|
PR BRONCHOSCOPY W/EXCISION TUMOR
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
HCPCS 31640
|
| Min. Negotiated Rate |
$208.40 |
| Max. Negotiated Rate |
$338.65 |
| Rate for Payer: Aetna Commercial |
$310.36
|
| Rate for Payer: Aetna Medicare |
$240.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.36
|
| Rate for Payer: BCBS Complete |
$208.40
|
| Rate for Payer: BCBS MAPPO |
$231.61
|
| Rate for Payer: BCN Medicare Advantage |
$231.61
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cofinity Commercial |
$333.52
|
| Rate for Payer: Cofinity Commercial |
$310.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$277.93
|
| Rate for Payer: PACE SWMI |
$231.61
|
| Rate for Payer: PHP Commercial |
$324.25
|
| Rate for Payer: PHP Medicare Advantage |
$231.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.65
|
| Rate for Payer: Priority Health Medicare |
$231.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.61
|
| Rate for Payer: UHC Medicare Advantage |
$231.61
|
| Rate for Payer: UMR Bronson Commercial |
$239.66
|
|
|
PR BRONCHOSCOPY W/PLACEMENT TRACHEAL STENT
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 31631
|
| Min. Negotiated Rate |
$213.42 |
| Max. Negotiated Rate |
$497.25 |
| Rate for Payer: Aetna Commercial |
$285.98
|
| Rate for Payer: Aetna Medicare |
$221.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.98
|
| Rate for Payer: BCBS Complete |
$306.00
|
| Rate for Payer: BCBS MAPPO |
$213.42
|
| Rate for Payer: BCN Medicare Advantage |
$213.42
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$307.32
|
| Rate for Payer: Cofinity Commercial |
$285.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$213.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.09
|
| Rate for Payer: Nomi Health Commercial |
$256.10
|
| Rate for Payer: PACE SWMI |
$213.42
|
| Rate for Payer: PHP Commercial |
$298.79
|
| Rate for Payer: PHP Medicare Advantage |
$213.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health Medicare |
$213.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$213.42
|
| Rate for Payer: UHC Medicare Advantage |
$213.42
|
| Rate for Payer: UMR Bronson Commercial |
$351.90
|
|
|
PR BRONCHOSCOPY W/REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 31635
|
| Min. Negotiated Rate |
$164.95 |
| Max. Negotiated Rate |
$739.05 |
| Rate for Payer: Aetna Commercial |
$221.03
|
| Rate for Payer: Aetna Medicare |
$171.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.03
|
| Rate for Payer: BCBS Complete |
$454.80
|
| Rate for Payer: BCBS MAPPO |
$164.95
|
| Rate for Payer: BCN Medicare Advantage |
$164.95
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cofinity Commercial |
$237.53
|
| Rate for Payer: Cofinity Commercial |
$221.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.20
|
| Rate for Payer: Nomi Health Commercial |
$197.94
|
| Rate for Payer: PACE SWMI |
$164.95
|
| Rate for Payer: PHP Commercial |
$230.93
|
| Rate for Payer: PHP Medicare Advantage |
$164.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.05
|
| Rate for Payer: Priority Health Medicare |
$164.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.95
|
| Rate for Payer: UHC Medicare Advantage |
$164.95
|
| Rate for Payer: UMR Bronson Commercial |
$523.02
|
|
|
PR BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE 1ST
|
Professional
|
Both
|
$689.00
|
|
|
Service Code
|
HCPCS 31645
|
| Min. Negotiated Rate |
$138.26 |
| Max. Negotiated Rate |
$447.85 |
| Rate for Payer: Aetna Commercial |
$185.27
|
| Rate for Payer: Aetna Medicare |
$143.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.27
|
| Rate for Payer: BCBS Complete |
$275.60
|
| Rate for Payer: BCBS MAPPO |
$138.26
|
