid |
$461.78
|
| Rate for Payer: UMR Bronson Commercial |
$1,322.04
|
|
|
PR REPAIR BLOOD VESSEL VEIN GRAFT INTRA-ABDOMINAL
|
Professional
|
Both
|
$3,954.00
|
|
|
Service Code
|
HCPCS 35251
|
| Min. Negotiated Rate |
$998.33 |
| Max. Negotiated Rate |
$3,123.02 |
| Rate for Payer: Aetna Commercial |
$2,112.30
|
| Rate for Payer: Aetna Medicare |
$1,639.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,112.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,269.93
|
| Rate for Payer: BCBS Complete |
$1,048.25
|
| Rate for Payer: BCBS MAPPO |
$1,576.34
|
| Rate for Payer: BCN Commercial |
$2,542.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,576.34
|
| Rate for Payer: Cash Price |
$3,163.20
|
| Rate for Payer: Cash Price |
$3,163.20
|
| Rate for Payer: Cofinity Commercial |
$2,112.30
|
| Rate for Payer: Cofinity Commercial |
$2,269.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,576.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,655.16
|
| Rate for Payer: Meridian Medicaid |
$1,048.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,733.97
|
| Rate for Payer: Nomi Health Commercial |
$1,891.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,965.50
|
| Rate for Payer: PACE SWMI |
$1,576.34
|
| Rate for Payer: PHP Commercial |
$2,206.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,576.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$998.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,733.81
|
| Rate for Payer: Priority Health Medicare |
$1,576.34
|
| Rate for Payer: Priority Health SBD |
$2,733.81
|
| Rate for Payer: Priority Health Tiered Network |
$2,733.81
|
| Rate for Payer: Railroad Medicare Medicare |
$1,576.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,123.02
|
| Rate for Payer: UHC Core |
$3,123.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,576.34
|
| Rate for Payer: UHC Exchange |
$3,123.02
|
| Rate for Payer: UHC Medicaid |
$998.33
|
| Rate for Payer: UHCCP Medicaid |
$998.33
|
| Rate for Payer: UMR Bronson Commercial |
$1,818.84
|
|
|
PR REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY
|
Professional
|
Both
|
$4,712.00
|
|
|
Service Code
|
HCPCS 35256
|
| Min. Negotiated Rate |
$591.50 |
| Max. Negotiated Rate |
$3,534.00 |
| Rate for Payer: Aetna Commercial |
$1,250.82
|
| Rate for Payer: Aetna Medicare |
$970.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,250.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,344.17
|
| Rate for Payer: BCBS Complete |
$621.08
|
| Rate for Payer: BCBS MAPPO |
$933.45
|
| Rate for Payer: BCN Commercial |
$1,494.94
|
| Rate for Payer: BCN Medicare Advantage |
$933.45
|
| Rate for Payer: Cash Price |
$3,769.60
|
| Rate for Payer: Cash Price |
$3,769.60
|
| Rate for Payer: Cofinity Commercial |
$1,250.82
|
| Rate for Payer: Cofinity Commercial |
$1,344.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$933.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$980.12
|
| Rate for Payer: Meridian Medicaid |
$621.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,026.80
|
| Rate for Payer: Nomi Health Commercial |
$1,120.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,534.00
|
| Rate for Payer: PACE SWMI |
$933.45
|
| Rate for Payer: PHP Commercial |
$1,306.83
|
| Rate for Payer: PHP Medicare Advantage |
$933.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$591.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,607.61
|
| Rate for Payer: Priority Health Medicare |
$933.45
|
| Rate for Payer: Priority Health SBD |
$1,607.61
|
| Rate for Payer: Priority Health Tiered Network |
$1,607.61
|
| Rate for Payer: Railroad Medicare Medicare |
$933.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,836.36
|
| Rate for Payer: UHC Core |
$1,836.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$933.45
|
| Rate for Payer: UHC Exchange |
$1,836.36
|
| Rate for Payer: UHC Medicaid |
$591.50
|
| Rate for Payer: UHCCP Medicaid |
$591.50
|
| Rate for Payer: UMR Bronson Commercial |
$2,167.52
|
|
|
PR REPAIR BLOOD VESSEL W/GRAFT OTHER/THAN VEIN NECK
|
Professional
