|
PR ABLATION & RCNSTJ ATRIA EXTNSV W/BYPASS
|
Professional
|
Both
|
$3,766.00
|
|
|
Service Code
|
HCPCS 33256
|
| Min. Negotiated Rate |
$1,209.84 |
| Max. Negotiated Rate |
$3,005.35 |
| Rate for Payer: Aetna Commercial |
$2,468.32
|
| Rate for Payer: Aetna Medicare |
$1,915.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,468.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,652.52
|
| Rate for Payer: BCBS Complete |
$1,270.33
|
| Rate for Payer: BCBS MAPPO |
$1,842.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,285.88
|
| Rate for Payer: BCN Commercial |
$2,757.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,842.03
|
| Rate for Payer: Cash Price |
$3,012.80
|
| Rate for Payer: Cash Price |
$3,012.80
|
| Rate for Payer: Cofinity Commercial |
$2,468.32
|
| Rate for Payer: Cofinity Commercial |
$2,652.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,842.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,934.13
|
| Rate for Payer: Meridian Medicaid |
$1,270.33
|
| Rate for Payer: Nomi Health Commercial |
$2,210.44
|
| Rate for Payer: PACE SWMI |
$1,842.03
|
| Rate for Payer: PHP Commercial |
$2,578.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,842.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,209.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,447.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,005.35
|
| Rate for Payer: Priority Health Medicare |
$1,842.03
|
| Rate for Payer: Priority Health Narrow Network |
$3,005.35
|
| Rate for Payer: Priority Health SBD |
$3,005.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,842.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,842.03
|
| Rate for Payer: UHCCP Medicaid |
$1,209.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,732.36
|
|
|
PR ABLATION & RECONSTRUCTION ATRIA LIMITED
|
Professional
|
Both
|
$3,359.00
|
|
|
Service Code
|
HCPCS 33254
|
| Min. Negotiated Rate |
$858.18 |
| Max. Negotiated Rate |
$2,183.35 |
| Rate for Payer: Aetna Commercial |
$1,746.54
|
| Rate for Payer: Aetna Medicare |
$1,355.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,746.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,876.88
|
| Rate for Payer: BCBS Complete |
$901.09
|
| Rate for Payer: BCBS MAPPO |
$1,303.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,663.62
|
| Rate for Payer: BCN Commercial |
$1,950.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,303.39
|
| Rate for Payer: Cash Price |
$2,687.20
|
| Rate for Payer: Cash Price |
$2,687.20
|
| Rate for Payer: Cofinity Commercial |
$1,746.54
|
| Rate for Payer: Cofinity Commercial |
$1,876.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,303.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,368.56
|
| Rate for Payer: Meridian Medicaid |
$901.09
|
| Rate for Payer: Nomi Health Commercial |
$1,564.07
|
| Rate for Payer: PACE SWMI |
$1,303.39
|
| Rate for Payer: PHP Commercial |
$1,824.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,303.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$858.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,183.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,138.47
|
| Rate for Payer: Priority Health Medicare |
$1,303.39
|
| Rate for Payer: Priority Health Narrow Network |
$2,138.47
|
| Rate for Payer: Priority Health SBD |
$2,138.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,303.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,303.39
|
| Rate for Payer: UHCCP Medicaid |
$858.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,545.14
|
|
|
PR ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
HCPCS 30802
|
| Min. Negotiated Rate |
$128.65 |
| Max. Negotiated Rate |
$724.30 |
| Rate for Payer: Cash Price |
$445.60
|
| Rate for Payer: Aetna Commercial |
$249.82
|
| Rate for Payer: Aetna Medicare |
$193.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.46
|
| Rate for Payer: BCBS Complete |
$135.08
|
| Rate for Payer: BCBS MAPPO |
$186.43
|
| Rate for Payer: BCBS Trust/PPO |
$724.30
|
| Rate for Payer: BCN Commercial |