| Rate for Payer: BCN Medicare Advantage |
$138.26
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cofinity Commercial |
$199.09
|
| Rate for Payer: Cofinity Commercial |
$185.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.17
|
| Rate for Payer: Nomi Health Commercial |
$165.91
|
| Rate for Payer: PACE SWMI |
$138.26
|
| Rate for Payer: PHP Commercial |
$193.56
|
| Rate for Payer: PHP Medicare Advantage |
$138.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.85
|
| Rate for Payer: Priority Health Medicare |
$138.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.26
|
| Rate for Payer: UHC Medicare Advantage |
$138.26
|
| Rate for Payer: UMR Bronson Commercial |
$316.94
|
|
|
PR BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE SBSQ
|
Professional
|
Both
|
$614.00
|
|
|
Service Code
|
HCPCS 31646
|
| Min. Negotiated Rate |
$134.06 |
| Max. Negotiated Rate |
$399.10 |
| Rate for Payer: Aetna Commercial |
$179.64
|
| Rate for Payer: Aetna Medicare |
$139.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.64
|
| Rate for Payer: BCBS Complete |
$245.60
|
| Rate for Payer: BCBS MAPPO |
$134.06
|
| Rate for Payer: BCN Medicare Advantage |
$134.06
|
| Rate for Payer: Cash Price |
$491.20
|
| Rate for Payer: Cash Price |
$491.20
|
| Rate for Payer: Cofinity Commercial |
$193.05
|
| Rate for Payer: Cofinity Commercial |
$179.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.76
|
| Rate for Payer: Nomi Health Commercial |
$160.87
|
| Rate for Payer: PACE SWMI |
$134.06
|
| Rate for Payer: PHP Commercial |
$187.68
|
| Rate for Payer: PHP Medicare Advantage |
$134.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.10
|
| Rate for Payer: Priority Health Medicare |
$134.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.06
|
| Rate for Payer: UHC Medicare Advantage |
$134.06
|
| Rate for Payer: UMR Bronson Commercial |
$282.44
|
|
|
PR BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
HCPCS 31628
|
| Min. Negotiated Rate |
$164.44 |
| Max. Negotiated Rate |
$494.00 |
| Rate for Payer: Aetna Commercial |
$220.35
|
| Rate for Payer: Aetna Medicare |
$171.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.35
|
| Rate for Payer: BCBS Complete |
$304.00
|
| Rate for Payer: BCBS MAPPO |
$164.44
|
| Rate for Payer: BCN Medicare Advantage |
$164.44
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cofinity Commercial |
$236.79
|
| Rate for Payer: Cofinity Commercial |
$220.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.66
|
| Rate for Payer: Nomi Health Commercial |
$197.33
|
| Rate for Payer: PACE SWMI |
$164.44
|
| Rate for Payer: PHP Commercial |
$230.22
|
| Rate for Payer: PHP Medicare Advantage |
$164.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.00
|
| Rate for Payer: Priority Health Medicare |
$164.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.44
|
| Rate for Payer: UHC Medicare Advantage |
$164.44
|
| Rate for Payer: UMR Bronson Commercial |
$349.60
|
|
|
PR BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 31632
|
| Min. Negotiated Rate |
$45.49 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: Aetna Commercial |
$60.96
|
| Rate for Payer: Aetna Medicare |
$47.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.96
|
| Rate for Payer: BCBS Complete |
$51.60
|
| Rate for Payer: BCBS MAPPO |
$45.49
|
| Rate for Payer: BCN Medicare Advantage |
$45.49
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$65.51
|
| Rate for Payer: Cofinity Commercial |
$60.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.76
|
| Rate for Payer: Nomi Health Commercial |
$54.59
|
| Rate for Payer: PACE SWMI |
$45.49
|
| Rate for Payer: PHP Commercial |
$63.69
|
| Rate for Payer: PHP Medicare Advantage |