|
Both
|
$4,833.00
|
|
|
Service Code
|
HCPCS 35261
|
| Min. Negotiated Rate |
$572.33 |
| Max. Negotiated Rate |
$3,624.75 |
| Rate for Payer: Aetna Commercial |
$1,215.73
|
| Rate for Payer: Aetna Medicare |
$943.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,215.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,306.45
|
| Rate for Payer: BCBS Complete |
$600.95
|
| Rate for Payer: BCBS MAPPO |
$907.26
|
| Rate for Payer: BCN Commercial |
$1,438.67
|
| Rate for Payer: BCN Medicare Advantage |
$907.26
|
| Rate for Payer: Cash Price |
$3,866.40
|
| Rate for Payer: Cash Price |
$3,866.40
|
| Rate for Payer: Cofinity Commercial |
$1,215.73
|
| Rate for Payer: Cofinity Commercial |
$1,306.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$907.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$952.62
|
| Rate for Payer: Meridian Medicaid |
$600.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$997.99
|
| Rate for Payer: Nomi Health Commercial |
$1,088.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,624.75
|
| Rate for Payer: PACE SWMI |
$907.26
|
| Rate for Payer: PHP Commercial |
$1,270.16
|
| Rate for Payer: PHP Medicare Advantage |
$907.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$572.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,547.10
|
| Rate for Payer: Priority Health Medicare |
$907.26
|
| Rate for Payer: Priority Health SBD |
$1,547.10
|
| Rate for Payer: Priority Health Tiered Network |
$1,547.10
|
| Rate for Payer: Railroad Medicare Medicare |
$907.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,758.74
|
| Rate for Payer: UHC Core |
$1,758.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$907.26
|
| Rate for Payer: UHC Exchange |
$1,758.74
|
| Rate for Payer: UHC Medicaid |
$572.33
|
| Rate for Payer: UHCCP Medicaid |
$572.33
|
| Rate for Payer: UMR Bronson Commercial |
$2,223.18
|
|
|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT NECK
|
Professional
|
Both
|
$1,953.00
|
|
|
Service Code
|
HCPCS 35231
|
| Min. Negotiated Rate |
$692.04 |
| Max. Negotiated Rate |
$2,224.85 |
| Rate for Payer: Aetna Commercial |
$1,444.61
|
| Rate for Payer: Aetna Medicare |
$1,121.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,444.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,552.42
|
| Rate for Payer: BCBS Complete |
$726.64
|
| Rate for Payer: BCBS MAPPO |
$1,078.07
|
| Rate for Payer: BCN Commercial |
$1,858.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,078.07
|
| Rate for Payer: Cash Price |
$1,562.40
|
| Rate for Payer: Cash Price |
$1,562.40
|
| Rate for Payer: Cofinity Commercial |
$1,444.61
|
| Rate for Payer: Cofinity Commercial |
$1,552.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,078.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,131.97
|
| Rate for Payer: Meridian Medicaid |
$726.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,185.88
|
| Rate for Payer: Nomi Health Commercial |
$1,293.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,464.75
|
| Rate for Payer: PACE SWMI |
$1,078.07
|
| Rate for Payer: PHP Commercial |
$1,509.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,078.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$692.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,998.54
|
| Rate for Payer: Priority Health Medicare |
$1,078.07
|
| Rate for Payer: Priority Health SBD |
$1,998.54
|
| Rate for Payer: Priority Health Tiered Network |
$1,998.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,078.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,224.85
|
| Rate for Payer: UHC Core |
$2,224.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,078.07
|
| Rate for Payer: UHC Exchange |
$2,224.85
|
| Rate for Payer: UHC Medicaid |
$692.04
|
| Rate for Payer: UHCCP Medicaid |
$692.04
|
| Rate for Payer: UMR Bronson Commercial |
$898.38
|
|
|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY
|
Professional
|
Both
|
$3,809.00
|
|
|
Service Code
|
HCPCS 35236
|
| Min. Negotiated Rate |
$584.90 |
| Max. Negotiated Rate |
$2,856.75 |
