|
PR ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,615.00
|
|
|
Service Code
|
HCPCS 14041
|
| Min. Negotiated Rate |
$491.18 |
| Max. Negotiated Rate |
$1,457.41 |
| Rate for Payer: Aetna Commercial |
$967.67
|
| Rate for Payer: Aetna Medicare |
$751.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,039.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$967.67
|
| Rate for Payer: BCBS Complete |
$515.74
|
| Rate for Payer: BCBS MAPPO |
$722.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,457.41
|
| Rate for Payer: BCN Commercial |
$1,347.28
|
| Rate for Payer: BCN Medicare Advantage |
$722.14
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Cofinity Commercial |
$1,039.88
|
| Rate for Payer: Cofinity Commercial |
$967.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$758.25
|
| Rate for Payer: Meridian Medicaid |
$515.74
|
| Rate for Payer: Nomi Health Commercial |
$866.57
|
| Rate for Payer: PACE SWMI |
$722.14
|
| Rate for Payer: PHP Commercial |
$1,011.00
|
| Rate for Payer: PHP Medicare Advantage |
$722.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$491.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,049.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,031.27
|
| Rate for Payer: Priority Health Medicare |
$722.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,031.27
|
| Rate for Payer: Priority Health SBD |
$1,031.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$722.14
|
| Rate for Payer: UHC Medicare Advantage |
$722.14
|
| Rate for Payer: UHCCP Medicaid |
$491.18
|
| Rate for Payer: UMR Bronson Commercial |
$742.90
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,479.00
|
|
|
Service Code
|
HCPCS 14021
|
| Hospital Charge Code |
14021
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,266.65 |
| Rate for Payer: Aetna Commercial |
$901.23
|
| Rate for Payer: Aetna Medicare |
$699.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$901.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$968.49
|
| Rate for Payer: BCBS Complete |
$480.40
|
| Rate for Payer: BCBS MAPPO |
$672.56
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,266.65
|
| Rate for Payer: BCN Medicare Advantage |
$672.56
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cofinity Commercial |
$968.49
|
| Rate for Payer: Cofinity Commercial |
$901.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$672.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$706.19
|
| Rate for Payer: Meridian Medicaid |
$480.40
|
| Rate for Payer: Nomi Health Commercial |
$807.07
|
| Rate for Payer: PACE SWMI |
$672.56
|
| Rate for Payer: PHP Commercial |
$941.58
|
| Rate for Payer: PHP Medicare Advantage |
$672.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$457.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$960.38
|
| Rate for Payer: Priority Health Medicare |
$672.56
|
| Rate for Payer: Priority Health Narrow Network |
$960.38
|
| Rate for Payer: Priority Health SBD |
$960.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$672.56
|
| Rate for Payer: UHC Medicare Advantage |
$672.56
|
| Rate for Payer: UHCCP Medicaid |
$457.52
|
| Rate for Payer: UMR Bronson Commercial |
$680.34
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Facility
|
IP
|
$1,479.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
14021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$650.76 |
| Max. Negotiated Rate |
$1,331.10 |
| Rate for Payer: Aetna American Axle |
$961.35
|
| Rate for Payer: Aetna Commercial |
$1,257.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$961.35
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cofinity Commercial |
$1,035.30
|
| Rate for Payer: Cofinity Commercial |
$1,271.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,035.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,183.20
|
| Rate for Payer: Healthscope Commercial |
$1,331.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,035.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,109.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,257.15
|
| Rate for Payer: PHP Commercial |
$1,257.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.35
|
| Rate for Payer: Priority Health SBD |
$931.77
|
| Rate for Payer: UMR Bronson Commercial |
$650.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,109.25
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,479.00
|
|
|
Service Code
|
HCPCS 14021
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,266.65 |
| Rate for Payer: Aetna Commercial |