$411.96
|
| Rate for Payer: BCN Medicare Advantage |
$186.43
|
| Rate for Payer: Cash Price |
$445.60
|
| Rate for Payer: Cofinity Commercial |
$249.82
|
| Rate for Payer: Cofinity Commercial |
$268.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.75
|
| Rate for Payer: Meridian Medicaid |
$135.08
|
| Rate for Payer: Nomi Health Commercial |
$223.72
|
| Rate for Payer: PACE SWMI |
$186.43
|
| Rate for Payer: PHP Commercial |
$261.00
|
| Rate for Payer: PHP Medicare Advantage |
$186.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.64
|
| Rate for Payer: Priority Health Medicare |
$186.43
|
| Rate for Payer: Priority Health Narrow Network |
$283.64
|
| Rate for Payer: Priority Health SBD |
$283.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.43
|
| Rate for Payer: UHC Medicare Advantage |
$186.43
|
| Rate for Payer: UHCCP Medicaid |
$128.65
|
| Rate for Payer: UMR Bronson Commercial |
$256.22
|
|
|
PR ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 30801
|
| Min. Negotiated Rate |
$96.06 |
| Max. Negotiated Rate |
$959.39 |
| Rate for Payer: Aetna Commercial |
$184.30
|
| Rate for Payer: Aetna Medicare |
$143.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.06
|
| Rate for Payer: BCBS Complete |
$100.86
|
| Rate for Payer: BCBS MAPPO |
$137.54
|
| Rate for Payer: BCBS Trust/PPO |
$959.39
|
| Rate for Payer: BCN Commercial |
$324.48
|
| Rate for Payer: BCN Medicare Advantage |
$137.54
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cofinity Commercial |
$184.30
|
| Rate for Payer: Cofinity Commercial |
$198.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.42
|
| Rate for Payer: Meridian Medicaid |
$100.86
|
| Rate for Payer: Nomi Health Commercial |
$165.05
|
| Rate for Payer: PACE SWMI |
$137.54
|
| Rate for Payer: PHP Commercial |
$192.56
|
| Rate for Payer: PHP Medicare Advantage |
$137.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.19
|
| Rate for Payer: Priority Health Medicare |
$137.54
|
| Rate for Payer: Priority Health Narrow Network |
$213.19
|
| Rate for Payer: Priority Health SBD |
$213.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.54
|
| Rate for Payer: UHC Medicare Advantage |
$137.54
|
| Rate for Payer: UHCCP Medicaid |
$96.06
|
| Rate for Payer: UMR Bronson Commercial |
$171.12
|
|
|
PR ABRASION 1 LESION
|
Professional
|
Both
|
$441.66
|
|
|
Service Code
|
HCPCS 15786
|
| Hospital Charge Code |
15786
|
| Min. Negotiated Rate |
$86.90 |
| Max. Negotiated Rate |
$337.19 |
| Rate for Payer: Aetna Commercial |
$171.52
|
| Rate for Payer: Aetna Medicare |
$133.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.32
|
| Rate for Payer: BCBS Complete |
$91.24
|
| Rate for Payer: BCBS MAPPO |
$128.00
|
| Rate for Payer: BCN Commercial |
$337.19
|
| Rate for Payer: BCN Medicare Advantage |
$128.00
|
| Rate for Payer: Cash Price |
$353.33
|
| Rate for Payer: Cash Price |
$353.33
|
| Rate for Payer: Cofinity Commercial |
$171.52
|
| Rate for Payer: Cofinity Commercial |
$184.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.40
|
| Rate for Payer: Meridian Medicaid |
$91.24
|
| Rate for Payer: Nomi Health Commercial |
$153.60
|
| Rate for Payer: PACE SWMI |
$128.00
|
| Rate for Payer: PHP Commercial |
$179.20
|
| Rate for Payer: PHP Medicare Advantage |
$128.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.41
|
| Rate for Payer: Priority Health Medicare |
$128.00
|
| Rate for Payer: Priority Health Narrow Network |
$182.41
|
| Rate for Payer: Priority Health SBD |
$182.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.00
|
| Rate for Payer: UHC Medicare Advantage |
$128.00
|
| Rate for Payer: UHCCP Medicaid |
$86.90
|
| Rate for Payer: UMR Bronson Commercial |
$203.16
|
|
|
PR ABRASION 1 LESION
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 15786
|
| Hospital Charge Code |
15786
|
| Min. Negotiated Rate |
$194.48 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna American Axle |
$287.30
|
| Rate for Payer: Aetna Commercial |
$375.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.30