| Rate for Payer: Aetna Commercial |
$1,231.42
|
| Rate for Payer: Aetna Medicare |
$955.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,231.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,323.32
|
| Rate for Payer: BCBS Complete |
$614.14
|
| Rate for Payer: BCBS MAPPO |
$918.97
|
| Rate for Payer: BCN Commercial |
$1,486.97
|
| Rate for Payer: BCN Medicare Advantage |
$918.97
|
| Rate for Payer: Cash Price |
$3,047.20
|
| Rate for Payer: Cash Price |
$3,047.20
|
| Rate for Payer: Cofinity Commercial |
$1,231.42
|
| Rate for Payer: Cofinity Commercial |
$1,323.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.92
|
| Rate for Payer: Meridian Medicaid |
$614.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,010.87
|
| Rate for Payer: Nomi Health Commercial |
$1,102.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,856.75
|
| Rate for Payer: PACE SWMI |
$918.97
|
| Rate for Payer: PHP Commercial |
$1,286.56
|
| Rate for Payer: PHP Medicare Advantage |
$918.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,599.06
|
| Rate for Payer: Priority Health Medicare |
$918.97
|
| Rate for Payer: Priority Health SBD |
$1,599.06
|
| Rate for Payer: Priority Health Tiered Network |
$1,599.06
|
| Rate for Payer: Railroad Medicare Medicare |
$918.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,794.18
|
| Rate for Payer: UHC Core |
$1,794.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$918.97
|
| Rate for Payer: UHC Exchange |
$1,794.18
|
| Rate for Payer: UHC Medicaid |
$584.90
|
| Rate for Payer: UHCCP Medicaid |
$584.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,752.14
|
|
|
PR REPAIR BROW PTOSIS
|
Professional
|
Both
|
$1,366.00
|
|
|
Service Code
|
HCPCS 67900
|
| Min. Negotiated Rate |
$276.05 |
| Max. Negotiated Rate |
$1,024.50 |
| Rate for Payer: Aetna Commercial |
$561.29
|
| Rate for Payer: Aetna Medicare |
$435.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$561.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.17
|
| Rate for Payer: BCBS Complete |
$289.85
|
| Rate for Payer: BCBS MAPPO |
$418.87
|
| Rate for Payer: BCN Commercial |
$749.46
|
| Rate for Payer: BCN Medicare Advantage |
$418.87
|
| Rate for Payer: Cash Price |
$1,092.80
|
| Rate for Payer: Cash Price |
$1,092.80
|
| Rate for Payer: Cofinity Commercial |
$561.29
|
| Rate for Payer: Cofinity Commercial |
$603.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$418.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$439.81
|
| Rate for Payer: Meridian Medicaid |
$289.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$460.76
|
| Rate for Payer: Nomi Health Commercial |
$502.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,024.50
|
| Rate for Payer: PACE SWMI |
$418.87
|
| Rate for Payer: PHP Commercial |
$586.42
|
| Rate for Payer: PHP Medicare Advantage |
$418.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$276.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$877.87
|
| Rate for Payer: Priority Health Medicare |
$418.87
|
| Rate for Payer: Priority Health SBD |
$877.87
|
| Rate for Payer: Priority Health Tiered Network |
$877.87
|
| Rate for Payer: Railroad Medicare Medicare |
$418.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$865.82
|
| Rate for Payer: UHC Core |
$865.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$418.87
|
| Rate for Payer: UHC Exchange |
$865.82
|
| Rate for Payer: UHC Medicaid |
$276.05
|
| Rate for Payer: UHCCP Medicaid |
$276.05
|
| Rate for Payer: UMR Bronson Commercial |
$628.36
|
|
|
PR REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS
|
Professional
|
Both
|
$7,917.00
|
|
|
Service Code
|
HCPCS 33305
|
| Min. Negotiated Rate |
$2,402.64 |
| Max. Negotiated Rate |
$7,339.55 |
| Rate for Payer: Aetna Commercial |
$5,081.86
|
| Rate for Payer: Aetna Medicare |
$3,944.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,081.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,461.10
|
| Rate for Payer: BCBS Complete |
$2,522.77
|
| Rate for Payer: BCBS MAPPO |
$3,792.43
|
| Rate for Payer: BCN Commercial |
