|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 13133
|
| Min. Negotiated Rate |
$118.59 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Commercial |
$158.91
|
| Rate for Payer: Aetna Medicare |
$118.59
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: BCBS MAPPO |
$118.59
|
| Rate for Payer: BCN Medicare Advantage |
$118.59
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$170.77
|
| Rate for Payer: Cofinity Commercial |
$158.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.59
|
| Rate for Payer: Healthscope Commercial |
$142.31
|
| Rate for Payer: Healthscope Whirlpool |
$142.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.52
|
| Rate for Payer: Nomi Health Commercial |
$142.31
|
| Rate for Payer: PACE SWMI |
$118.59
|
| Rate for Payer: PHP Medicare Advantage |
$118.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health Medicare |
$118.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.59
|
| Rate for Payer: UHC Medicare Advantage |
$118.59
|
| Rate for Payer: UHCCP DNSP |
$118.59
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
HCPCS 13120
|
| Min. Negotiated Rate |
$216.90 |
| Max. Negotiated Rate |
$355.55 |
| Rate for Payer: Aetna Commercial |
$290.65
|
| Rate for Payer: Aetna Medicare |
$216.90
|
| Rate for Payer: BCBS Complete |
$218.80
|
| Rate for Payer: BCBS MAPPO |
$216.90
|
| Rate for Payer: BCN Medicare Advantage |
$216.90
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cofinity Commercial |
$312.34
|
| Rate for Payer: Cofinity Commercial |
$290.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.90
|
| Rate for Payer: Healthscope Commercial |
$260.28
|
| Rate for Payer: Healthscope Whirlpool |
$260.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.75
|
| Rate for Payer: Nomi Health Commercial |
$260.28
|
| Rate for Payer: PACE SWMI |
$216.90
|
| Rate for Payer: PHP Medicare Advantage |
$216.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.55
|
| Rate for Payer: Priority Health Medicare |
$216.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.90
|
| Rate for Payer: UHC Medicare Advantage |
$216.90
|
| Rate for Payer: UHCCP DNSP |
$216.90
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$583.70 |
| Max. Negotiated Rate |
$898.00 |
| Rate for Payer: Aetna Commercial |
$808.20
|
| Rate for Payer: ASR ASR |
$871.06
|
| Rate for Payer: ASR Commercial |
$871.06
|
| Rate for Payer: BCBS Trust/PPO |
$731.78
|
| Rate for Payer: BCN Commercial |
$696.22
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$844.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$718.40
|
| Rate for Payer: Healthscope Commercial |
$898.00
|
| Rate for Payer: Healthscope Whirlpool |
$871.06
|
| Rate for Payer: Mclaren Commercial |
$808.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$763.30
|
| Rate for Payer: Nomi Health Commercial |
$736.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$790.24
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$319.99 |
| Max. Negotiated Rate |
$925.35 |
| Rate for Payer: Aetna Commercial |
$808.20
|
| Rate for Payer: Aetna Medicare |
$597.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: ASR ASR |
$871.06
|
| Rate for Payer: ASR Commercial |
$871.06
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCBS Trust/PPO |
$735.37
|
| Rate for Payer: BCN Commercial |
$696.22
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$844.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$718.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$898.00
|
| Rate for Payer: Healthscope Whirlpool |
$871.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$597.00
|
| Rate for Payer: Mclaren Commercial |
$808.20
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$763.30
|
| Rate for Payer: Nomi Health Commercial |
$736.36
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$656.70
|
| Rate for Payer: PHP Medicaid |
$319.99
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$786.83
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health Narrow Network |
$629.50
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$790.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Exchange |
$925.35
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP DNSP |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$319.99
