|
PR AMPUTATION THIGH THROUGH FEMUR ANY LEVEL
|
Professional
|
Both
|
$2,582.00
|
|
|
Service Code
|
HCPCS 27590
|
| Min. Negotiated Rate |
$499.27 |
| Max. Negotiated Rate |
$2,644.67 |
| Rate for Payer: Aetna Commercial |
$1,014.21
|
| Rate for Payer: Aetna Medicare |
$787.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,014.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,089.89
|
| Rate for Payer: BCBS Complete |
$524.23
|
| Rate for Payer: BCBS MAPPO |
$756.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,644.67
|
| Rate for Payer: BCN Commercial |
$1,139.60
|
| Rate for Payer: BCN Medicare Advantage |
$756.87
|
| Rate for Payer: Cash Price |
$2,065.60
|
| Rate for Payer: Cash Price |
$2,065.60
|
| Rate for Payer: Cofinity Commercial |
$1,014.21
|
| Rate for Payer: Cofinity Commercial |
$1,089.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$756.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$794.71
|
| Rate for Payer: Meridian Medicaid |
$524.23
|
| Rate for Payer: Nomi Health Commercial |
$908.24
|
| Rate for Payer: PACE SWMI |
$756.87
|
| Rate for Payer: PHP Commercial |
$1,059.62
|
| Rate for Payer: PHP Medicare Advantage |
$756.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$499.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,678.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,192.77
|
| Rate for Payer: Priority Health Medicare |
$756.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,192.77
|
| Rate for Payer: Priority Health SBD |
$1,192.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$756.87
|
| Rate for Payer: UHC Medicare Advantage |
$756.87
|
| Rate for Payer: UHCCP Medicaid |
$499.27
|
| Rate for Payer: UMR Bronson Commercial |
$1,187.72
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION
|
Professional
|
Both
|
$2,428.00
|
|
|
Service Code
|
HCPCS 27596
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$1,578.20 |
| Rate for Payer: Aetna Commercial |
$918.82
|
| Rate for Payer: Aetna Medicare |
$713.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$918.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$987.39
|
| Rate for Payer: BCBS Complete |
$478.83
|
| Rate for Payer: BCBS MAPPO |
$685.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,116.83
|
| Rate for Payer: BCN Commercial |
$1,040.39
|
| Rate for Payer: BCN Medicare Advantage |
$685.69
|
| Rate for Payer: Cash Price |
$1,942.40
|
| Rate for Payer: Cash Price |
$1,942.40
|
| Rate for Payer: Cofinity Commercial |
$918.82
|
| Rate for Payer: Cofinity Commercial |
$987.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$685.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.97
|
| Rate for Payer: Meridian Medicaid |
$478.83
|
| Rate for Payer: Nomi Health Commercial |
$822.83
|
| Rate for Payer: PACE SWMI |
$685.69
|
| Rate for Payer: PHP Commercial |
$959.97
|
| Rate for Payer: PHP Medicare Advantage |
$685.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$456.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,578.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,085.40
|
| Rate for Payer: Priority Health Medicare |
$685.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,085.40
|
| Rate for Payer: Priority Health SBD |
$1,085.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$685.69
|
| Rate for Payer: UHC Medicare Advantage |
$685.69
|
| Rate for Payer: UHCCP Medicaid |
$456.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,116.88
|
|
|
PR AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR
|
Professional
|
Both
|
$3,097.00
|
|
|
Service Code
|
HCPCS 27592
|
| Min. Negotiated Rate |
$432.60 |
| Max. Negotiated Rate |
$2,013.05 |
| Rate for Payer: Aetna Commercial |
$873.75
|
| Rate for Payer: Aetna Medicare |
$678.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$938.95
|
| Rate for Payer: BCBS Complete |
$454.23
|
| Rate for Payer: BCBS MAPPO |
$652.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,803.62
|
| Rate for Payer: BCN Commercial |
$975.89
|
| Rate for Payer: BCN Medicare Advantage |
$652.05
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cofinity Commercial |
$873.75
|
| Rate for Payer: Cofinity Commercial |
$938.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$652.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$684.65