$5,987.23
|
| Rate for Payer: BCN Medicare Advantage |
$3,792.43
|
| Rate for Payer: Cash Price |
$6,333.60
|
| Rate for Payer: Cash Price |
$6,333.60
|
| Rate for Payer: Cofinity Commercial |
$5,081.86
|
| Rate for Payer: Cofinity Commercial |
$5,461.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,792.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,982.05
|
| Rate for Payer: Meridian Medicaid |
$2,522.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,171.67
|
| Rate for Payer: Nomi Health Commercial |
$4,550.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,937.75
|
| Rate for Payer: PACE SWMI |
$3,792.43
|
| Rate for Payer: PHP Commercial |
$5,309.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,792.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,402.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,438.50
|
| Rate for Payer: Priority Health Medicare |
$3,792.43
|
| Rate for Payer: Priority Health SBD |
$6,438.50
|
| Rate for Payer: Priority Health Tiered Network |
$6,438.50
|
| Rate for Payer: Railroad Medicare Medicare |
$3,792.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,339.55
|
| Rate for Payer: UHC Core |
$7,339.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,792.43
|
| Rate for Payer: UHC Exchange |
$7,339.55
|
| Rate for Payer: UHC Medicaid |
$2,402.64
|
| Rate for Payer: UHCCP Medicaid |
$2,402.64
|
| Rate for Payer: UMR Bronson Commercial |
$3,641.82
|
|
|
PR REPAIR CARDIAC WOUND W/O BYPASS
|
Professional
|
Both
|
$4,735.00
|
|
|
Service Code
|
HCPCS 33300
|
| Min. Negotiated Rate |
$1,446.91 |
| Max. Negotiated Rate |
$4,377.20 |
| Rate for Payer: Aetna Commercial |
$3,051.49
|
| Rate for Payer: Aetna Medicare |
$2,368.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,051.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,279.21
|
| Rate for Payer: BCBS Complete |
$1,519.26
|
| Rate for Payer: BCBS MAPPO |
$2,277.23
|
| Rate for Payer: BCN Commercial |
$3,593.92
|
| Rate for Payer: BCN Medicare Advantage |
$2,277.23
|
| Rate for Payer: Cash Price |
$3,788.00
|
| Rate for Payer: Cash Price |
$3,788.00
|
| Rate for Payer: Cofinity Commercial |
$3,051.49
|
| Rate for Payer: Cofinity Commercial |
$3,279.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,277.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,391.09
|
| Rate for Payer: Meridian Medicaid |
$1,519.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,504.95
|
| Rate for Payer: Nomi Health Commercial |
$2,732.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,551.25
|
| Rate for Payer: PACE SWMI |
$2,277.23
|
| Rate for Payer: PHP Commercial |
$3,188.12
|
| Rate for Payer: PHP Medicare Advantage |
$2,277.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,864.82
|
| Rate for Payer: Priority Health Medicare |
$2,277.23
|
| Rate for Payer: Priority Health SBD |
$3,864.82
|
| Rate for Payer: Priority Health Tiered Network |
$3,864.82
|
| Rate for Payer: Railroad Medicare Medicare |
$2,277.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,377.20
|
| Rate for Payer: UHC Core |
$4,377.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,277.23
|
| Rate for Payer: UHC Exchange |
$4,377.20
|
| Rate for Payer: UHC Medicaid |
$1,446.91
|
| Rate for Payer: UHCCP Medicaid |
$1,446.91
|
| Rate for Payer: UMR Bronson Commercial |
$2,178.10
|
|
|
PR REPAIR CHOANAL ATRESIA INTRANASAL
|
Professional
|
Both
|
$1,264.00
|
|
|
Service Code
|
HCPCS 30540
|
| Min. Negotiated Rate |
$428.98 |
| Max. Negotiated Rate |
$1,210.92 |
| Rate for Payer: Aetna Commercial |
$863.98
|
| Rate for Payer: Aetna Medicare |
$670.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$863.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$928.45
|
| Rate for Payer: BCBS Complete |
$450.43
|
| Rate for Payer: BCBS MAPPO |
$644.76
|
| Rate for Payer: BCN Commercial |
$1,104.52
|
| Rate for Payer: BCN Medicare Advantage |
$644.76
|
| Rate for Payer: Cash Price |
$1,011.20
|
| Rate for Payer: Cash Price |
$1,011.20
|
| Rate for Payer: Cofinity Commercial |
$863.98
|