$901.23
|
| Rate for Payer: Aetna Medicare |
$699.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$901.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$968.49
|
| Rate for Payer: BCBS Complete |
$480.40
|
| Rate for Payer: BCBS MAPPO |
$672.56
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,266.65
|
| Rate for Payer: BCN Medicare Advantage |
$672.56
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cofinity Commercial |
$901.23
|
| Rate for Payer: Cofinity Commercial |
$968.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$672.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$706.19
|
| Rate for Payer: Meridian Medicaid |
$480.40
|
| Rate for Payer: Nomi Health Commercial |
$807.07
|
| Rate for Payer: PACE SWMI |
$672.56
|
| Rate for Payer: PHP Commercial |
$941.58
|
| Rate for Payer: PHP Medicare Advantage |
$672.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$457.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$960.38
|
| Rate for Payer: Priority Health Medicare |
$672.56
|
| Rate for Payer: Priority Health Narrow Network |
$960.38
|
| Rate for Payer: Priority Health SBD |
$960.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$672.56
|
| Rate for Payer: UHC Medicare Advantage |
$672.56
|
| Rate for Payer: UHCCP Medicaid |
$457.52
|
| Rate for Payer: UMR Bronson Commercial |
$680.34
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Facility
|
OP
|
$1,479.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
14021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$547.23 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna American Axle |
$961.35
|
| Rate for Payer: Aetna Commercial |
$1,257.15
|
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$961.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,428.57
|
| Rate for Payer: BCN Commercial |
$1,428.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cofinity Commercial |
$1,035.30
|
| Rate for Payer: Cofinity Commercial |
$1,271.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,035.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,183.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$1,331.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,035.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,109.25
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,257.15
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,257.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Priority Health SBD |
$931.77
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$741.93
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$674.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: UMR Bronson Commercial |
$547.23
|
| Rate for Payer: VA VA |
$1,792.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,109.25
|
|
|
PR ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM
|
Professional
|
Both
|
$2,235.00
|
|
|
Service Code
|
HCPCS 14061
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$1,452.75 |
| Rate for Payer: Nomi Health Commercial |
$928.22
|
| Rate for Payer: Aetna Commercial |
$1,036.52
|
| Rate for Payer: Aetna Medicare |
$804.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,036.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,113.87
|
| Rate for Payer: BCBS Complete |
$552.87
|
| Rate for Payer: BCBS MAPPO |
$773.52
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,452.35
|
| Rate for Payer: BCN Medicare Advantage |
$773.52
|
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Cofinity Commercial |
$1,036.52
|
| Rate for Payer: Cofinity Commercial |
$1,113.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$773.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.20
|
| Rate for Payer: Meridian Medicaid |
$552.87
|
| Rate for Payer: PACE SWMI |
$773.52
|
| Rate for Payer: PHP Commercial |
$1,082.93
|
| Rate for Payer: PHP Medicare Advantage |
$773.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$526.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,452.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,107.57
|
| Rate for Payer: Priority Health Medicare |
$773.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,107.57
|
| Rate for Payer: Priority Health SBD |
$1,107.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$773.52
|
| Rate for Payer: UHC Medicare Advantage |
$773.52
|
| Rate for Payer: UHCCP Medicaid |
$526.54
|
| Rate for Payer: UMR Bronson Commercial |
$1,028.10
|
|
|
PR ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 14302
|