|
| Rate for Payer: Meridian Medicaid |
$454.23
|
| Rate for Payer: Nomi Health Commercial |
$782.46
|
| Rate for Payer: PACE SWMI |
$652.05
|
| Rate for Payer: PHP Commercial |
$912.87
|
| Rate for Payer: PHP Medicare Advantage |
$652.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$432.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,021.28
|
| Rate for Payer: Priority Health Medicare |
$652.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,021.28
|
| Rate for Payer: Priority Health SBD |
$1,021.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$652.05
|
| Rate for Payer: UHC Medicare Advantage |
$652.05
|
| Rate for Payer: UHCCP Medicaid |
$432.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,424.62
|
|
|
PR AMPUTATION TOE INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$1,346.00
|
|
|
Service Code
|
HCPCS 28825
|
| Min. Negotiated Rate |
$110.76 |
| Max. Negotiated Rate |
$995.32 |
| Rate for Payer: Aetna Commercial |
$222.91
|
| Rate for Payer: Aetna Medicare |
$173.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.54
|
| Rate for Payer: BCBS Complete |
$116.30
|
| Rate for Payer: BCBS MAPPO |
$166.35
|
| Rate for Payer: BCBS Trust/PPO |
$995.32
|
| Rate for Payer: BCN Commercial |
$425.15
|
| Rate for Payer: BCN Medicare Advantage |
$166.35
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cofinity Commercial |
$222.91
|
| Rate for Payer: Cofinity Commercial |
$239.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.67
|
| Rate for Payer: Meridian Medicaid |
$116.30
|
| Rate for Payer: Nomi Health Commercial |
$199.62
|
| Rate for Payer: PACE SWMI |
$166.35
|
| Rate for Payer: PHP Commercial |
$232.89
|
| Rate for Payer: PHP Medicare Advantage |
$166.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.09
|
| Rate for Payer: Priority Health Medicare |
$166.35
|
| Rate for Payer: Priority Health Narrow Network |
$263.09
|
| Rate for Payer: Priority Health SBD |
$263.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.35
|
| Rate for Payer: UHC Medicare Advantage |
$166.35
|
| Rate for Payer: UHCCP Medicaid |
$110.76
|
| Rate for Payer: UMR Bronson Commercial |
$619.16
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$1,557.00
|
|
|
Service Code
|
HCPCS 28820
|
| Min. Negotiated Rate |
$113.53 |
| Max. Negotiated Rate |
$1,012.05 |
| Rate for Payer: Aetna Commercial |
$228.55
|
| Rate for Payer: Aetna Medicare |
$177.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.61
|
| Rate for Payer: BCBS Complete |
$119.21
|
| Rate for Payer: BCBS MAPPO |
$170.56
|
| Rate for Payer: BCBS Trust/PPO |
$852.68
|
| Rate for Payer: BCN Commercial |
$434.44
|
| Rate for Payer: BCN Medicare Advantage |
$170.56
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cofinity Commercial |
$245.61
|
| Rate for Payer: Cofinity Commercial |
$228.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.09
|
| Rate for Payer: Meridian Medicaid |
$119.21
|
| Rate for Payer: Nomi Health Commercial |
$204.67
|
| Rate for Payer: PACE SWMI |
$170.56
|
| Rate for Payer: PHP Commercial |
$238.78
|
| Rate for Payer: PHP Medicare Advantage |
$170.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.69
|
| Rate for Payer: Priority Health Medicare |
$170.56
|
| Rate for Payer: Priority Health Narrow Network |
$269.69
|
| Rate for Payer: Priority Health SBD |
$269.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.56
|
| Rate for Payer: UHC Medicare Advantage |
$170.56
|
| Rate for Payer: UHCCP Medicaid |
$113.53
|
| Rate for Payer: UMR Bronson Commercial |
$716.22
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$1,557.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
28820
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$171.85 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna American Axle |
$1,012.05
|
| Rate for Payer: Aetna Commercial |
$1,323.45
|
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,012.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,547.91
|
| Rate for Payer: BCN Commercial |
$2,547.91
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cofinity Commercial |
$1,339.02
|
| Rate for Payer: Cofinity Commercial |