| Rate for Payer: Cofinity Commercial |
$928.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$677.00
|
| Rate for Payer: Meridian Medicaid |
$450.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$709.24
|
| Rate for Payer: Nomi Health Commercial |
$773.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$948.00
|
| Rate for Payer: PACE SWMI |
$644.76
|
| Rate for Payer: PHP Commercial |
$902.66
|
| Rate for Payer: PHP Medicare Advantage |
$644.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$428.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,040.14
|
| Rate for Payer: Priority Health Medicare |
$644.76
|
| Rate for Payer: Priority Health SBD |
$1,040.14
|
| Rate for Payer: Priority Health Tiered Network |
$1,040.14
|
| Rate for Payer: Railroad Medicare Medicare |
$644.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,210.92
|
| Rate for Payer: UHC Core |
$1,210.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$644.76
|
| Rate for Payer: UHC Exchange |
$1,210.92
|
| Rate for Payer: UHC Medicaid |
$428.98
|
| Rate for Payer: UHCCP Medicaid |
$428.98
|
| Rate for Payer: UMR Bronson Commercial |
$581.44
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 13151
|
| Min. Negotiated Rate |
$148.67 |
| Max. Negotiated Rate |
$717.00 |
| Rate for Payer: Aetna Commercial |
$306.52
|
| Rate for Payer: Aetna Medicare |
$237.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.40
|
| Rate for Payer: BCBS Complete |
$156.10
|
| Rate for Payer: BCBS MAPPO |
$228.75
|
| Rate for Payer: BCN Commercial |
$415.81
|
| Rate for Payer: BCN Medicare Advantage |
$228.75
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cofinity Commercial |
$306.52
|
| Rate for Payer: Cofinity Commercial |
$329.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$228.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.19
|
| Rate for Payer: Meridian Medicaid |
$156.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$251.62
|
| Rate for Payer: Nomi Health Commercial |
$274.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$717.00
|
| Rate for Payer: PACE SWMI |
$228.75
|
| Rate for Payer: PHP Commercial |
$320.25
|
| Rate for Payer: PHP Medicare Advantage |
$228.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$380.57
|
| Rate for Payer: Priority Health Medicare |
$228.75
|
| Rate for Payer: Priority Health SBD |
$380.57
|
| Rate for Payer: Priority Health Tiered Network |
$380.57
|
| Rate for Payer: Railroad Medicare Medicare |
$228.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$490.70
|
| Rate for Payer: UHC Core |
$490.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$228.75
|
| Rate for Payer: UHC Exchange |
$490.70
|
| Rate for Payer: UHC Medicaid |
$148.67
|
| Rate for Payer: UHCCP Medicaid |
$148.67
|
| Rate for Payer: UMR Bronson Commercial |
$439.76
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Professional
|
Both
|
$1,269.00
|
|
|
Service Code
|
HCPCS 13152
|
| Min. Negotiated Rate |
$177.64 |
| Max. Negotiated Rate |
$951.75 |
| Rate for Payer: Aetna Commercial |
$366.99
|
| Rate for Payer: Aetna Medicare |
$284.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$394.37
|
| Rate for Payer: BCBS Complete |
$186.52
|
| Rate for Payer: BCBS MAPPO |
$273.87
|
| Rate for Payer: BCN Commercial |
$499.48
|
| Rate for Payer: BCN Medicare Advantage |
$273.87
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cofinity Commercial |
$366.99
|
| Rate for Payer: Cofinity Commercial |
$394.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$287.56
|
| Rate for Payer: Meridian Medicaid |
$186.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$301.26
|
| Rate for Payer: Nomi Health Commercial |
$328.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$951.75
|
| Rate for Payer: PACE SWMI |
$273.87
|
| Rate for Payer: PHP Commercial |
$383.42
|
| Rate for Payer: PHP Medicare Advantage |
$273.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$177.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$457.16
|
| Rate for Payer: Priority Health Medicare |
$273.87
|
