|
PR BREAST RECONSTRUCTION BIPEDICLED TRAM FLAP
|
Professional
|
Both
|
$4,213.00
|
|
|
Service Code
|
HCPCS 19369
|
| Min. Negotiated Rate |
$1,685.20 |
| Max. Negotiated Rate |
$2,776.28 |
| Rate for Payer: Aetna Commercial |
$2,583.48
|
| Rate for Payer: Aetna Medicare |
$2,005.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,776.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,583.48
|
| Rate for Payer: BCBS Complete |
$1,685.20
|
| Rate for Payer: BCBS MAPPO |
$1,927.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,927.97
|
| Rate for Payer: Cash Price |
$3,370.40
|
| Rate for Payer: Cash Price |
$3,370.40
|
| Rate for Payer: Cofinity Commercial |
$2,776.28
|
| Rate for Payer: Cofinity Commercial |
$2,583.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,927.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,024.37
|
| Rate for Payer: Nomi Health Commercial |
$2,313.56
|
| Rate for Payer: PACE SWMI |
$1,927.97
|
| Rate for Payer: PHP Commercial |
$2,699.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,927.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,738.45
|
| Rate for Payer: Priority Health Medicare |
$1,927.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,927.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,927.97
|
| Rate for Payer: UMR Bronson Commercial |
$1,937.98
|
|
|
PR BREAST RECONSTRUCTION SINGLE PEDICLED TRAM FLAP
|
Professional
|
Both
|
$3,032.00
|
|
|
Service Code
|
HCPCS 19367
|
| Min. Negotiated Rate |
$1,212.80 |
| Max. Negotiated Rate |
$2,440.35 |
| Rate for Payer: Aetna Commercial |
$2,270.88
|
| Rate for Payer: Aetna Medicare |
$1,762.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,440.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,270.88
|
| Rate for Payer: BCBS Complete |
$1,212.80
|
| Rate for Payer: BCBS MAPPO |
$1,694.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,694.69
|
| Rate for Payer: Cash Price |
$2,425.60
|
| Rate for Payer: Cash Price |
$2,425.60
|
| Rate for Payer: Cofinity Commercial |
$2,440.35
|
| Rate for Payer: Cofinity Commercial |
$2,270.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,694.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,779.42
|
| Rate for Payer: Nomi Health Commercial |
$2,033.63
|
| Rate for Payer: PACE SWMI |
$1,694.69
|
| Rate for Payer: PHP Commercial |
$2,372.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,694.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,970.80
|
| Rate for Payer: Priority Health Medicare |
$1,694.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,694.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,694.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,394.72
|
|
|
PR BREAST RECONSTRUCTION W/LATISSIMUS DORSI FLAP
|
Professional
|
Both
|
$2,920.00
|
|
|
Service Code
|
HCPCS 19361
|
| Min. Negotiated Rate |
$1,168.00 |
| Max. Negotiated Rate |
$2,148.97 |
| Rate for Payer: Aetna Commercial |
$1,999.74
|
| Rate for Payer: Aetna Medicare |
$1,552.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,148.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,999.74
|
| Rate for Payer: BCBS Complete |
$1,168.00
|
| Rate for Payer: BCBS MAPPO |
$1,492.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,492.34
|
| Rate for Payer: Cash Price |
$2,336.00
|
| Rate for Payer: Cash Price |
$2,336.00
|
| Rate for Payer: Cofinity Commercial |
$2,148.97
|
| Rate for Payer: Cofinity Commercial |
$1,999.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,492.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,566.96
|
| Rate for Payer: Nomi Health Commercial |
$1,790.81
|
| Rate for Payer: PACE SWMI |
$1,492.34
|
| Rate for Payer: PHP Commercial |
$2,089.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,492.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,898.00
|
| Rate for Payer: Priority Health Medicare |
$1,492.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,492.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,492.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,343.20
|
|
|