|
| Rate for Payer: VA VA |
$597.00
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
13121
|
| Min. Negotiated Rate |
$244.04 |
| Max. Negotiated Rate |
$583.70 |
| Rate for Payer: Aetna Commercial |
$327.01
|
| Rate for Payer: Aetna Medicare |
$244.04
|
| Rate for Payer: BCBS Complete |
$359.20
|
| Rate for Payer: BCBS MAPPO |
$244.04
|
| Rate for Payer: BCN Medicare Advantage |
$244.04
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$351.42
|
| Rate for Payer: Cofinity Commercial |
$327.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.04
|
| Rate for Payer: Healthscope Commercial |
$292.85
|
| Rate for Payer: Healthscope Whirlpool |
$292.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.24
|
| Rate for Payer: Nomi Health Commercial |
$292.85
|
| Rate for Payer: PACE SWMI |
$244.04
|
| Rate for Payer: PHP Medicare Advantage |
$244.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health Medicare |
$244.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.04
|
| Rate for Payer: UHC Medicare Advantage |
$244.04
|
| Rate for Payer: UHCCP DNSP |
$244.04
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
HCPCS 13121
|
| Min. Negotiated Rate |
$244.04 |
| Max. Negotiated Rate |
$583.70 |
| Rate for Payer: Aetna Commercial |
$327.01
|
| Rate for Payer: Aetna Medicare |
$244.04
|
| Rate for Payer: BCBS Complete |
$359.20
|
| Rate for Payer: BCBS MAPPO |
$244.04
|
| Rate for Payer: BCN Medicare Advantage |
$244.04
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$351.42
|
| Rate for Payer: Cofinity Commercial |
$327.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.04
|
| Rate for Payer: Healthscope Commercial |
$292.85
|
| Rate for Payer: Healthscope Whirlpool |
$292.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.24
|
| Rate for Payer: Nomi Health Commercial |
$292.85
|
| Rate for Payer: PACE SWMI |
$244.04
|
| Rate for Payer: PHP Medicare Advantage |
$244.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health Medicare |
$244.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.04
|
| Rate for Payer: UHC Medicare Advantage |
$244.04
|
| Rate for Payer: UHCCP DNSP |
$244.04
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$281.00 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: ASR ASR |
$272.57
|
| Rate for Payer: ASR Commercial |
$272.57
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS Trust/PPO |
$230.11
|
| Rate for Payer: BCN Commercial |
$217.86
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$264.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Healthscope Commercial |
$281.00
|
| Rate for Payer: Healthscope Whirlpool |
$272.57
|
| Rate for Payer: Mclaren Commercial |
$252.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.85
|
| Rate for Payer: Nomi Health Commercial |
$230.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$246.21
|
| Rate for Payer: Priority Health Narrow Network |
$196.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.28
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 13122
|
| Hospital Charge Code |
13122
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Commercial |
$104.68
|
| Rate for Payer: Aetna Medicare |
$78.12
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS MAPPO |
$78.12
|
| Rate for Payer: BCN Medicare Advantage |
$78.12
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$112.49
|
| Rate for Payer: Cofinity Commercial |
$104.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$93.74
|
| Rate for Payer: Healthscope Whirlpool |
$93.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.03
|
| Rate for Payer: Nomi Health Commercial |
$93.74
|
| Rate for Payer: PACE SWMI |
$78.12
|
| Rate for Payer: PHP Medicare Advantage |
$78.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health Medicare |
$78.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.12
|
| Rate for Payer: UHC Medicare Advantage |
$78.12
|
| Rate for Payer: UHCCP DNSP |
$78.12
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$182.65 |
| Max. Negotiated Rate |
$281.00 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: ASR ASR |
$272.57
|
| Rate for Payer: ASR Commercial |
$272.57
|
| Rate for Payer: BCBS Trust/PPO |
$228.99
|