| Rate for Payer: Priority Health SBD |
$457.16
|
| Rate for Payer: Priority Health Tiered Network |
$457.16
|
| Rate for Payer: Railroad Medicare Medicare |
$273.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$591.20
|
| Rate for Payer: UHC Core |
$591.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$273.87
|
| Rate for Payer: UHC Exchange |
$591.20
|
| Rate for Payer: UHC Medicaid |
$177.64
|
| Rate for Payer: UHCCP Medicaid |
$177.64
|
| Rate for Payer: UMR Bronson Commercial |
$583.74
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM
|
Professional
|
Both
|
$623.00
|
|
|
Service Code
|
HCPCS 13131
|
| Min. Negotiated Rate |
$130.14 |
| Max. Negotiated Rate |
$467.25 |
| Rate for Payer: Aetna Commercial |
$268.00
|
| Rate for Payer: Aetna Medicare |
$208.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.00
|
| Rate for Payer: BCBS Complete |
$136.65
|
| Rate for Payer: BCBS MAPPO |
$200.00
|
| Rate for Payer: BCN Commercial |
$362.53
|
| Rate for Payer: BCN Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: Cofinity Commercial |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$288.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.00
|
| Rate for Payer: Meridian Medicaid |
$136.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$220.00
|
| Rate for Payer: Nomi Health Commercial |
$240.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$467.25
|
| Rate for Payer: PACE SWMI |
$200.00
|
| Rate for Payer: PHP Commercial |
$280.00
|
| Rate for Payer: PHP Medicare Advantage |
$200.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$331.81
|
| Rate for Payer: Priority Health Medicare |
$200.00
|
| Rate for Payer: Priority Health SBD |
$331.81
|
| Rate for Payer: Priority Health Tiered Network |
$331.81
|
| Rate for Payer: Railroad Medicare Medicare |
$200.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.68
|
| Rate for Payer: UHC Core |
$426.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$200.00
|
| Rate for Payer: UHC Exchange |
$426.68
|
| Rate for Payer: UHC Medicaid |
$130.14
|
| Rate for Payer: UHCCP Medicaid |
$130.14
|
| Rate for Payer: UMR Bronson Commercial |
$286.58
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Professional
|
Both
|
$1,345.00
|
|
|
Service Code
|
HCPCS 13132
|
| Min. Negotiated Rate |
$160.18 |
| Max. Negotiated Rate |
$1,008.75 |
| Rate for Payer: Aetna Commercial |
$330.36
|
| Rate for Payer: Aetna Medicare |
$256.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.02
|
| Rate for Payer: BCBS Complete |
$168.19
|
| Rate for Payer: BCBS MAPPO |
$246.54
|
| Rate for Payer: BCN Commercial |
$451.17
|
| Rate for Payer: BCN Medicare Advantage |
$246.54
|
| Rate for Payer: Cash Price |
$1,076.00
|
| Rate for Payer: Cash Price |
$1,076.00
|
| Rate for Payer: Cofinity Commercial |
$330.36
|
| Rate for Payer: Cofinity Commercial |
$355.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.87
|
| Rate for Payer: Meridian Medicaid |
$168.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$271.19
|
| Rate for Payer: Nomi Health Commercial |
$295.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,008.75
|
| Rate for Payer: PACE SWMI |
$246.54
|
| Rate for Payer: PHP Commercial |
$345.16
|
| Rate for Payer: PHP Medicare Advantage |
$246.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$412.94
|
| Rate for Payer: Priority Health Medicare |
$246.54
|
| Rate for Payer: Priority Health SBD |
$412.94
|
| Rate for Payer: Priority Health Tiered Network |
$412.94
|
| Rate for Payer: Railroad Medicare Medicare |
$246.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$534.41
|
| Rate for Payer: UHC Core |
$534.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$246.54
|
| Rate for Payer: UHC Exchange |
$534.41
|
| Rate for Payer: UHC Medicaid |
$160.18
|
| Rate for Payer: UHCCP Medicaid |
$160.18
|
| Rate for Payer: UMR Bronson Commercial |
$618.70
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 13133
|
| Min. Negotiated Rate |
$65.18 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$135.98
|