PR BREAST RECONSTRUC W OTHR TECHNIQ
|
Professional
|
Both
|
$2,903.00
|
|
|
Service Code
|
HCPCS 19366
|
| Min. Negotiated Rate |
$1,161.20 |
| Max. Negotiated Rate |
$1,886.95 |
| Rate for Payer: Aetna Medicare |
$1,451.50
|
| Rate for Payer: BCBS Complete |
$1,161.20
|
| Rate for Payer: Cash Price |
$2,322.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,886.95
|
| Rate for Payer: UMR Bronson Commercial |
$1,335.38
|
|
|
PR BREAST REDUCTION
|
Facility
|
OP
|
$1,938.00
|
|
|
Service Code
|
CPT 19318
|
| Hospital Charge Code |
19318
|
| Min. Negotiated Rate |
$717.06 |
| Max. Negotiated Rate |
$17,903.47 |
| Rate for Payer: Aetna American Axle |
$1,259.70
|
| Rate for Payer: Aetna Commercial |
$1,647.30
|
| Rate for Payer: Aetna Medicare |
$6,614.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,259.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,950.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,950.31
|
| Rate for Payer: BCBS Complete |
$3,579.55
|
| Rate for Payer: BCBS MAPPO |
$6,360.25
|
| Rate for Payer: BCN Medicare Advantage |
$6,360.25
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cofinity Commercial |
$1,666.68
|
| Rate for Payer: Cofinity Commercial |
$1,356.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,356.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,550.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,360.25
|
| Rate for Payer: Healthscope Commercial |
$1,744.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,356.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,453.50
|
| Rate for Payer: Mclaren Medicaid |
$3,409.09
|
| Rate for Payer: Mclaren Medicare |
$6,360.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,678.26
|
| Rate for Payer: Meridian Medicaid |
$3,579.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,314.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,647.30
|
| Rate for Payer: PACE Medicare |
$6,042.24
|
| Rate for Payer: PACE SWMI |
$6,360.25
|
| Rate for Payer: PHP Commercial |
$1,647.30
|
| Rate for Payer: PHP Medicare Advantage |
$6,360.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,409.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health Medicare |
$6,360.25
|
| Rate for Payer: Priority Health SBD |
$1,220.94
|
| Rate for Payer: Railroad Medicare Medicare |
$6,360.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,903.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,360.25
|
| Rate for Payer: UHC Exchange |
$12,155.07
|
| Rate for Payer: UHC Medicare Advantage |
$6,360.25
|
| Rate for Payer: UHCCP Medicaid |
$3,409.09
|
| Rate for Payer: UMR Bronson Commercial |
$717.06
|
| Rate for Payer: VA VA |
$6,360.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,453.50
|
|
|
PR BREAST REDUCTION
|
Facility
|
IP
|
$1,938.00
|
|
|
Service Code
|
CPT 19318
|
| Hospital Charge Code |
19318
|
| Min. Negotiated Rate |
$852.72 |
| Max. Negotiated Rate |
$1,744.20 |
| Rate for Payer: Aetna American Axle |
$1,259.70
|
| Rate for Payer: Aetna Commercial |
$1,647.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,259.70
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cofinity Commercial |
$1,356.60
|
| Rate for Payer: Cofinity Commercial |
$1,666.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,356.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,550.40
|
| Rate for Payer: Healthscope Commercial |
$1,744.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,356.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,453.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,647.30
|
| Rate for Payer: PHP Commercial |
$1,647.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health SBD |
$1,220.94
|
| Rate for Payer: UMR Bronson Commercial |
$852.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,453.50
|
|
|
PR BREAST REDUCTION
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 19318
|
| Min. Negotiated Rate |
$775.20 |
| Max. Negotiated Rate |
$1,509.61 |
| Rate for Payer: Aetna Commercial |
$1,404.78
|
| Rate for Payer: Aetna Medicare |