$1,089.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,089.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,245.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Healthscope Commercial |
$1,401.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,089.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,167.75
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,323.45
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$1,323.45
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Priority Health SBD |
$980.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.04
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$171.85
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: UMR Bronson Commercial |
$576.09
|
| Rate for Payer: VA VA |
$3,179.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,167.75
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Facility
|
IP
|
$1,557.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
28820
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$685.08 |
| Max. Negotiated Rate |
$1,401.30 |
| Rate for Payer: Aetna American Axle |
$1,012.05
|
| Rate for Payer: Aetna Commercial |
$1,323.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,012.05
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cofinity Commercial |
$1,089.90
|
| Rate for Payer: Cofinity Commercial |
$1,339.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,089.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,245.60
|
| Rate for Payer: Healthscope Commercial |
$1,401.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,089.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,167.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,323.45
|
| Rate for Payer: PHP Commercial |
$1,323.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: Priority Health SBD |
$980.91
|
| Rate for Payer: UMR Bronson Commercial |
$685.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,167.75
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$1,557.00
|
|
|
Service Code
|
HCPCS 28820
|
| Hospital Charge Code |
28820
|
| Min. Negotiated Rate |
$113.53 |
| Max. Negotiated Rate |
$1,012.05 |
| Rate for Payer: Aetna Commercial |
$228.55
|
| Rate for Payer: Aetna Medicare |
$177.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.61
|
| Rate for Payer: BCBS Complete |
$119.21
|
| Rate for Payer: BCBS MAPPO |
$170.56
|
| Rate for Payer: BCBS Trust/PPO |
$852.68
|
| Rate for Payer: BCN Commercial |
$434.44
|
| Rate for Payer: BCN Medicare Advantage |
$170.56
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cofinity Commercial |
$245.61
|
| Rate for Payer: Cofinity Commercial |
$228.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.09
|
| Rate for Payer: Meridian Medicaid |
$119.21
|
| Rate for Payer: Nomi Health Commercial |
$204.67
|
| Rate for Payer: PACE SWMI |
$170.56
|
| Rate for Payer: PHP Commercial |
$238.78
|
| Rate for Payer: PHP Medicare Advantage |
$170.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.69
|
| Rate for Payer: Priority Health Medicare |
$170.56
|
| Rate for Payer: Priority Health Narrow Network |
$269.69
|
| Rate for Payer: Priority Health SBD |
$269.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.56
|
| Rate for Payer: UHC Medicare Advantage |
$170.56
|
| Rate for Payer: UHCCP Medicaid |
$113.53
|
| Rate for Payer: UMR Bronson Commercial |
$716.22
|
|
|
PR ANALYSIS COCHLEAR IMPLT 7 YR/> PRGRMG
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 92603
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$219.91 |
| Rate for Payer: Aetna Commercial |
$149.03
|
| Rate for Payer: Aetna Medicare |
$115.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.16
|
| Rate for Payer: BCBS Complete |
$79.17
|
| Rate for Payer: BCBS MAPPO |
$111.22
|
| Rate for Payer: BCN Commercial |
$219.91
|
| Rate for Payer: BCN Medicare Advantage |
$111.22
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$149.03
|
| Rate for Payer: Cofinity Commercial |
$160.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.78
|
| Rate for Payer: Meridian Medicaid |
$79.17
|
| Rate for Payer: Nomi Health Commercial |
$133.46
|
| Rate for Payer: PACE SWMI |
$111.22
|
| Rate for Payer: PHP Commercial |
$155.71
|
| Rate for Payer: PHP Medicare Advantage |
$111.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.21
|
| Rate for Payer: Priority Health Medicare |