| Rate for Payer: Aetna Medicare |
$105.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.13
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCBS MAPPO |
$101.48
|
| Rate for Payer: BCN Commercial |
$185.75
|
| Rate for Payer: BCN Medicare Advantage |
$101.48
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cofinity Commercial |
$135.98
|
| Rate for Payer: Cofinity Commercial |
$146.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.55
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.63
|
| Rate for Payer: Nomi Health Commercial |
$121.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.00
|
| Rate for Payer: PACE SWMI |
$101.48
|
| Rate for Payer: PHP Commercial |
$142.07
|
| Rate for Payer: PHP Medicare Advantage |
$101.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$170.00
|
| Rate for Payer: Priority Health Medicare |
$101.48
|
| Rate for Payer: Priority Health SBD |
$170.00
|
| Rate for Payer: Priority Health Tiered Network |
$170.00
|
| Rate for Payer: Railroad Medicare Medicare |
$101.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.14
|
| Rate for Payer: UHC Core |
$225.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.48
|
| Rate for Payer: UHC Exchange |
$225.14
|
| Rate for Payer: UHC Medicaid |
$65.18
|
| Rate for Payer: UHCCP Medicaid |
$65.18
|
| Rate for Payer: UMR Bronson Commercial |
$193.20
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 13120
|
| Min. Negotiated Rate |
$126.52 |
| Max. Negotiated Rate |
$422.25 |
| Rate for Payer: Aetna Commercial |
$258.67
|
| Rate for Payer: Aetna Medicare |
$200.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.98
|
| Rate for Payer: BCBS Complete |
$132.85
|
| Rate for Payer: BCBS MAPPO |
$193.04
|
| Rate for Payer: BCN Commercial |
$345.10
|
| Rate for Payer: BCN Medicare Advantage |
$193.04
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cofinity Commercial |
$258.67
|
| Rate for Payer: Cofinity Commercial |
$277.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$202.69
|
| Rate for Payer: Meridian Medicaid |
$132.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$212.34
|
| Rate for Payer: Nomi Health Commercial |
$231.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.25
|
| Rate for Payer: PACE SWMI |
$193.04
|
| Rate for Payer: PHP Commercial |
$270.26
|
| Rate for Payer: PHP Medicare Advantage |
$193.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$315.85
|
| Rate for Payer: Priority Health Medicare |
$193.04
|
| Rate for Payer: Priority Health SBD |
$315.85
|
| Rate for Payer: Priority Health Tiered Network |
$315.85
|
| Rate for Payer: Railroad Medicare Medicare |
$193.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.07
|
| Rate for Payer: UHC Core |
$403.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$193.04
|
| Rate for Payer: UHC Exchange |
$403.07
|
| Rate for Payer: UHC Medicaid |
$126.52
|
| Rate for Payer: UHCCP Medicaid |
$126.52
|
| Rate for Payer: UMR Bronson Commercial |
$258.98
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
13121
|
| Min. Negotiated Rate |
$137.39 |
| Max. Negotiated Rate |
$693.75 |
| Rate for Payer: Aetna Commercial |
$283.01
|
| Rate for Payer: Aetna Medicare |
$219.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.13
|
| Rate for Payer: BCBS Complete |
$144.26
|
| Rate for Payer: BCBS MAPPO |
$211.20
|
| Rate for Payer: BCN Commercial |
$385.94
|
| Rate for Payer: BCN Medicare Advantage |
$211.20
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cofinity Commercial |
$283.01
|
| Rate for Payer: Cofinity Commercial |
$304.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$221.76
|
| Rate for Payer: Meridian Medicaid |
$144.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$232.32
|
| Rate for Payer: Nomi Health Commercial |
$253.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$693.75
|
| Rate for Payer: PACE SWMI |
$211.20
|
| Rate for Payer: PHP Commercial |
$295.68
|
| Rate for Payer: PHP Medicare Advantage |
$211.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$353.24
|