$1,090.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,404.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,509.61
|
| Rate for Payer: BCBS Complete |
$775.20
|
| Rate for Payer: BCBS MAPPO |
$1,048.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.34
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cofinity Commercial |
$1,404.78
|
| Rate for Payer: Cofinity Commercial |
$1,509.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,100.76
|
| Rate for Payer: Nomi Health Commercial |
$1,258.01
|
| Rate for Payer: PACE SWMI |
$1,048.34
|
| Rate for Payer: PHP Commercial |
$1,467.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health Medicare |
$1,048.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,048.34
|
| Rate for Payer: UMR Bronson Commercial |
$891.48
|
|
|
PR BREAST REDUCTION
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 19318
|
| Hospital Charge Code |
19318
|
| Min. Negotiated Rate |
$775.20 |
| Max. Negotiated Rate |
$1,509.61 |
| Rate for Payer: Aetna Commercial |
$1,404.78
|
| Rate for Payer: Aetna Medicare |
$1,090.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,509.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,404.78
|
| Rate for Payer: BCBS Complete |
$775.20
|
| Rate for Payer: BCBS MAPPO |
$1,048.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.34
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cofinity Commercial |
$1,404.78
|
| Rate for Payer: Cofinity Commercial |
$1,509.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,100.76
|
| Rate for Payer: Nomi Health Commercial |
$1,258.01
|
| Rate for Payer: PACE SWMI |
$1,048.34
|
| Rate for Payer: PHP Commercial |
$1,467.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health Medicare |
$1,048.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,048.34
|
| Rate for Payer: UMR Bronson Commercial |
$891.48
|
|
|
PR BREATH HYDROGEN/METHANE TEST
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 91065
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$108.55 |
| Rate for Payer: Aetna Commercial |
$78.39
|
| Rate for Payer: Aetna Medicare |
$60.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.39
|
| Rate for Payer: BCBS Complete |
$66.80
|
| Rate for Payer: BCBS MAPPO |
$58.50
|
| Rate for Payer: BCN Medicare Advantage |
$58.50
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$84.24
|
| Rate for Payer: Cofinity Commercial |
$78.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.42
|
| Rate for Payer: Nomi Health Commercial |
$70.20
|
| Rate for Payer: PACE SWMI |
$58.50
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: PHP Medicare Advantage |
$58.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health Medicare |
$58.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.50
|
| Rate for Payer: UHC Medicare Advantage |
$58.50
|
| Rate for Payer: UMR Bronson Commercial |
$76.82
|
|
|
PR BREATHING RESPONSE TO HYPOXIA
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 94450
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna Commercial |
$105.85
|
| Rate for Payer: Aetna Medicare |
$82.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.85
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS MAPPO |
$78.99
|
| Rate for Payer: BCN Medicare Advantage |
$78.99
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$113.75
|
| Rate for Payer: Cofinity Commercial |
$105.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.94
|
| Rate for Payer: Nomi Health Commercial |
$94.79
|
| Rate for Payer: PACE SWMI |
$78.99
|
| Rate for Payer: PHP Commercial |
$110.59
|
| Rate for Payer: PHP Medicare Advantage |
$78.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: Priority Health Medicare |
$78.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.99
|
| Rate for Payer: UHC Medicare Advantage |
$78.99
|
| Rate for Payer: UMR Bronson Commercial |
$82.80
|
|
|
PR BRIEF CHECK IN BY MD/QHP
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS G2012
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Aetna Medicare |
$15.00
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: UMR Bronson Commercial |