| Min. Negotiated Rate |
$136.96 |
| Max. Negotiated Rate |
$312.75 |
| Rate for Payer: Aetna Commercial |
$275.79
|
| Rate for Payer: Aetna Medicare |
$214.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.37
|
| Rate for Payer: BCBS Complete |
$143.81
|
| Rate for Payer: BCBS MAPPO |
$205.81
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$312.75
|
| Rate for Payer: BCN Medicare Advantage |
$205.81
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$275.79
|
| Rate for Payer: Cofinity Commercial |
$296.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.10
|
| Rate for Payer: Meridian Medicaid |
$143.81
|
| Rate for Payer: Nomi Health Commercial |
$246.97
|
| Rate for Payer: PACE SWMI |
$205.81
|
| Rate for Payer: PHP Commercial |
$288.13
|
| Rate for Payer: PHP Medicare Advantage |
$205.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.97
|
| Rate for Payer: Priority Health Medicare |
$205.81
|
| Rate for Payer: Priority Health Narrow Network |
$288.97
|
| Rate for Payer: Priority Health SBD |
$288.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.81
|
| Rate for Payer: UHC Medicare Advantage |
$205.81
|
| Rate for Payer: UHCCP Medicaid |
$136.96
|
| Rate for Payer: UMR Bronson Commercial |
$207.92
|
|
|
PR ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Professional
|
Both
|
$1,169.00
|
|
|
Service Code
|
HCPCS 14020
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$1,028.66 |
| Rate for Payer: Aetna Commercial |
$719.11
|
| Rate for Payer: Aetna Medicare |
$558.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.78
|
| Rate for Payer: BCBS Complete |
$384.90
|
| Rate for Payer: BCBS MAPPO |
$536.65
|
| Rate for Payer: BCBS Trust/PPO |
$48.14
|
| Rate for Payer: BCN Commercial |
$1,028.66
|
| Rate for Payer: BCN Medicare Advantage |
$536.65
|
| Rate for Payer: Cash Price |
$935.20
|
| Rate for Payer: Cash Price |
$935.20
|
| Rate for Payer: Cofinity Commercial |
$719.11
|
| Rate for Payer: Cofinity Commercial |
$772.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$536.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$563.48
|
| Rate for Payer: Meridian Medicaid |
$384.90
|
| Rate for Payer: Nomi Health Commercial |
$643.98
|
| Rate for Payer: PACE SWMI |
$536.65
|
| Rate for Payer: PHP Commercial |
$751.31
|
| Rate for Payer: PHP Medicare Advantage |
$536.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$366.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$770.28
|
| Rate for Payer: Priority Health Medicare |
$536.65
|
| Rate for Payer: Priority Health Narrow Network |
$770.28
|
| Rate for Payer: Priority Health SBD |
$770.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$536.65
|
| Rate for Payer: UHC Medicare Advantage |
$536.65
|
| Rate for Payer: UHCCP Medicaid |
$366.57
|
| Rate for Payer: UMR Bronson Commercial |
$537.74
|
|
|
PR ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Professional
|
Both
|
$2,067.00
|
|
|
Service Code
|
HCPCS 14060
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,343.55 |
| Rate for Payer: Aetna Commercial |
$842.79
|
| Rate for Payer: Aetna Medicare |
$654.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$842.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$905.69
|
| Rate for Payer: BCBS Complete |
$449.99
|
| Rate for Payer: BCBS MAPPO |
$628.95
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,122.50
|
| Rate for Payer: BCN Medicare Advantage |
$628.95
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cofinity Commercial |
$842.79
|
| Rate for Payer: Cofinity Commercial |
$905.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$628.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$660.40
|
| Rate for Payer: Meridian Medicaid |
$449.99
|
| Rate for Payer: Nomi Health Commercial |
$754.74
|
| Rate for Payer: PACE SWMI |
$628.95
|
| Rate for Payer: PHP Commercial |
$880.53
|
| Rate for Payer: PHP Medicare Advantage |
$628.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$428.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,343.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$900.78
|
| Rate for Payer: Priority Health Medicare |
$628.95
|
| Rate for Payer: Priority Health Narrow Network |
$900.78
|
| Rate for Payer: Priority Health SBD |
$900.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$628.95
|
| Rate for Payer: UHC Medicare Advantage |
$628.95
|
| Rate for Payer: UHCCP Medicaid |
$428.56
|
| Rate for Payer: UMR Bronson Commercial |
$950.82
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Facility