| Rate for Payer: Priority Health Medicare |
$211.20
|
| Rate for Payer: Priority Health SBD |
$353.24
|
| Rate for Payer: Priority Health Tiered Network |
$353.24
|
| Rate for Payer: Railroad Medicare Medicare |
$211.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$454.56
|
| Rate for Payer: UHC Core |
$454.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.20
|
| Rate for Payer: UHC Exchange |
$454.56
|
| Rate for Payer: UHC Medicaid |
$137.39
|
| Rate for Payer: UHCCP Medicaid |
$137.39
|
| Rate for Payer: UMR Bronson Commercial |
$425.50
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna American Axle |
$601.25
|
| Rate for Payer: Aetna Commercial |
$786.25
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$787.19
|
| Rate for Payer: BCN Commercial |
$787.19
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cofinity Advantage |
$647.50
|
| Rate for Payer: Cofinity Commercial |
$795.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$832.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$647.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$693.75
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$786.25
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$693.75
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$786.25
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$582.75
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: UMR Bronson Commercial |
$342.25
|
| Rate for Payer: VA VA |
$405.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$693.75
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$407.00 |
| Max. Negotiated Rate |
$832.50 |
| Rate for Payer: Aetna American Axle |
$601.25
|
| Rate for Payer: Aetna Commercial |
$786.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.25
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cofinity Advantage |
$647.50
|
| Rate for Payer: Cofinity Commercial |
$795.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.00
|
| Rate for Payer: Healthscope Commercial |
$832.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$647.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$693.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$786.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$693.75
|
| Rate for Payer: PHP Commercial |
$786.25
|
| Rate for Payer: Priority Health SBD |
$582.75
|
| Rate for Payer: UMR Bronson Commercial |
$407.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$693.75
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 13121
|
| Min. Negotiated Rate |
$137.39 |
| Max. Negotiated Rate |
$693.75 |
| Rate for Payer: Aetna Commercial |
$283.01
|
| Rate for Payer: Aetna Medicare |
$219.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.13
|
| Rate for Payer: BCBS Complete |
$144.26
|
| Rate for Payer: BCBS MAPPO |
$211.20
|
| Rate for Payer: BCN Commercial |
$385.94
|
| Rate for Payer: BCN Medicare Advantage |
$211.20
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cofinity Commercial |
$283.01
|
| Rate for Payer: Cofinity Commercial |
$304.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$221.76
|
| Rate for Payer: Meridian Medicaid |
$144.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$232.32
|
| Rate for Payer: Nomi Health Commercial |
$253.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$693.75
|
| Rate for Payer: PACE SWMI |
$211.20
|
| Rate for Payer: PHP Commercial |
$295.68
|
| Rate for Payer: PHP Medicare Advantage |
$211.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$353.24
|
| Rate for Payer: Priority Health Medicare |
$211.20
|
| Rate for Payer: Priority Health SBD |
$353.24
|
| Rate for Payer: Priority Health Tiered Network |
$353.24
|
| Rate for Payer: Railroad Medicare Medicare |
$211.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$454.56
|
| Rate for Payer: UHC Core |
$454.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.20
|
| Rate for Payer: UHC Exchange |
$454.56
|
| Rate for Payer: UHC Medicaid |
$137.39
|
| Rate for Payer: UHCCP Medicaid |
$137.39
|
| Rate for Payer: UMR Bronson Commercial |
$425.50
|
|