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cofinity Commercial |
$309.40
|
| Rate for Payer: Cofinity Commercial |
$380.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.60
|
| Rate for Payer: Healthscope Commercial |
$397.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.70
|
| Rate for Payer: PHP Commercial |
$375.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.30
|
| Rate for Payer: Priority Health SBD |
$278.46
|
| Rate for Payer: UMR Bronson Commercial |
$194.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.50
|
|
|
PR ABRASION 1 LESION
|
Professional
|
Both
|
$441.66
|
|
|
Service Code
|
HCPCS 15786
|
| Min. Negotiated Rate |
$86.90 |
| Max. Negotiated Rate |
$337.19 |
| Rate for Payer: Aetna Commercial |
$171.52
|
| Rate for Payer: Aetna Medicare |
$133.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.32
|
| Rate for Payer: BCBS Complete |
$91.24
|
| Rate for Payer: BCBS MAPPO |
$128.00
|
| Rate for Payer: BCN Commercial |
$337.19
|
| Rate for Payer: BCN Medicare Advantage |
$128.00
|
| Rate for Payer: Cash Price |
$353.33
|
| Rate for Payer: Cash Price |
$353.33
|
| Rate for Payer: Cofinity Commercial |
$171.52
|
| Rate for Payer: Cofinity Commercial |
$184.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.40
|
| Rate for Payer: Meridian Medicaid |
$91.24
|
| Rate for Payer: Nomi Health Commercial |
$153.60
|
| Rate for Payer: PACE SWMI |
$128.00
|
| Rate for Payer: PHP Commercial |
$179.20
|
| Rate for Payer: PHP Medicare Advantage |
$128.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.41
|
| Rate for Payer: Priority Health Medicare |
$128.00
|
| Rate for Payer: Priority Health Narrow Network |
$182.41
|
| Rate for Payer: Priority Health SBD |
$182.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.00
|
| Rate for Payer: UHC Medicare Advantage |
$128.00
|
| Rate for Payer: UHCCP Medicaid |
$86.90
|
| Rate for Payer: UMR Bronson Commercial |
$203.16
|
|
|
PR ABRASION 1 LESION
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 15786
|
| Hospital Charge Code |
15786
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$287.30
|
| Rate for Payer: Aetna Commercial |
$375.70
|
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$143.02
|
| Rate for Payer: BCN Commercial |
$143.02
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cofinity Commercial |
$309.40
|
| Rate for Payer: Cofinity Commercial |
$380.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$397.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.50
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.70
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$375.70
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Priority Health SBD |
$278.46
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.40
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$128.55
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: UMR Bronson Commercial |
$163.54
|
| Rate for Payer: VA VA |
$194.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.50
|
|
|
PR ACETABULOPLASTY RESECTION FEMORAL HEAD
|
Professional
|
Both
|
$1,976.00
|
|
|
Service Code
|
HCPCS 27122
|
| Min. Negotiated Rate |
$674.11 |
| Max. Negotiated Rate |
$1,695.02 |
| Rate for Payer: Aetna Commercial |
$1,423.70
|
| Rate for Payer: Aetna Medicare |
$1,104.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,423.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,529.94
|
| Rate for Payer: BCBS Complete |
$750.12
|
| Rate for Payer: BCBS MAPPO |
$1,062.46
|
| Rate for Payer: BCBS Trust/PPO |
$674.11
|
| Rate for Payer: BCN Commercial |
$1,615.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,062.46
|
| Rate for Payer: Cash Price |
$1,580.80
|
| Rate for Payer: Cash Price |
$1,580.80
|
| Rate for Payer: Cofinity Commercial |
$1,423.70
|
| Rate for Payer: Cofinity Commercial |
$1,529.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,062.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,115.58
|
| Rate for Payer: Meridian Medicaid |
$750.12
|
| Rate for Payer: Nomi Health Commercial |
$1,274.95