| Rate for Payer: BCN Commercial |
$217.86
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$264.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Healthscope Commercial |
$281.00
|
| Rate for Payer: Healthscope Whirlpool |
$272.57
|
| Rate for Payer: Mclaren Commercial |
$252.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.85
|
| Rate for Payer: Nomi Health Commercial |
$230.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.28
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 13122
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Commercial |
$104.68
|
| Rate for Payer: Aetna Medicare |
$78.12
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS MAPPO |
$78.12
|
| Rate for Payer: BCN Medicare Advantage |
$78.12
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$112.49
|
| Rate for Payer: Cofinity Commercial |
$104.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$93.74
|
| Rate for Payer: Healthscope Whirlpool |
$93.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.03
|
| Rate for Payer: Nomi Health Commercial |
$93.74
|
| Rate for Payer: PACE SWMI |
$78.12
|
| Rate for Payer: PHP Medicare Advantage |
$78.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health Medicare |
$78.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.12
|
| Rate for Payer: UHC Medicare Advantage |
$78.12
|
| Rate for Payer: UHCCP DNSP |
$78.12
|
|
|
PR REPAIR COMPLEX TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
HCPCS 13100
|
| Min. Negotiated Rate |
$189.93 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna Commercial |
$254.51
|
| Rate for Payer: Aetna Medicare |
$189.93
|
| Rate for Payer: BCBS Complete |
$220.80
|
| Rate for Payer: BCBS MAPPO |
$189.93
|
| Rate for Payer: BCN Medicare Advantage |
$189.93
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cofinity Commercial |
$273.50
|
| Rate for Payer: Cofinity Commercial |
$254.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.93
|
| Rate for Payer: Healthscope Commercial |
$227.92
|
| Rate for Payer: Healthscope Whirlpool |
$227.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.43
|
| Rate for Payer: Nomi Health Commercial |
$227.92
|
| Rate for Payer: PACE SWMI |
$189.93
|
| Rate for Payer: PHP Medicare Advantage |
$189.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.80
|
| Rate for Payer: Priority Health Medicare |
$189.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.93
|
| Rate for Payer: UHC Medicare Advantage |
$189.93
|
| Rate for Payer: UHCCP DNSP |
$189.93
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 13101
|
| Min. Negotiated Rate |
$231.78 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Aetna Commercial |
$310.59
|
| Rate for Payer: Aetna Medicare |
$231.78
|
| Rate for Payer: BCBS Complete |
$266.40
|
| Rate for Payer: BCBS MAPPO |
$231.78
|
| Rate for Payer: BCN Medicare Advantage |
$231.78
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$333.76
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.78
|
| Rate for Payer: Healthscope Commercial |
$278.14
|
| Rate for Payer: Healthscope Whirlpool |
$278.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.37
|
| Rate for Payer: Nomi Health Commercial |
$278.14
|
| Rate for Payer: PACE SWMI |
$231.78
|
| Rate for Payer: PHP Medicare Advantage |
$231.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health Medicare |
$231.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.78
|
| Rate for Payer: UHC Medicare Advantage |
$231.78
|
| Rate for Payer: UHCCP DNSP |
$231.78
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$231.78 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Aetna Commercial |
$310.59
|
| Rate for Payer: Aetna Medicare |
$231.78
|
| Rate for Payer: BCBS Complete |
$266.40
|
| Rate for Payer: BCBS MAPPO |
$231.78
|
| Rate for Payer: BCN Medicare Advantage |
$231.78
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$333.76
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.78
|
| Rate for Payer: Healthscope Commercial |
$278.14
|
| Rate for Payer: Healthscope Whirlpool |
$278.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.37
|
| Rate for Payer: Nomi Health Commercial |
$278.14
|
| Rate for Payer: PACE SWMI |
$231.78
|
| Rate for Payer: PHP Medicare Advantage |