|
IP
|
$1,299.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
14040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$571.56 |
| Max. Negotiated Rate |
$1,169.10 |
| Rate for Payer: Aetna American Axle |
$844.35
|
| Rate for Payer: Aetna Commercial |
$1,104.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$844.35
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cofinity Commercial |
$1,117.14
|
| Rate for Payer: Cofinity Commercial |
$909.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$909.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,039.20
|
| Rate for Payer: Healthscope Commercial |
$1,169.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$909.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$974.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,104.15
|
| Rate for Payer: PHP Commercial |
$1,104.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.35
|
| Rate for Payer: Priority Health SBD |
$818.37
|
| Rate for Payer: UMR Bronson Commercial |
$571.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$974.25
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,299.00
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
14040
|
| Min. Negotiated Rate |
$344.90 |
| Max. Negotiated Rate |
$1,110.28 |
| Rate for Payer: Aetna Commercial |
$792.07
|
| Rate for Payer: Aetna Medicare |
$614.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$792.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.18
|
| Rate for Payer: BCBS Complete |
$422.70
|
| Rate for Payer: BCBS MAPPO |
$591.10
|
| Rate for Payer: BCBS Trust/PPO |
$344.90
|
| Rate for Payer: BCN Commercial |
$1,110.28
|
| Rate for Payer: BCN Medicare Advantage |
$591.10
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cofinity Commercial |
$851.18
|
| Rate for Payer: Cofinity Commercial |
$792.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$591.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$620.66
|
| Rate for Payer: Meridian Medicaid |
$422.70
|
| Rate for Payer: Nomi Health Commercial |
$709.32
|
| Rate for Payer: PACE SWMI |
$591.10
|
| Rate for Payer: PHP Commercial |
$827.54
|
| Rate for Payer: PHP Medicare Advantage |
$591.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$402.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.68
|
| Rate for Payer: Priority Health Medicare |
$591.10
|
| Rate for Payer: Priority Health Narrow Network |
$845.68
|
| Rate for Payer: Priority Health SBD |
$845.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$591.10
|
| Rate for Payer: UHC Medicare Advantage |
$591.10
|
| Rate for Payer: UHCCP Medicaid |
$402.57
|
| Rate for Payer: UMR Bronson Commercial |
$597.54
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Facility
|
OP
|
$1,299.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
14040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$480.63 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna American Axle |
$844.35
|
| Rate for Payer: Aetna Commercial |
$1,104.15
|
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$844.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,066.09
|
| Rate for Payer: BCN Commercial |
$2,066.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cofinity Commercial |
$1,117.14
|
| Rate for Payer: Cofinity Commercial |
$909.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$909.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,039.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$1,169.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$909.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$974.25
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,104.15
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,104.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Priority Health SBD |
$818.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$652.73
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$593.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: UMR Bronson Commercial |
$480.63
|
| Rate for Payer: VA VA |
$1,792.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$974.25
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,299.00
|
|
|
Service Code
|
HCPCS 14040
|
| Min. Negotiated Rate |
$344.90 |
| Max. Negotiated Rate |
$1,110.28 |
| Rate for Payer: Aetna Commercial |
$792.07
|
| Rate for Payer: Aetna Medicare |
$614.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$792.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.18
|
| Rate for Payer: BCBS Complete |