|
| Rate for Payer: PACE SWMI |
$1,062.46
|
| Rate for Payer: PHP Commercial |
$1,487.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,062.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$714.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,284.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,695.02
|
| Rate for Payer: Priority Health Medicare |
$1,062.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,695.02
|
| Rate for Payer: Priority Health SBD |
$1,695.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,062.46
|
| Rate for Payer: UHC Medicare Advantage |
$1,062.46
|
| Rate for Payer: UHCCP Medicaid |
$714.40
|
| Rate for Payer: UMR Bronson Commercial |
$908.96
|
|
|
PR ACNE SURGERY
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 10040
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$137.04 |
| Rate for Payer: Aetna Commercial |
$66.25
|
| Rate for Payer: Aetna Medicare |
$51.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.19
|
| Rate for Payer: BCBS Complete |
$34.89
|
| Rate for Payer: BCBS MAPPO |
$49.44
|
| Rate for Payer: BCBS Trust/PPO |
$22.20
|
| Rate for Payer: BCN Commercial |
$137.04
|
| Rate for Payer: BCN Medicare Advantage |
$49.44
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$66.25
|
| Rate for Payer: Cofinity Commercial |
$71.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.91
|
| Rate for Payer: Meridian Medicaid |
$34.89
|
| Rate for Payer: Nomi Health Commercial |
$59.33
|
| Rate for Payer: PACE SWMI |
$49.44
|
| Rate for Payer: PHP Commercial |
$69.22
|
| Rate for Payer: PHP Medicare Advantage |
$49.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.99
|
| Rate for Payer: Priority Health Medicare |
$49.44
|
| Rate for Payer: Priority Health Narrow Network |
$69.99
|
| Rate for Payer: Priority Health SBD |
$69.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.44
|
| Rate for Payer: UHC Medicare Advantage |
$49.44
|
| Rate for Payer: UHCCP Medicaid |
$33.23
|
| Rate for Payer: UMR Bronson Commercial |
$83.26
|
|
|
PR ACOUSTIC IMMIT TEST TYMPANOM/ACOUST REFLX/DECAY
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 92570
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$1,989.05 |
| Rate for Payer: Aetna Commercial |
$36.31
|
| Rate for Payer: Aetna Medicare |
$28.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.02
|
| Rate for Payer: BCBS Complete |
$19.24
|
| Rate for Payer: BCBS MAPPO |
$27.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,989.05
|
| Rate for Payer: BCN Commercial |
$46.92
|
| Rate for Payer: BCN Medicare Advantage |
$27.10
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$36.31
|
| Rate for Payer: Cofinity Commercial |
$39.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.46
|
| Rate for Payer: Meridian Medicaid |
$19.24
|
| Rate for Payer: Nomi Health Commercial |
$32.52
|
| Rate for Payer: PACE SWMI |
$27.10
|
| Rate for Payer: PHP Commercial |
$37.94
|
| Rate for Payer: PHP Medicare Advantage |
$27.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.90
|
| Rate for Payer: Priority Health Medicare |
$27.10
|
| Rate for Payer: Priority Health Narrow Network |
$38.90
|
| Rate for Payer: Priority Health SBD |
$38.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.10
|
| Rate for Payer: UHC Medicare Advantage |
$27.10
|
| Rate for Payer: UHCCP Medicaid |
$18.32
|
| Rate for Payer: UMR Bronson Commercial |
$26.68
|
|
|
PR ACROMIOPLASTY/ACROMIONECTOMY PRTL +-LIGAMENT RLS
|
Professional
|
Both
|
$1,143.00
|
|
|
Service Code
|
HCPCS 23130
|
| Min. Negotiated Rate |
$47.54 |
| Max. Negotiated Rate |
$961.24 |
| Rate for Payer: Aetna Commercial |
$800.42
|
| Rate for Payer: Aetna Medicare |
$621.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$800.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$860.16
|
| Rate for Payer: BCBS Complete |
$426.28
|
| Rate for Payer: BCBS MAPPO |
$597.33
|
| Rate for Payer: BCBS Trust/PPO |
$47.54
|
| Rate for Payer: BCN Commercial |
$914.32
|
| Rate for Payer: BCN Medicare Advantage |
$597.33