$231.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health Medicare |
$231.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.78
|
| Rate for Payer: UHC Medicare Advantage |
$231.78
|
| Rate for Payer: UHCCP DNSP |
$231.78
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$319.99 |
| Max. Negotiated Rate |
$925.35 |
| Rate for Payer: Aetna Commercial |
$599.40
|
| Rate for Payer: Aetna Medicare |
$597.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: ASR ASR |
$646.02
|
| Rate for Payer: ASR Commercial |
$646.02
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCBS Trust/PPO |
$545.39
|
| Rate for Payer: BCN Commercial |
$516.35
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$626.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$666.00
|
| Rate for Payer: Healthscope Whirlpool |
$646.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$597.00
|
| Rate for Payer: Mclaren Commercial |
$599.40
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.10
|
| Rate for Payer: Nomi Health Commercial |
$546.12
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$656.70
|
| Rate for Payer: PHP Medicaid |
$319.99
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$583.55
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health Narrow Network |
$466.87
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$586.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Exchange |
$925.35
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP DNSP |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$319.99
|
| Rate for Payer: VA VA |
$597.00
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$432.90 |
| Max. Negotiated Rate |
$666.00 |
| Rate for Payer: Aetna Commercial |
$599.40
|
| Rate for Payer: ASR ASR |
$646.02
|
| Rate for Payer: ASR Commercial |
$646.02
|
| Rate for Payer: BCBS Trust/PPO |
$542.72
|
| Rate for Payer: BCN Commercial |
$516.35
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$626.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.80
|
| Rate for Payer: Healthscope Commercial |
$666.00
|
| Rate for Payer: Healthscope Whirlpool |
$646.02
|
| Rate for Payer: Mclaren Commercial |
$599.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.10
|
| Rate for Payer: Nomi Health Commercial |
$546.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$586.08
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 13102
|
| Min. Negotiated Rate |
$68.33 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Aetna Commercial |
$91.56
|
| Rate for Payer: Aetna Medicare |
$68.33
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS MAPPO |
$68.33
|
| Rate for Payer: BCN Medicare Advantage |
$68.33
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$91.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.33
|
| Rate for Payer: Healthscope Commercial |
$82.00
|
| Rate for Payer: Healthscope Whirlpool |
$82.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.75
|
| Rate for Payer: Nomi Health Commercial |
$82.00
|
| Rate for Payer: PACE SWMI |
$68.33
|
| Rate for Payer: PHP Medicare Advantage |
$68.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health Medicare |
$68.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.33
|
| Rate for Payer: UHC Medicare Advantage |
$68.33
|
| Rate for Payer: UHCCP DNSP |
$68.33
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$135.85 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: ASR ASR |
$202.73
|
| Rate for Payer: ASR Commercial |
$202.73
|
| Rate for Payer: BCBS Trust/PPO |
$170.31
|
| Rate for Payer: BCN Commercial |
$162.04
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$196.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$209.00
|
| Rate for Payer: Healthscope Whirlpool |
$202.73
|
| Rate for Payer: Mclaren Commercial |
$188.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: Nomi Health Commercial |
$171.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.92
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: ASR ASR |
$202.73
|
| Rate for Payer: ASR Commercial |
$202.73
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS Trust/PPO |
$171.15
|
| Rate for Payer: BCN Commercial |
$162.04
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$196.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$209.00