$13.80
|
|
|
PR BRIEF COMMUNICATION TECH-BSD SVC EST PT 5-10 MIN
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 98016
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$19.15
|
| Rate for Payer: Aetna Medicare |
$14.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.58
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$14.29
|
| Rate for Payer: BCN Medicare Advantage |
$14.29
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$20.58
|
| Rate for Payer: Cofinity Commercial |
$19.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.00
|
| Rate for Payer: Nomi Health Commercial |
$17.15
|
| Rate for Payer: PACE SWMI |
$14.29
|
| Rate for Payer: PHP Commercial |
$20.01
|
| Rate for Payer: PHP Medicare Advantage |
$14.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$14.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.29
|
| Rate for Payer: UHC Medicare Advantage |
$14.29
|
| Rate for Payer: UMR Bronson Commercial |
$19.78
|
|
|
PR BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 94060
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$50.80 |
| Rate for Payer: Aetna Commercial |
$47.28
|
| Rate for Payer: Aetna Commercial |
$47.28
|
| Rate for Payer: Aetna Medicare |
$36.69
|
| Rate for Payer: Aetna Medicare |
$36.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.80
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS MAPPO |
$35.28
|
| Rate for Payer: BCBS MAPPO |
$35.28
|
| Rate for Payer: BCN Medicare Advantage |
$35.28
|
| Rate for Payer: BCN Medicare Advantage |
$35.28
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$47.28
|
| Rate for Payer: Cofinity Commercial |
$50.80
|
| Rate for Payer: Cofinity Commercial |
$47.28
|
| Rate for Payer: Cofinity Commercial |
$50.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.04
|
| Rate for Payer: Nomi Health Commercial |
$42.34
|
| Rate for Payer: Nomi Health Commercial |
$42.34
|
| Rate for Payer: PACE SWMI |
$35.28
|
| Rate for Payer: PACE SWMI |
$35.28
|
| Rate for Payer: PHP Commercial |
$49.39
|
| Rate for Payer: PHP Commercial |
$49.39
|
| Rate for Payer: PHP Medicare Advantage |
$35.28
|
| Rate for Payer: PHP Medicare Advantage |
$35.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.95
|
| Rate for Payer: Priority Health Medicare |
$35.28
|
| Rate for Payer: Priority Health Medicare |
$35.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.28
|
| Rate for Payer: UHC Medicare Advantage |
$35.28
|
| Rate for Payer: UHC Medicare Advantage |
$35.28
|
| Rate for Payer: UMR Bronson Commercial |
$56.58
|
| Rate for Payer: UMR Bronson Commercial |
$12.88
|
|
|
PR BRNCHSC BRUSHING/PROTECTED BRUSHINGS
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
HCPCS 31623
|
| Min. Negotiated Rate |
$123.86 |
| Max. Negotiated Rate |
$421.85 |
| Rate for Payer: Aetna Commercial |
$165.97
|
| Rate for Payer: Aetna Medicare |
$128.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.97
|
| Rate for Payer: BCBS Complete |
$259.60
|
| Rate for Payer: BCBS MAPPO |
$123.86
|
| Rate for Payer: BCN Medicare Advantage |
$123.86
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Cofinity Commercial |
$178.36
|
| Rate for Payer: Cofinity Commercial |
$165.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$148.63
|
| Rate for Payer: PACE SWMI |
$123.86
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: PHP Medicare Advantage |
$123.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$421.85
|
| Rate for Payer: Priority Health Medicare |
$123.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.86
|
| Rate for Payer: UHC Medicare Advantage |
$123.86
|
| Rate for Payer: UMR Bronson Commercial |
$298.54
|
|
|
PR BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
HCPCS 31652
|
| Min. Negotiated Rate |
$192.80 |
| Max. Negotiated Rate |
$313.30 |
| Rate for Payer: Aetna Commercial |
$277.96
|
| Rate for Payer: Aetna Medicare |
$215.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.96
|
| Rate for Payer: BCBS Complete |
$192.80
|
| Rate for Payer: BCBS MAPPO |
$207.43