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cofinity Commercial |
$800.42
|
| Rate for Payer: Cofinity Commercial |
$860.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$627.20
|
| Rate for Payer: Meridian Medicaid |
$426.28
|
| Rate for Payer: Nomi Health Commercial |
$716.80
|
| Rate for Payer: PACE SWMI |
$597.33
|
| Rate for Payer: PHP Commercial |
$836.26
|
| Rate for Payer: PHP Medicare Advantage |
$597.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$405.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$742.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$961.24
|
| Rate for Payer: Priority Health Medicare |
$597.33
|
| Rate for Payer: Priority Health Narrow Network |
$961.24
|
| Rate for Payer: Priority Health SBD |
$961.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.33
|
| Rate for Payer: UHC Medicare Advantage |
$597.33
|
| Rate for Payer: UHCCP Medicaid |
$405.98
|
| Rate for Payer: UMR Bronson Commercial |
$525.78
|
|
|
PR ACTIGRAPHY TESTING RECORDING ANALYSIS I&R
|
Professional
|
Both
|
$604.00
|
|
|
Service Code
|
HCPCS 95803
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$641.88 |
| Rate for Payer: Aetna Commercial |
$158.20
|
| Rate for Payer: Aetna Commercial |
$158.20
|
| Rate for Payer: Aetna Medicare |
$122.78
|
| Rate for Payer: Aetna Medicare |
$122.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.01
|
| Rate for Payer: BCBS Complete |
$27.51
|
| Rate for Payer: BCBS Complete |
$27.51
|
| Rate for Payer: BCBS MAPPO |
$118.06
|
| Rate for Payer: BCBS MAPPO |
$118.06
|
| Rate for Payer: BCBS Trust/PPO |
$641.88
|
| Rate for Payer: BCBS Trust/PPO |
$641.88
|
| Rate for Payer: BCN Commercial |
$202.80
|
| Rate for Payer: BCN Commercial |
$202.80
|
| Rate for Payer: BCN Medicare Advantage |
$118.06
|
| Rate for Payer: BCN Medicare Advantage |
$118.06
|
| Rate for Payer: Cash Price |
$483.20
|
| Rate for Payer: Cash Price |
$483.20
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$158.20
|
| Rate for Payer: Cofinity Commercial |
$170.01
|
| Rate for Payer: Cofinity Commercial |
$170.01
|
| Rate for Payer: Cofinity Commercial |
$158.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.96
|
| Rate for Payer: Meridian Medicaid |
$27.51
|
| Rate for Payer: Meridian Medicaid |
$27.51
|
| Rate for Payer: Nomi Health Commercial |
$141.67
|
| Rate for Payer: Nomi Health Commercial |
$141.67
|
| Rate for Payer: PACE SWMI |
$118.06
|
| Rate for Payer: PACE SWMI |
$118.06
|
| Rate for Payer: PHP Commercial |
$165.28
|
| Rate for Payer: PHP Commercial |
$165.28
|
| Rate for Payer: PHP Medicare Advantage |
$118.06
|
| Rate for Payer: PHP Medicare Advantage |
$118.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.64
|
| Rate for Payer: Priority Health Medicare |
$118.06
|
| Rate for Payer: Priority Health Medicare |
$118.06
|
| Rate for Payer: Priority Health Narrow Network |
$183.64
|
| Rate for Payer: Priority Health Narrow Network |
$183.64
|
| Rate for Payer: Priority Health SBD |
$55.63
|
| Rate for Payer: Priority Health SBD |
$55.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.06
|
| Rate for Payer: UHC Medicare Advantage |
$118.06
|
| Rate for Payer: UHC Medicare Advantage |
$118.06
|
| Rate for Payer: UHCCP Medicaid |
$26.20
|
| Rate for Payer: UHCCP Medicaid |
$26.20
|
| Rate for Payer: UMR Bronson Commercial |
$41.86
|
| Rate for Payer: UMR Bronson Commercial |
$277.84
|
|
|
PR ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 97155
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$1,401.05 |
| Rate for Payer: Aetna Commercial |
$20.80
|
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.80
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,401.05
|
| Rate for Payer: BCN Commercial |
$25.38
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.23
|
| Rate for Payer: Priority Health Narrow Network |
$45.23
|
| Rate for Payer: Priority Health SBD |
$45.23
|
| Rate for Payer: UMR Bronson Commercial |
$24.38
|
|
|
PR ADDITIONAL KIT 2-4 CC, INJECTION, PLATELET RICH PLASMA
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 00673