|
| Rate for Payer: Healthscope Whirlpool |
$202.73
|
| Rate for Payer: Mclaren Commercial |
$188.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: Nomi Health Commercial |
$171.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.13
|
| Rate for Payer: Priority Health Narrow Network |
$146.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.92
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$68.33 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Aetna Commercial |
$91.56
|
| Rate for Payer: Aetna Medicare |
$68.33
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS MAPPO |
$68.33
|
| Rate for Payer: BCN Medicare Advantage |
$68.33
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$91.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.33
|
| Rate for Payer: Healthscope Commercial |
$82.00
|
| Rate for Payer: Healthscope Whirlpool |
$82.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.75
|
| Rate for Payer: Nomi Health Commercial |
$82.00
|
| Rate for Payer: PACE SWMI |
$68.33
|
| Rate for Payer: PHP Medicare Advantage |
$68.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health Medicare |
$68.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.33
|
| Rate for Payer: UHC Medicare Advantage |
$68.33
|
| Rate for Payer: UHCCP DNSP |
$68.33
|
|
|
PR REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS 13153
|
| Min. Negotiated Rate |
$130.89 |
| Max. Negotiated Rate |
$307.45 |
| Rate for Payer: Aetna Commercial |
$175.39
|
| Rate for Payer: Aetna Medicare |
$130.89
|
| Rate for Payer: BCBS Complete |
$189.20
|
| Rate for Payer: BCBS MAPPO |
$130.89
|
| Rate for Payer: BCN Medicare Advantage |
$130.89
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cofinity Commercial |
$188.48
|
| Rate for Payer: Cofinity Commercial |
$175.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.89
|
| Rate for Payer: Healthscope Commercial |
$157.07
|
| Rate for Payer: Healthscope Whirlpool |
$157.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.43
|
| Rate for Payer: Nomi Health Commercial |
$157.07
|
| Rate for Payer: PACE SWMI |
$130.89
|
| Rate for Payer: PHP Medicare Advantage |
$130.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.45
|
| Rate for Payer: Priority Health Medicare |
$130.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.89
|
| Rate for Payer: UHC Medicare Advantage |
$130.89
|
| Rate for Payer: UHCCP DNSP |
$130.89
|
|
|
PR REPAIR CONGENITAL AV FISTULA EXTREMITIES
|
Professional
|
Both
|
$4,223.00
|
|
|
Service Code
|
HCPCS 35184
|
| Min. Negotiated Rate |
$929.71 |
| Max. Negotiated Rate |
$2,744.95 |
| Rate for Payer: Aetna Commercial |
$1,245.81
|
| Rate for Payer: Aetna Medicare |
$929.71
|
| Rate for Payer: BCBS Complete |
$1,689.20
|
| Rate for Payer: BCBS MAPPO |
$929.71
|
| Rate for Payer: BCN Medicare Advantage |
$929.71
|
| Rate for Payer: Cash Price |
$3,378.40
|
| Rate for Payer: Cash Price |
$3,378.40
|
| Rate for Payer: Cofinity Commercial |
$1,338.78
|
| Rate for Payer: Cofinity Commercial |
$1,245.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$929.71
|
| Rate for Payer: Healthscope Commercial |
$1,115.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,115.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$976.20
|
| Rate for Payer: Nomi Health Commercial |
$1,115.65
|
| Rate for Payer: PACE SWMI |
$929.71
|
| Rate for Payer: PHP Medicare Advantage |
$929.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,744.95
|
| Rate for Payer: Priority Health Medicare |
$929.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$929.71
|
| Rate for Payer: UHC Medicare Advantage |
$929.71
|
| Rate for Payer: UHCCP DNSP |
$929.71
|
|
|
PR REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA
|
Professional
|
Both
|
$1,951.00
|
|
|
Service Code
|
HCPCS 25425
|
| Min. Negotiated Rate |
$780.40 |
| Max. Negotiated Rate |
$1,338.90 |
| Rate for Payer: Aetna Commercial |
$1,245.92
|
| Rate for Payer: Aetna Medicare |
$929.79
|
| Rate for Payer: BCBS Complete |
$780.40
|
| Rate for Payer: BCBS MAPPO |
$929.79
|
| Rate for Payer: BCN Medicare Advantage |
$929.79
|
| Rate for Payer: Cash Price |
$1,560.80
|
| Rate for Payer: Cash Price |
$1,560.80
|