$111.22
|
| Rate for Payer: Priority Health Narrow Network |
$159.21
|
| Rate for Payer: Priority Health SBD |
$159.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$111.22
|
| Rate for Payer: UHC Medicare Advantage |
$111.22
|
| Rate for Payer: UHCCP Medicaid |
$75.40
|
| Rate for Payer: UMR Bronson Commercial |
$145.36
|
|
|
PR ANALYSIS COCHLEAR IMPLT 7 YR/> SBSQ REPRGRMG
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 92604
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$132.92 |
| Rate for Payer: Aetna Commercial |
$82.95
|
| Rate for Payer: Aetna Medicare |
$64.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.14
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: BCBS MAPPO |
$61.90
|
| Rate for Payer: BCN Commercial |
$132.92
|
| Rate for Payer: BCN Medicare Advantage |
$61.90
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$89.14
|
| Rate for Payer: Cofinity Commercial |
$82.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.00
|
| Rate for Payer: Meridian Medicaid |
$44.06
|
| Rate for Payer: Nomi Health Commercial |
$74.28
|
| Rate for Payer: PACE SWMI |
$61.90
|
| Rate for Payer: PHP Commercial |
$86.66
|
| Rate for Payer: PHP Medicare Advantage |
$61.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.20
|
| Rate for Payer: Priority Health Medicare |
$61.90
|
| Rate for Payer: Priority Health Narrow Network |
$88.20
|
| Rate for Payer: Priority Health SBD |
$88.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.90
|
| Rate for Payer: UHC Medicare Advantage |
$61.90
|
| Rate for Payer: UHCCP Medicaid |
$41.96
|
| Rate for Payer: UMR Bronson Commercial |
$87.40
|
|
|
PR ANALYZE NEUROSTIM BRAIN, FIRST 1H
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
HCPCS 95978
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$329.55 |
| Rate for Payer: Aetna Medicare |
$253.50
|
| Rate for Payer: BCBS Complete |
$202.80
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.55
|
| Rate for Payer: UMR Bronson Commercial |
$233.22
|
|
|
PR ANALYZ NEUROSTIM BRAIN, EACH ADD 30 MIN
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 95979
|
| Min. Negotiated Rate |
$87.20 |
| Max. Negotiated Rate |
$141.70 |
| Rate for Payer: Aetna Medicare |
$109.00
|
| Rate for Payer: BCBS Complete |
$87.20
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.70
|
| Rate for Payer: UMR Bronson Commercial |
$100.28
|
|
|
PR ANAST ARTL EXTRACRANIAL-INTRACRANIAL ARTERIES
|
Professional
|
Both
|
$7,866.00
|
|
|
Service Code
|
HCPCS 61711
|
| Min. Negotiated Rate |
$134.19 |
| Max. Negotiated Rate |
$5,246.52 |
| Rate for Payer: Aetna Commercial |
$3,466.08
|
| Rate for Payer: Aetna Medicare |
$2,690.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,466.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,724.75
|
| Rate for Payer: BCBS Complete |
$1,778.91
|
| Rate for Payer: BCBS MAPPO |
$2,586.63
|
| Rate for Payer: BCBS Trust/PPO |
$134.19
|
| Rate for Payer: BCN Commercial |
$5,246.52
|
| Rate for Payer: BCN Medicare Advantage |
$2,586.63
|
| Rate for Payer: Cash Price |
$6,292.80
|
| Rate for Payer: Cash Price |
$6,292.80
|
| Rate for Payer: Cofinity Commercial |
$3,724.75
|
| Rate for Payer: Cofinity Commercial |
$3,466.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,586.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,715.96
|
| Rate for Payer: Meridian Medicaid |
$1,778.91
|
| Rate for Payer: Nomi Health Commercial |
$3,103.96
|
| Rate for Payer: PACE SWMI |
$2,586.63
|
| Rate for Payer: PHP Commercial |
$3,621.28
|
| Rate for Payer: PHP Medicare Advantage |
$2,586.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,694.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,112.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,504.23
|
| Rate for Payer: Priority Health Medicare |
$2,586.63
|
| Rate for Payer: Priority Health Narrow Network |
$4,504.23
|
| Rate for Payer: Priority Health SBD |
$4,504.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,586.63
|
| Rate for Payer: UHC Medicare Advantage |
$2,586.63
|
| Rate for Payer: UHCCP Medicaid |
$1,694.20
|
| Rate for Payer: UMR Bronson Commercial |
$3,618.36
|
|
|
PR ANAST INTRAHEPATC DUCTS & GI TRACT
|
Professional
|
Both
|
$6,161.00
|
|
|
Service Code
|
HCPCS 47765
|
| Min. Negotiated Rate |