$422.70
|
| Rate for Payer: BCBS MAPPO |
$591.10
|
| Rate for Payer: BCBS Trust/PPO |
$344.90
|
| Rate for Payer: BCN Commercial |
$1,110.28
|
| Rate for Payer: BCN Medicare Advantage |
$591.10
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cofinity Commercial |
$851.18
|
| Rate for Payer: Cofinity Commercial |
$792.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$591.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$620.66
|
| Rate for Payer: Meridian Medicaid |
$422.70
|
| Rate for Payer: Nomi Health Commercial |
$709.32
|
| Rate for Payer: PACE SWMI |
$591.10
|
| Rate for Payer: PHP Commercial |
$827.54
|
| Rate for Payer: PHP Medicare Advantage |
$591.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$402.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.68
|
| Rate for Payer: Priority Health Medicare |
$591.10
|
| Rate for Payer: Priority Health Narrow Network |
$845.68
|
| Rate for Payer: Priority Health SBD |
$845.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$591.10
|
| Rate for Payer: UHC Medicare Advantage |
$591.10
|
| Rate for Payer: UHCCP Medicaid |
$402.57
|
| Rate for Payer: UMR Bronson Commercial |
$597.54
|
|
|
PR ADJUSTMENT GASTRIC BAND
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS S2083
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$486.56 |
| Rate for Payer: Aetna Commercial |
$67.62
|
| Rate for Payer: Aetna Medicare |
$57.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.62
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: BCBS Trust/PPO |
$486.56
|
| Rate for Payer: BCN Commercial |
$108.60
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.75
|
| Rate for Payer: UMR Bronson Commercial |
$52.90
|
|
|
PR ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 20693
|
| Min. Negotiated Rate |
$294.15 |
| Max. Negotiated Rate |
$3,350.93 |
| Rate for Payer: Aetna Commercial |
$580.27
|
| Rate for Payer: Aetna Medicare |
$450.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$623.58
|
| Rate for Payer: BCBS Complete |
$308.86
|
| Rate for Payer: BCBS MAPPO |
$433.04
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: BCN Commercial |
$649.94
|
| Rate for Payer: BCN Medicare Advantage |
$433.04
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cofinity Commercial |
$623.58
|
| Rate for Payer: Cofinity Commercial |
$580.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$454.69
|
| Rate for Payer: Meridian Medicaid |
$308.86
|
| Rate for Payer: Nomi Health Commercial |
$519.65
|
| Rate for Payer: PACE SWMI |
$433.04
|
| Rate for Payer: PHP Commercial |
$606.26
|
| Rate for Payer: PHP Medicare Advantage |
$433.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$294.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$691.03
|
| Rate for Payer: Priority Health Medicare |
$433.04
|
| Rate for Payer: Priority Health Narrow Network |
$691.03
|
| Rate for Payer: Priority Health SBD |
$691.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.04
|
| Rate for Payer: UHC Medicare Advantage |
$433.04
|
| Rate for Payer: UHCCP Medicaid |
$294.15
|
| Rate for Payer: UMR Bronson Commercial |
$471.50
|
|
|
PR ADMIN HEPATITIS B VACCINE
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS G0010
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$1,469.20 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Aetna Medicare |
$15.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.00
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,469.20
|
| Rate for Payer: BCN Commercial |
$21.88
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.32
|
| Rate for Payer: Priority Health Narrow Network |
$44.32
|
| Rate for Payer: Priority Health SBD |
$44.32
|
| Rate for Payer: UMR Bronson Commercial |
$13.80
|
|
|
PR ADMIN INFLUENZA VIRUS VAC
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS G0008
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$4,626.85 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.00
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,626.85
|
| Rate for Payer: BCN Commercial |
$21.88
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.32
|
| Rate for Payer: Priority Health Narrow Network |
$44.32
|
| Rate for Payer: Priority Health SBD |
$44.32
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
|
PR ADMIN PNEUMOCOCCAL VACCINE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS G0009
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$1,331.32 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.00