| Rate for Payer: Cofinity Commercial |
$1,338.90
|
| Rate for Payer: Cofinity Commercial |
$1,245.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$929.79
|
| Rate for Payer: Healthscope Commercial |
$1,115.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,115.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$976.28
|
| Rate for Payer: Nomi Health Commercial |
$1,115.75
|
| Rate for Payer: PACE SWMI |
$929.79
|
| Rate for Payer: PHP Medicare Advantage |
$929.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,268.15
|
| Rate for Payer: Priority Health Medicare |
$929.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$929.79
|
| Rate for Payer: UHC Medicare Advantage |
$929.79
|
| Rate for Payer: UHCCP DNSP |
$929.79
|
|
|
PR REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT
|
Professional
|
Both
|
$2,169.00
|
|
|
Service Code
|
HCPCS 27676
|
| Min. Negotiated Rate |
$587.75 |
| Max. Negotiated Rate |
$1,409.85 |
| Rate for Payer: Aetna Commercial |
$787.59
|
| Rate for Payer: Aetna Medicare |
$587.75
|
| Rate for Payer: BCBS Complete |
$867.60
|
| Rate for Payer: BCBS MAPPO |
$587.75
|
| Rate for Payer: BCN Medicare Advantage |
$587.75
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cofinity Commercial |
$846.36
|
| Rate for Payer: Cofinity Commercial |
$787.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$587.75
|
| Rate for Payer: Healthscope Commercial |
$705.30
|
| Rate for Payer: Healthscope Whirlpool |
$705.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$617.14
|
| Rate for Payer: Nomi Health Commercial |
$705.30
|
| Rate for Payer: PACE SWMI |
$587.75
|
| Rate for Payer: PHP Medicare Advantage |
$587.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,409.85
|
| Rate for Payer: Priority Health Medicare |
$587.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$587.75
|
| Rate for Payer: UHC Medicare Advantage |
$587.75
|
| Rate for Payer: UHCCP DNSP |
$587.75
|
|
|
PR REPAIR ECTROPION EXTENSIVE
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 67917
|
| Min. Negotiated Rate |
$421.77 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$565.17
|
| Rate for Payer: Aetna Medicare |
$421.77
|
| Rate for Payer: BCBS Complete |
$500.00
|
| Rate for Payer: BCBS MAPPO |
$421.77
|
| Rate for Payer: BCN Medicare Advantage |
$421.77
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cofinity Commercial |
$607.35
|
| Rate for Payer: Cofinity Commercial |
$565.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.77
|
| Rate for Payer: Healthscope Commercial |
$506.12
|
| Rate for Payer: Healthscope Whirlpool |
$506.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.86
|
| Rate for Payer: Nomi Health Commercial |
$506.12
|
| Rate for Payer: PACE SWMI |
$421.77
|
| Rate for Payer: PHP Medicare Advantage |
$421.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$812.50
|
| Rate for Payer: Priority Health Medicare |
$421.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$421.77
|
| Rate for Payer: UHC Medicare Advantage |
$421.77
|
| Rate for Payer: UHCCP DNSP |
$421.77
|
|
|
PR REPAIR ENTEROCELE ABDOMINAL APPROACH SPX
|
Professional
|
Both
|
$2,063.00
|
|
|
Service Code
|
HCPCS 57270
|
| Min. Negotiated Rate |
$778.02 |
| Max. Negotiated Rate |
$1,340.95 |
| Rate for Payer: Aetna Commercial |
$1,042.55
|
| Rate for Payer: Aetna Medicare |
$778.02
|
| Rate for Payer: BCBS Complete |
$825.20
|
| Rate for Payer: BCBS MAPPO |
$778.02
|
| Rate for Payer: BCN Medicare Advantage |
$778.02
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Cofinity Commercial |
$1,120.35
|
| Rate for Payer: Cofinity Commercial |
$1,042.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$778.02
|
| Rate for Payer: Healthscope Commercial |
$933.62
|
| Rate for Payer: Healthscope Whirlpool |
$933.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$816.92
|
| Rate for Payer: Nomi Health Commercial |
$933.62
|
| Rate for Payer: PACE SWMI |
$778.02
|
| Rate for Payer: PHP Medicare Advantage |
$778.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,340.95
|
| Rate for Payer: Priority Health Medicare |
$778.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$778.02
|
| Rate for Payer: UHC Medicare Advantage |
$778.02
|
| Rate for Payer: UHCCP DNSP |
$778.02
|
|