$1,935.74 |
| Max. Negotiated Rate |
$5,401.56 |
| Rate for Payer: Aetna Commercial |
$3,940.81
|
| Rate for Payer: Aetna Medicare |
$3,058.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,940.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,234.90
|
| Rate for Payer: BCBS Complete |
$2,032.53
|
| Rate for Payer: BCBS MAPPO |
$2,940.90
|
| Rate for Payer: BCN Commercial |
$4,295.97
|
| Rate for Payer: BCN Medicare Advantage |
$2,940.90
|
| Rate for Payer: Cash Price |
$4,928.80
|
| Rate for Payer: Cash Price |
$4,928.80
|
| Rate for Payer: Cofinity Commercial |
$3,940.81
|
| Rate for Payer: Cofinity Commercial |
$4,234.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,940.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,087.94
|
| Rate for Payer: Meridian Medicaid |
$2,032.53
|
| Rate for Payer: Nomi Health Commercial |
$3,529.08
|
| Rate for Payer: PACE SWMI |
$2,940.90
|
| Rate for Payer: PHP Commercial |
$4,117.26
|
| Rate for Payer: PHP Medicare Advantage |
$2,940.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,935.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,004.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,401.56
|
| Rate for Payer: Priority Health Medicare |
$2,940.90
|
| Rate for Payer: Priority Health Narrow Network |
$5,401.56
|
| Rate for Payer: Priority Health SBD |
$5,401.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,940.90
|
| Rate for Payer: UHC Medicare Advantage |
$2,940.90
|
| Rate for Payer: UHCCP Medicaid |
$1,935.74
|
| Rate for Payer: UMR Bronson Commercial |
$2,834.06
|
|
|
PR ANASTOMOSIS FACIAL HYPOGLOSSAL
|
Professional
|
Both
|
$1,858.00
|
|
|
Service Code
|
HCPCS 64868
|
| Min. Negotiated Rate |
$190.19 |
| Max. Negotiated Rate |
$1,700.47 |
| Rate for Payer: Aetna Commercial |
$1,259.28
|
| Rate for Payer: Aetna Medicare |
$977.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,259.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,353.25
|
| Rate for Payer: BCBS Complete |
$666.93
|
| Rate for Payer: BCBS MAPPO |
$939.76
|
| Rate for Payer: BCBS Trust/PPO |
$190.19
|
| Rate for Payer: BCN Commercial |
$1,459.68
|
| Rate for Payer: BCN Medicare Advantage |
$939.76
|
| Rate for Payer: Cash Price |
$1,486.40
|
| Rate for Payer: Cash Price |
$1,486.40
|
| Rate for Payer: Cofinity Commercial |
$1,259.28
|
| Rate for Payer: Cofinity Commercial |
$1,353.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$939.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$986.75
|
| Rate for Payer: Meridian Medicaid |
$666.93
|
| Rate for Payer: Nomi Health Commercial |
$1,127.71
|
| Rate for Payer: PACE SWMI |
$939.76
|
| Rate for Payer: PHP Commercial |
$1,315.66
|
| Rate for Payer: PHP Medicare Advantage |
$939.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$635.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,207.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,700.47
|
| Rate for Payer: Priority Health Medicare |
$939.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,700.47
|
| Rate for Payer: Priority Health SBD |
$1,700.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$939.76
|
| Rate for Payer: UHC Medicare Advantage |
$939.76
|
| Rate for Payer: UHCCP Medicaid |
$635.17
|
| Rate for Payer: UMR Bronson Commercial |
$854.68
|
|
|
PR ANAST ROUX-EN-Y XTRHEPATC BILIARY DUCTS & GI
|
Professional
|
Both
|
$4,710.00
|
|
|
Service Code
|
HCPCS 47780
|
| Min. Negotiated Rate |
$1,284.83 |
| Max. Negotiated Rate |
$4,418.98 |
| Rate for Payer: Aetna Commercial |
$3,216.47
|
| Rate for Payer: Aetna Medicare |
$2,496.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,216.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,456.50
|
| Rate for Payer: BCBS Complete |
$1,661.72
|
| Rate for Payer: BCBS MAPPO |
$2,400.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,284.83
|
| Rate for Payer: BCN Commercial |
$3,600.09
|
| Rate for Payer: BCN Medicare Advantage |
$2,400.35
|
| Rate for Payer: Cash Price |
$3,768.00
|
| Rate for Payer: Cash Price |
$3,768.00
|
| Rate for Payer: Cofinity Commercial |
$3,216.47
|
| Rate for Payer: Cofinity Commercial |
$3,456.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,400.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,520.37
|
| Rate for Payer: Meridian Medicaid |