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,331.32
|
| Rate for Payer: BCN Commercial |
$21.88
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.32
|
| Rate for Payer: Priority Health Narrow Network |
$44.32
|
| Rate for Payer: Priority Health SBD |
$44.32
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
|
PR ADMN RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 96380
|
| Min. Negotiated Rate |
$21.11 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Aetna Commercial |
$28.29
|
| Rate for Payer: Aetna Medicare |
$21.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.29
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS MAPPO |
$21.11
|
| Rate for Payer: BCN Medicare Advantage |
$21.11
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cofinity Commercial |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$28.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.17
|
| Rate for Payer: Nomi Health Commercial |
$25.33
|
| Rate for Payer: PACE SWMI |
$21.11
|
| Rate for Payer: PHP Commercial |
$29.55
|
| Rate for Payer: PHP Medicare Advantage |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.76
|
| Rate for Payer: Priority Health Medicare |
$21.11
|
| Rate for Payer: Priority Health Narrow Network |
$30.76
|
| Rate for Payer: Priority Health SBD |
$30.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.11
|
| Rate for Payer: UHC Medicare Advantage |
$21.11
|
| Rate for Payer: UMR Bronson Commercial |
$39.10
|
|
|
PR ADMN RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 96381
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Aetna Commercial |
$24.07
|
| Rate for Payer: Aetna Medicare |
$18.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.07
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS MAPPO |
$17.96
|
| Rate for Payer: BCN Medicare Advantage |
$17.96
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cofinity Commercial |
$25.86
|
| Rate for Payer: Cofinity Commercial |
$24.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.86
|
| Rate for Payer: Nomi Health Commercial |
$21.55
|
| Rate for Payer: PACE SWMI |
$17.96
|
| Rate for Payer: PHP Commercial |
$25.14
|
| Rate for Payer: PHP Medicare Advantage |
$17.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.69
|
| Rate for Payer: Priority Health Medicare |
$17.96
|
| Rate for Payer: Priority Health Narrow Network |
$26.69
|
| Rate for Payer: Priority Health SBD |
$26.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.96
|
| Rate for Payer: UHC Medicare Advantage |
$17.96
|
| Rate for Payer: UMR Bronson Commercial |
$39.10
|
|
|
PR ADRENALECTOMY EXPL W/EXC RETROPERTINEAL TUMOR
|
Professional
|
Both
|
$4,437.00
|
|
|
Service Code
|
HCPCS 60545
|
| Min. Negotiated Rate |
$341.28 |
| Max. Negotiated Rate |
$2,884.05 |
| Rate for Payer: Aetna Commercial |
$1,612.31
|
| Rate for Payer: Aetna Medicare |
$1,251.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,612.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,732.64
|
| Rate for Payer: BCBS Complete |
$838.02
|
| Rate for Payer: BCBS MAPPO |
$1,203.22
|
| Rate for Payer: BCBS Trust/PPO |
$341.28
|
| Rate for Payer: BCN Commercial |
$1,817.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,203.22
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cofinity Commercial |
$1,612.31
|
| Rate for Payer: Cofinity Commercial |
$1,732.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,203.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,263.38
|
| Rate for Payer: Meridian Medicaid |
$838.02
|
| Rate for Payer: Nomi Health Commercial |
$1,443.86
|
| Rate for Payer: PACE SWMI |
$1,203.22
|
| Rate for Payer: PHP Commercial |
$1,684.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,203.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$798.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,884.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,019.90
|
| Rate for Payer: Priority Health Medicare |
$1,203.22
|
| Rate for Payer: Priority Health Narrow Network |
$2,019.90
|
| Rate for Payer: Priority Health SBD |
$2,019.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,203.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,203.22
|
| Rate for Payer: UHCCP Medicaid |
$798.11
|
| Rate for Payer: UMR Bronson Commercial |
$2,041.02
|
|
|
PR ADRENALECTOMY W/EXPL W/WO BX ABDL/LMBR/DRSAL SPX
|
Professional
|
Both
|
$3,369.00
|
|
|
Service Code
|
HCPCS 60540
|
| Min. Negotiated Rate |
$432.15 |
| Max. Negotiated Rate |
$2,189.85 |