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: UMR Bronson Commercial |
$93.84
|
|
|
PR ADDITIONAL KIT 4-10 CC, INJECTION, PLATELET RICH PLASMA
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00674
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: UMR Bronson Commercial |
$140.76
|
|
|
PR ADENOIDECTOMY PRIMARY <AGE 12
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 42830
|
| Min. Negotiated Rate |
$139.09 |
| Max. Negotiated Rate |
$1,152.22 |
| Rate for Payer: Aetna Commercial |
$272.50
|
| Rate for Payer: Aetna Medicare |
$211.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.50
|
| Rate for Payer: BCBS Complete |
$146.04
|
| Rate for Payer: BCBS MAPPO |
$203.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,152.22
|
| Rate for Payer: BCN Commercial |
$312.75
|
| Rate for Payer: BCN Medicare Advantage |
$203.36
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cofinity Commercial |
$272.50
|
| Rate for Payer: Cofinity Commercial |
$292.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.53
|
| Rate for Payer: Meridian Medicaid |
$146.04
|
| Rate for Payer: Nomi Health Commercial |
$244.03
|
| Rate for Payer: PACE SWMI |
$203.36
|
| Rate for Payer: PHP Commercial |
$284.70
|
| Rate for Payer: PHP Medicare Advantage |
$203.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.20
|
| Rate for Payer: Priority Health Medicare |
$203.36
|
| Rate for Payer: Priority Health Narrow Network |
$387.20
|
| Rate for Payer: Priority Health SBD |
$387.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.36
|
| Rate for Payer: UHC Medicare Advantage |
$203.36
|
| Rate for Payer: UHCCP Medicaid |
$139.09
|
| Rate for Payer: UMR Bronson Commercial |
$174.34
|
|
|
PR ADENOIDECTOMY PRIMARY AGE 12/>
|
Professional
|
Both
|
$646.00
|
|
|
Service Code
|
HCPCS 42831
|
| Min. Negotiated Rate |
$151.02 |
| Max. Negotiated Rate |
$1,232.52 |
| Rate for Payer: Aetna Commercial |
$295.35
|
| Rate for Payer: Aetna Medicare |
$229.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.39
|
| Rate for Payer: BCBS Complete |
$158.57
|
| Rate for Payer: BCBS MAPPO |
$220.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,232.52
|
| Rate for Payer: BCN Commercial |
$340.61
|
| Rate for Payer: BCN Medicare Advantage |
$220.41
|
| Rate for Payer: Cash Price |
$516.80
|
| Rate for Payer: Cash Price |
$516.80
|
| Rate for Payer: Cofinity Commercial |
$295.35
|
| Rate for Payer: Cofinity Commercial |
$317.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.43
|
| Rate for Payer: Meridian Medicaid |
$158.57
|
| Rate for Payer: Nomi Health Commercial |
$264.49
|
| Rate for Payer: PACE SWMI |
$220.41
|
| Rate for Payer: PHP Commercial |
$308.57
|
| Rate for Payer: PHP Medicare Advantage |
$220.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$151.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$420.60
|
| Rate for Payer: Priority Health Medicare |
$220.41
|
| Rate for Payer: Priority Health Narrow Network |
$420.60
|
| Rate for Payer: Priority Health SBD |
$420.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.41
|
| Rate for Payer: UHC Medicare Advantage |
$220.41
|
| Rate for Payer: UHCCP Medicaid |
$151.02
|
| Rate for Payer: UMR Bronson Commercial |
$297.16
|
|
|
PR ADENOIDECTOMY SECONDARY AGE 12/>
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
HCPCS 42836
|
| Min. Negotiated Rate |
$160.39 |
| Max. Negotiated Rate |
$975.24 |
| Rate for Payer: Aetna Commercial |
$315.48
|
| Rate for Payer: Aetna Medicare |
$244.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.02
|
| Rate for Payer: BCBS Complete |
$168.41
|
| Rate for Payer: BCBS MAPPO |
$235.43
|
| Rate for Payer: BCBS Trust/PPO |
$975.24
|
| Rate for Payer: BCN Commercial |
$361.13
|
| Rate for Payer: BCN Medicare Advantage |
$235.43
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Cofinity Commercial |
$315.48
|
| Rate for Payer: Cofinity Commercial |
$339.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.20
|
| Rate for Payer: Meridian Medicaid |
$168.41