|
| Rate for Payer: BCN Medicare Advantage |
$207.43
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cofinity Commercial |
$298.70
|
| Rate for Payer: Cofinity Commercial |
$277.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$217.80
|
| Rate for Payer: Nomi Health Commercial |
$248.92
|
| Rate for Payer: PACE SWMI |
$207.43
|
| Rate for Payer: PHP Commercial |
$290.40
|
| Rate for Payer: PHP Medicare Advantage |
$207.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.30
|
| Rate for Payer: Priority Health Medicare |
$207.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$207.43
|
| Rate for Payer: UHC Medicare Advantage |
$207.43
|
| Rate for Payer: UMR Bronson Commercial |
$221.72
|
|
|
PR BRNCHSC EBUS GUIDED SAMPL 3/> NODE STATION/STRUX
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
HCPCS 31653
|
| Min. Negotiated Rate |
$212.80 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna Commercial |
$308.21
|
| Rate for Payer: Aetna Medicare |
$239.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.21
|
| Rate for Payer: BCBS Complete |
$212.80
|
| Rate for Payer: BCBS MAPPO |
$230.01
|
| Rate for Payer: BCN Medicare Advantage |
$230.01
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cofinity Commercial |
$331.21
|
| Rate for Payer: Cofinity Commercial |
$308.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.51
|
| Rate for Payer: Nomi Health Commercial |
$276.01
|
| Rate for Payer: PACE SWMI |
$230.01
|
| Rate for Payer: PHP Commercial |
$322.01
|
| Rate for Payer: PHP Medicare Advantage |
$230.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health Medicare |
$230.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.01
|
| Rate for Payer: UHC Medicare Advantage |
$230.01
|
| Rate for Payer: UMR Bronson Commercial |
$244.72
|
|
|
PR BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 31622
|
| Min. Negotiated Rate |
$124.67 |
| Max. Negotiated Rate |
$387.40 |
| Rate for Payer: Aetna Commercial |
$167.06
|
| Rate for Payer: Aetna Medicare |
$129.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.06
|
| Rate for Payer: BCBS Complete |
$238.40
|
| Rate for Payer: BCBS MAPPO |
$124.67
|
| Rate for Payer: BCN Medicare Advantage |
$124.67
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cofinity Commercial |
$179.52
|
| Rate for Payer: Cofinity Commercial |
$167.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.90
|
| Rate for Payer: Nomi Health Commercial |
$149.60
|
| Rate for Payer: PACE SWMI |
$124.67
|
| Rate for Payer: PHP Commercial |
$174.54
|
| Rate for Payer: PHP Medicare Advantage |
$124.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.40
|
| Rate for Payer: Priority Health Medicare |
$124.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.67
|
| Rate for Payer: UHC Medicare Advantage |
$124.67
|
| Rate for Payer: UMR Bronson Commercial |
$274.16
|
|
|
PR BRNCHSC W/BRNCL ALVEOLAR LAVAGE
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 31624
|
| Min. Negotiated Rate |
$125.71 |
| Max. Negotiated Rate |
$393.25 |
| Rate for Payer: Aetna Commercial |
$168.45
|
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.45
|
| Rate for Payer: BCBS Complete |
$242.00
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cofinity Commercial |
$181.02
|
| Rate for Payer: Cofinity Commercial |
$168.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Nomi Health Commercial |
$150.85
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$175.99
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.25
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UMR Bronson Commercial |
$278.30
|
|
|
PR BRNCHSC W/TRACHEAL/BRONCHIAL DILAT/CLSD RDCTJ FX
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 31630
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$269.77 |
| Rate for Payer: Aetna Commercial |
$251.04
|
| Rate for Payer: Aetna Medicare |
$194.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.04
|
| Rate for Payer: BCBS Complete |
$150.80
|
| Rate for Payer: BCBS MAPPO |
$187.34
|
| Rate for Payer: BCN Medicare Advantage |