| Rate for Payer: Aetna Commercial |
$1,396.94
|
| Rate for Payer: Aetna Medicare |
$1,084.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,396.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,501.19
|
| Rate for Payer: BCBS Complete |
$727.53
|
| Rate for Payer: BCBS MAPPO |
$1,042.49
|
| Rate for Payer: BCBS Trust/PPO |
$432.15
|
| Rate for Payer: BCN Commercial |
$1,567.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,042.49
|
| Rate for Payer: Cash Price |
$2,695.20
|
| Rate for Payer: Cash Price |
$2,695.20
|
| Rate for Payer: Cofinity Commercial |
$1,501.19
|
| Rate for Payer: Cofinity Commercial |
$1,396.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,042.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,094.61
|
| Rate for Payer: Meridian Medicaid |
$727.53
|
| Rate for Payer: Nomi Health Commercial |
$1,250.99
|
| Rate for Payer: PACE SWMI |
$1,042.49
|
| Rate for Payer: PHP Commercial |
$1,459.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,042.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$692.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,189.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,743.12
|
| Rate for Payer: Priority Health Medicare |
$1,042.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,743.12
|
| Rate for Payer: Priority Health SBD |
$1,743.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,042.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,042.49
|
| Rate for Payer: UHCCP Medicaid |
$692.89
|
| Rate for Payer: UMR Bronson Commercial |
$1,549.74
|
|
|
PR ADRENALIN EPINEPHRINE INJECT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J0171
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$0.77
|
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.77
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
|
|
PR ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 99498
|
| Min. Negotiated Rate |
$37.72 |
| Max. Negotiated Rate |
$533.05 |
| Rate for Payer: Aetna Commercial |
$90.25
|
| Rate for Payer: Aetna Medicare |
$70.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.98
|
| Rate for Payer: BCBS Complete |
$47.42
|
| Rate for Payer: BCBS MAPPO |
$67.35
|
| Rate for Payer: BCBS Trust/PPO |
$533.05
|
| Rate for Payer: BCN Commercial |
$75.95
|
| Rate for Payer: BCN Medicare Advantage |
$67.35
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$90.25
|
| Rate for Payer: Cofinity Commercial |
$96.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.72
|
| Rate for Payer: Meridian Medicaid |
$47.42
|
| Rate for Payer: Nomi Health Commercial |
$80.82
|
| Rate for Payer: PACE SWMI |
$67.35
|
| Rate for Payer: PHP Commercial |
$94.29
|
| Rate for Payer: PHP Medicare Advantage |
$67.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.55
|
| Rate for Payer: Priority Health Medicare |
$67.35
|
| Rate for Payer: Priority Health Narrow Network |
$92.55
|
| Rate for Payer: Priority Health SBD |
$92.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.35
|
| Rate for Payer: UHC Medicare Advantage |
$67.35
|
| Rate for Payer: UHCCP Medicaid |
$45.16
|
| Rate for Payer: UMR Bronson Commercial |
$37.72
|
|
|
PR ADVANCE CARE PLANNING FIRST 30 MINS
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 99497
|
| Min. Negotiated Rate |
$47.38 |
| Max. Negotiated Rate |
$569.51 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: Aetna Medicare |
$74.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.37
|
| Rate for Payer: BCBS Complete |
$50.10
|
| Rate for Payer: BCBS MAPPO |
$71.17
|
| Rate for Payer: BCBS Trust/PPO |
$569.51
|
| Rate for Payer: BCN Commercial |
$87.77
|
| Rate for Payer: BCN Medicare Advantage |
$71.17
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$102.48
|
| Rate for Payer: Cofinity Commercial |
$95.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.73
|
| Rate for Payer: Meridian Medicaid |
$50.10
|
| Rate for Payer: Nomi Health Commercial |
$85.40
|
| Rate for Payer: PACE SWMI |
$71.17
|
| Rate for Payer: PHP Commercial |
$99.64
|
| Rate for Payer: PHP Medicare Advantage |
$71.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.24
|
| Rate for Payer: Priority Health Medicare |
$71.17
|
| Rate for Payer: Priority Health Narrow Network |
$98.24
|
| Rate for Payer: Priority Health SBD |
$98.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.17
|
| Rate for Payer: UHC Medicare Advantage |
$71.17
|
| Rate for Payer: UHCCP Medicaid |
$47.71
|
| Rate for Payer: UMR Bronson Commercial |
$47.38
|
|