|
| Rate for Payer: Nomi Health Commercial |
$282.52
|
| Rate for Payer: PACE SWMI |
$235.43
|
| Rate for Payer: PHP Commercial |
$329.60
|
| Rate for Payer: PHP Medicare Advantage |
$235.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$445.66
|
| Rate for Payer: Priority Health Medicare |
$235.43
|
| Rate for Payer: Priority Health Narrow Network |
$445.66
|
| Rate for Payer: Priority Health SBD |
$445.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.43
|
| Rate for Payer: UHC Medicare Advantage |
$235.43
|
| Rate for Payer: UHCCP Medicaid |
$160.39
|
| Rate for Payer: UMR Bronson Commercial |
$279.22
|
|
|
PR ADENOIDECTOMY SECONDARY<AGE 12
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
HCPCS 42835
|
| Min. Negotiated Rate |
$129.72 |
| Max. Negotiated Rate |
$1,082.49 |
| Rate for Payer: Aetna Commercial |
$253.64
|
| Rate for Payer: Aetna Medicare |
$196.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.56
|
| Rate for Payer: BCBS Complete |
$136.21
|
| Rate for Payer: BCBS MAPPO |
$189.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,082.49
|
| Rate for Payer: BCN Commercial |
$292.23
|
| Rate for Payer: BCN Medicare Advantage |
$189.28
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cofinity Commercial |
$272.56
|
| Rate for Payer: Cofinity Commercial |
$253.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.74
|
| Rate for Payer: Meridian Medicaid |
$136.21
|
| Rate for Payer: Nomi Health Commercial |
$227.14
|
| Rate for Payer: PACE SWMI |
$189.28
|
| Rate for Payer: PHP Commercial |
$264.99
|
| Rate for Payer: PHP Medicare Advantage |
$189.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$361.53
|
| Rate for Payer: Priority Health Medicare |
$189.28
|
| Rate for Payer: Priority Health Narrow Network |
$361.53
|
| Rate for Payer: Priority Health SBD |
$361.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.28
|
| Rate for Payer: UHC Medicare Advantage |
$189.28
|
| Rate for Payer: UHCCP Medicaid |
$129.72
|
| Rate for Payer: UMR Bronson Commercial |
$235.98
|
|
|
PR ADENOSINE INJ 1MG
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J0153
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Aetna Commercial |
$0.61
|
| Rate for Payer: Aetna Medicare |
$0.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.66
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.46
|
| Rate for Payer: BCBS Trust/PPO |
$0.28
|
| Rate for Payer: BCN Commercial |
$0.24
|
| Rate for Payer: BCN Medicare Advantage |
$0.46
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.61
|
| Rate for Payer: Cofinity Commercial |
$0.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: Nomi Health Commercial |
$0.55
|
| Rate for Payer: PACE SWMI |
$0.46
|
| Rate for Payer: PHP Commercial |
$0.64
|
| Rate for Payer: PHP Medicare Advantage |
$0.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: UMR Bronson Commercial |
$0.46
|
|
|
PR ADENOSINE INJECTION
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS J0152
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Aetna Medicare |
$59.50
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.35
|
| Rate for Payer: UMR Bronson Commercial |
$54.74
|
|
|
PR ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 14000
|
| Min. Negotiated Rate |
$327.17 |
| Max. Negotiated Rate |
$979.03 |
| Rate for Payer: Aetna Commercial |
$644.15
|
| Rate for Payer: Aetna Medicare |
$499.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$692.22
|
| Rate for Payer: BCBS Complete |
$343.53
|
| Rate for Payer: BCBS MAPPO |
$480.71
|
| Rate for Payer: BCBS Trust/PPO |
$979.03
|
| Rate for Payer: BCN Commercial |
$931.42
|
| Rate for Payer: BCN Medicare Advantage |
$480.71
|
| Rate for Payer: Cash Price |
$832.00
|
| Rate for Payer: Cash Price |
$832.00
|
| Rate for Payer: Cofinity Commercial |
$692.22
|
| Rate for Payer: Cofinity Commercial |
$644.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$504.75
|
| Rate for Payer: Meridian Medicaid |
$343.53
|
| Rate for Payer: Nomi Health Commercial |
$576.85
|