$187.34
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cofinity Commercial |
$269.77
|
| Rate for Payer: Cofinity Commercial |
$251.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.71
|
| Rate for Payer: Nomi Health Commercial |
$224.81
|
| Rate for Payer: PACE SWMI |
$187.34
|
| Rate for Payer: PHP Commercial |
$262.28
|
| Rate for Payer: PHP Medicare Advantage |
$187.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.05
|
| Rate for Payer: Priority Health Medicare |
$187.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.34
|
| Rate for Payer: UHC Medicare Advantage |
$187.34
|
| Rate for Payer: UMR Bronson Commercial |
$173.42
|
|
|
PR BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 94070
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$83.59 |
| Rate for Payer: Aetna Commercial |
$77.79
|
| Rate for Payer: Aetna Commercial |
$77.79
|
| Rate for Payer: Aetna Medicare |
$60.37
|
| Rate for Payer: Aetna Medicare |
$60.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.59
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS Complete |
$55.20
|
| Rate for Payer: BCBS MAPPO |
$58.05
|
| Rate for Payer: BCBS MAPPO |
$58.05
|
| Rate for Payer: BCN Medicare Advantage |
$58.05
|
| Rate for Payer: BCN Medicare Advantage |
$58.05
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$83.59
|
| Rate for Payer: Cofinity Commercial |
$83.59
|
| Rate for Payer: Cofinity Commercial |
$77.79
|
| Rate for Payer: Cofinity Commercial |
$77.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.95
|
| Rate for Payer: Nomi Health Commercial |
$69.66
|
| Rate for Payer: Nomi Health Commercial |
$69.66
|
| Rate for Payer: PACE SWMI |
$58.05
|
| Rate for Payer: PACE SWMI |
$58.05
|
| Rate for Payer: PHP Commercial |
$81.27
|
| Rate for Payer: PHP Commercial |
$81.27
|
| Rate for Payer: PHP Medicare Advantage |
$58.05
|
| Rate for Payer: PHP Medicare Advantage |
$58.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| Rate for Payer: Priority Health Medicare |
$58.05
|
| Rate for Payer: Priority Health Medicare |
$58.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.05
|
| Rate for Payer: UHC Medicare Advantage |
$58.05
|
| Rate for Payer: UHC Medicare Advantage |
$58.05
|
| Rate for Payer: UMR Bronson Commercial |
$24.38
|
| Rate for Payer: UMR Bronson Commercial |
$63.48
|
|
|
PR BRNSCHSC TNDSC EBUS DX/TX INTERVENTION PERPH LES
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 31654
|
| Min. Negotiated Rate |
$62.89 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna Commercial |
$84.27
|
| Rate for Payer: Aetna Medicare |
$65.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.27
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS MAPPO |
$62.89
|
| Rate for Payer: BCN Medicare Advantage |
$62.89
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$90.56
|
| Rate for Payer: Cofinity Commercial |
$84.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.03
|
| Rate for Payer: Nomi Health Commercial |
$75.47
|
| Rate for Payer: PACE SWMI |
$62.89
|
| Rate for Payer: PHP Commercial |
$88.05
|
| Rate for Payer: PHP Medicare Advantage |
$62.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health Medicare |
$62.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.89
|
| Rate for Payer: UHC Medicare Advantage |
$62.89
|
| Rate for Payer: UMR Bronson Commercial |
$99.36
|
|
|
PR BRONCHOPLASTY GRAFT REPAIR
|
Professional
|
Both
|
$2,953.00
|
|
|
Service Code
|
HCPCS 31770
|
| Min. Negotiated Rate |
$1,181.20 |
| Max. Negotiated Rate |
$1,919.45 |
| Rate for Payer: Aetna Commercial |
$1,710.70
|
| Rate for Payer: Aetna Medicare |
$1,327.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,838.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,710.70
|
| Rate for Payer: BCBS Complete |
$1,181.20
|
| Rate for Payer: BCBS MAPPO |
$1,276.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,276.64
|
| Rate for Payer: Cash Price |
$2,362.40
|
| Rate for Payer: Cash Price |
$2,362.40
|
| Rate for Payer: Cofinity Commercial |
$1,838.36
|
| Rate for Payer: Cofinity Commercial |