$1,661.72
|
| Rate for Payer: Nomi Health Commercial |
$2,880.42
|
| Rate for Payer: PACE SWMI |
$2,400.35
|
| Rate for Payer: PHP Commercial |
$3,360.49
|
| Rate for Payer: PHP Medicare Advantage |
$2,400.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,582.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,061.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,418.98
|
| Rate for Payer: Priority Health Medicare |
$2,400.35
|
| Rate for Payer: Priority Health Narrow Network |
$4,418.98
|
| Rate for Payer: Priority Health SBD |
$4,418.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,400.35
|
| Rate for Payer: UHC Medicare Advantage |
$2,400.35
|
| Rate for Payer: UHCCP Medicaid |
$1,582.59
|
| Rate for Payer: UMR Bronson Commercial |
$2,166.60
|
|
|
PR ANAST XTRHEPATC BILIARY DUCTS & GI TRACT
|
Professional
|
Both
|
$4,268.00
|
|
|
Service Code
|
HCPCS 47760
|
| Min. Negotiated Rate |
$328.07 |
| Max. Negotiated Rate |
$4,021.64 |
| Rate for Payer: Aetna Commercial |
$2,922.18
|
| Rate for Payer: Aetna Medicare |
$2,267.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,922.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,140.25
|
| Rate for Payer: BCBS Complete |
$1,510.98
|
| Rate for Payer: BCBS MAPPO |
$2,180.73
|
| Rate for Payer: BCBS Trust/PPO |
$328.07
|
| Rate for Payer: BCN Commercial |
$3,278.53
|
| Rate for Payer: BCN Medicare Advantage |
$2,180.73
|
| Rate for Payer: Cash Price |
$3,414.40
|
| Rate for Payer: Cash Price |
$3,414.40
|
| Rate for Payer: Cofinity Commercial |
$2,922.18
|
| Rate for Payer: Cofinity Commercial |
$3,140.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,180.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,289.77
|
| Rate for Payer: Meridian Medicaid |
$1,510.98
|
| Rate for Payer: Nomi Health Commercial |
$2,616.88
|
| Rate for Payer: PACE SWMI |
$2,180.73
|
| Rate for Payer: PHP Commercial |
$3,053.02
|
| Rate for Payer: PHP Medicare Advantage |
$2,180.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,439.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,774.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,021.64
|
| Rate for Payer: Priority Health Medicare |
$2,180.73
|
| Rate for Payer: Priority Health Narrow Network |
$4,021.64
|
| Rate for Payer: Priority Health SBD |
$4,021.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,180.73
|
| Rate for Payer: UHC Medicare Advantage |
$2,180.73
|
| Rate for Payer: UHCCP Medicaid |
$1,439.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,963.28
|
|
|
PR ANES 2&3 DGR BURN EXC/DBRDMT W/WO GRFG 4-9% TBSA
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS 01952
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| 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 ANES 2&3 DGR BURN EXC/DBRDMT W/WO GRFG <4% TBSA
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS 01951
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
|
|
PR ANES 2&3 DGR BURN EXC/DBRDMT W/WO GRFG EA 9%TBSA
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS 01953
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.50
|
| Rate for Payer: Priority Health Narrow Network |
$44.50
|
| Rate for Payer: Priority Health SBD |
$44.50
|
| Rate for Payer: UMR Bronson Commercial |
$0.46
|
|
|
PR ANES ARTERIES FOREARM WRIST & HAND EMBOLECTOMY
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS 01842
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna Medicare |
$3.00
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: UMR Bronson Commercial |
$2.76
|
|
|
PR ANES ARTERIES OF KNEE & POPLITEAL AREA NOS
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 01440
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: UMR Bronson Commercial |
$3.68
|
|
|
PR ANES ARTERIES SHOULDER & AXILLA BYPASS GRAFT
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 01654
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: UMR Bronson Commercial |
$3.68
|
|
|
PR ANES ARTHROSCOPIC TOTAL SHOULDER REPLACEMENT
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS 01638
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR ANES ARTHRS/ENDSCPY DSTL RADIUS ULNA/WRIST/HAND
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS 01830
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
|