| Rate for Payer: PACE SWMI |
$480.71
|
| Rate for Payer: PHP Commercial |
$672.99
|
| Rate for Payer: PHP Medicare Advantage |
$480.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$327.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$686.31
|
| Rate for Payer: Priority Health Medicare |
$480.71
|
| Rate for Payer: Priority Health Narrow Network |
$686.31
|
| Rate for Payer: Priority Health SBD |
$686.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$480.71
|
| Rate for Payer: UHC Medicare Advantage |
$480.71
|
| Rate for Payer: UHCCP Medicaid |
$327.17
|
| Rate for Payer: UMR Bronson Commercial |
$478.40
|
|
|
PR ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM
|
Professional
|
Both
|
$1,354.00
|
|
|
Service Code
|
HCPCS 14001
|
| Min. Negotiated Rate |
$422.17 |
| Max. Negotiated Rate |
$1,187.00 |
| Rate for Payer: Aetna Commercial |
$835.24
|
| Rate for Payer: Aetna Medicare |
$648.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$835.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.57
|
| Rate for Payer: BCBS Complete |
$443.28
|
| Rate for Payer: BCBS MAPPO |
$623.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,002.07
|
| Rate for Payer: BCN Commercial |
$1,187.00
|
| Rate for Payer: BCN Medicare Advantage |
$623.31
|
| Rate for Payer: Cash Price |
$1,083.20
|
| Rate for Payer: Cash Price |
$1,083.20
|
| Rate for Payer: Cofinity Commercial |
$835.24
|
| Rate for Payer: Cofinity Commercial |
$897.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$623.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$654.48
|
| Rate for Payer: Meridian Medicaid |
$443.28
|
| Rate for Payer: Nomi Health Commercial |
$747.97
|
| Rate for Payer: PACE SWMI |
$623.31
|
| Rate for Payer: PHP Commercial |
$872.63
|
| Rate for Payer: PHP Medicare Advantage |
$623.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$422.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$880.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$887.68
|
| Rate for Payer: Priority Health Medicare |
$623.31
|
| Rate for Payer: Priority Health Narrow Network |
$887.68
|
| Rate for Payer: Priority Health SBD |
$887.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$623.31
|
| Rate for Payer: UHC Medicare Advantage |
$623.31
|
| Rate for Payer: UHCCP Medicaid |
$422.17
|
| Rate for Payer: UMR Bronson Commercial |
$622.84
|
|
|
PR ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM
|
Professional
|
Both
|
$1,727.00
|
|
|
Service Code
|
HCPCS 14301
|
| Min. Negotiated Rate |
$226.01 |
| Max. Negotiated Rate |
$1,586.25 |
| Rate for Payer: Aetna Commercial |
$1,108.72
|
| Rate for Payer: Aetna Medicare |
$860.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,108.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,191.46
|
| Rate for Payer: BCBS Complete |
$587.09
|
| Rate for Payer: BCBS MAPPO |
$827.40
|
| Rate for Payer: BCBS Trust/PPO |
$226.01
|
| Rate for Payer: BCN Commercial |
$1,586.25
|
| Rate for Payer: BCN Medicare Advantage |
$827.40
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Cofinity Commercial |
$1,108.72
|
| Rate for Payer: Cofinity Commercial |
$1,191.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$827.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$868.77
|
| Rate for Payer: Meridian Medicaid |
$587.09
|
| Rate for Payer: Nomi Health Commercial |
$992.88
|
| Rate for Payer: PACE SWMI |
$827.40
|
| Rate for Payer: PHP Commercial |
$1,158.36
|
| Rate for Payer: PHP Medicare Advantage |
$827.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$559.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,122.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,176.20
|
| Rate for Payer: Priority Health Medicare |
$827.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,176.20
|
| Rate for Payer: Priority Health SBD |
$1,176.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$827.40
|
| Rate for Payer: UHC Medicare Advantage |
$827.40
|
| Rate for Payer: UHCCP Medicaid |
$559.13
|
| Rate for Payer: UMR Bronson Commercial |
$794.42
|
|