$1,710.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,276.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,340.47
|
| Rate for Payer: Nomi Health Commercial |
$1,531.97
|
| Rate for Payer: PACE SWMI |
$1,276.64
|
| Rate for Payer: PHP Commercial |
$1,787.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,276.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,919.45
|
| Rate for Payer: Priority Health Medicare |
$1,276.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,276.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,276.64
|
| Rate for Payer: UMR Bronson Commercial |
$1,358.38
|
|
|
PR BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES
|
Professional
|
Both
|
$648.00
|
|
|
Service Code
|
HCPCS 31625
|
| Min. Negotiated Rate |
$146.37 |
| Max. Negotiated Rate |
$421.20 |
| Rate for Payer: Aetna Commercial |
$196.14
|
| Rate for Payer: Aetna Medicare |
$152.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.14
|
| Rate for Payer: BCBS Complete |
$259.20
|
| Rate for Payer: BCBS MAPPO |
$146.37
|
| Rate for Payer: BCN Medicare Advantage |
$146.37
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cofinity Commercial |
$210.77
|
| Rate for Payer: Cofinity Commercial |
$196.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.69
|
| Rate for Payer: Nomi Health Commercial |
$175.64
|
| Rate for Payer: PACE SWMI |
$146.37
|
| Rate for Payer: PHP Commercial |
$204.92
|
| Rate for Payer: PHP Medicare Advantage |
$146.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$421.20
|
| Rate for Payer: Priority Health Medicare |
$146.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.37
|
| Rate for Payer: UHC Medicare Advantage |
$146.37
|
| Rate for Payer: UMR Bronson Commercial |
$298.08
|
|
|
PR BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON
|
Professional
|
Both
|
$1,259.00
|
|
|
Service Code
|
HCPCS 31629
|
| Min. Negotiated Rate |
$175.62 |
| Max. Negotiated Rate |
$818.35 |
| Rate for Payer: Aetna Commercial |
$235.33
|
| Rate for Payer: Aetna Medicare |
$182.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.33
|
| Rate for Payer: BCBS Complete |
$503.60
|
| Rate for Payer: BCBS MAPPO |
$175.62
|
| Rate for Payer: BCN Medicare Advantage |
$175.62
|
| Rate for Payer: Cash Price |
$1,007.20
|
| Rate for Payer: Cash Price |
$1,007.20
|
| Rate for Payer: Cofinity Commercial |
$252.89
|
| Rate for Payer: Cofinity Commercial |
$235.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.40
|
| Rate for Payer: Nomi Health Commercial |
$210.74
|
| Rate for Payer: PACE SWMI |
$175.62
|
| Rate for Payer: PHP Commercial |
$245.87
|
| Rate for Payer: PHP Medicare Advantage |
$175.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.35
|
| Rate for Payer: Priority Health Medicare |
$175.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$175.62
|
| Rate for Payer: UHC Medicare Advantage |
$175.62
|
| Rate for Payer: UMR Bronson Commercial |
$579.14
|
|
|
PR BRONCHOSCOPY W/CPTR-ASST IMAGE-GUIDED NAVIGATION
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 31627
|
| Min. Negotiated Rate |
$69.20 |
| Max. Negotiated Rate |
$130.39 |
| Rate for Payer: Aetna Commercial |
$121.34
|
| Rate for Payer: Aetna Medicare |
$94.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.34
|
| Rate for Payer: BCBS Complete |
$69.20
|
| Rate for Payer: BCBS MAPPO |
$90.55
|
| Rate for Payer: BCN Medicare Advantage |
$90.55
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cofinity Commercial |
$130.39
|
| Rate for Payer: Cofinity Commercial |
$121.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.08
|
| Rate for Payer: Nomi Health Commercial |
$108.66
|
| Rate for Payer: PACE SWMI |
$90.55
|
| Rate for Payer: PHP Commercial |
$126.77
|
| Rate for Payer: PHP Medicare Advantage |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.45
|
| Rate for Payer: Priority Health Medicare |
$90.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.55
|
| Rate for Payer: UHC Medicare Advantage |
$90.55
|
| Rate for Payer: UMR Bronson Commercial |
$79.58
|
|