$45.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.85
|
| Rate for Payer: Priority Health Medicare |
$45.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.49
|
| Rate for Payer: UHC Medicare Advantage |
$45.49
|
| Rate for Payer: UMR Bronson Commercial |
$59.34
|
|
|
PR BRONCHOSCOPY W/TRANSBRONCL NDL ASPIR BX EA LOBE
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS 31633
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$79.62
|
| Rate for Payer: Aetna Medicare |
$61.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.62
|
| Rate for Payer: BCBS Complete |
$39.60
|
| Rate for Payer: BCBS MAPPO |
$59.42
|
| Rate for Payer: BCN Medicare Advantage |
$59.42
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cofinity Commercial |
$85.56
|
| Rate for Payer: Cofinity Commercial |
$79.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.39
|
| Rate for Payer: Nomi Health Commercial |
$71.30
|
| Rate for Payer: PACE SWMI |
$59.42
|
| Rate for Payer: PHP Commercial |
$83.19
|
| Rate for Payer: PHP Medicare Advantage |
$59.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.35
|
| Rate for Payer: Priority Health Medicare |
$59.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.42
|
| Rate for Payer: UHC Medicare Advantage |
$59.42
|
| Rate for Payer: UMR Bronson Commercial |
$45.54
|
|
|
PR BROWLIFT
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 00532
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$1,723.80 |
| Rate for Payer: Aetna Medicare |
$1,326.00
|
| Rate for Payer: BCBS Complete |
$1,060.80
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,219.92
|
|
|
PR BSO W/OMENTECTOMY TAH DEBULKING W/LMPHADECTOMY
|
Professional
|
Both
|
$5,993.00
|
|
|
Service Code
|
HCPCS 58954
|
| Min. Negotiated Rate |
$2,083.85 |
| Max. Negotiated Rate |
$3,895.45 |
| Rate for Payer: Aetna Commercial |
$2,792.36
|
| Rate for Payer: Aetna Medicare |
$2,167.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,792.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,000.74
|
| Rate for Payer: BCBS Complete |
$2,397.20
|
| Rate for Payer: BCBS MAPPO |
$2,083.85
|
| Rate for Payer: BCN Medicare Advantage |
$2,083.85
|
| Rate for Payer: Cash Price |
$4,794.40
|
| Rate for Payer: Cash Price |
$4,794.40
|
| Rate for Payer: Cofinity Commercial |
$2,792.36
|
| Rate for Payer: Cofinity Commercial |
$3,000.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,083.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,188.04
|
| Rate for Payer: Nomi Health Commercial |
$2,500.62
|
| Rate for Payer: PACE SWMI |
$2,083.85
|
| Rate for Payer: PHP Commercial |
$2,917.39
|
| Rate for Payer: PHP Medicare Advantage |
$2,083.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,895.45
|
| Rate for Payer: Priority Health Medicare |
$2,083.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,083.85
|
| Rate for Payer: UHC Medicare Advantage |
$2,083.85
|
| Rate for Payer: UMR Bronson Commercial |
$2,756.78
|
|
|
PR BSO W/OMENTECTOMY TAH&RAD DEBULKING DISSECTION
|
Professional
|
Both
|
$5,240.00
|
|
|
Service Code
|
HCPCS 58953
|
| Min. Negotiated Rate |
$1,924.47 |
| Max. Negotiated Rate |
$3,406.00 |
| Rate for Payer: Aetna Commercial |
$2,578.79
|
| Rate for Payer: Aetna Medicare |
$2,001.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,771.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,578.79
|
| Rate for Payer: BCBS Complete |
$2,096.00
|
| Rate for Payer: BCBS MAPPO |
$1,924.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,924.47
|
| Rate for Payer: Cash Price |
$4,192.00
|
| Rate for Payer: Cash Price |
$4,192.00
|
| Rate for Payer: Cofinity Commercial |
$2,771.24
|
| Rate for Payer: Cofinity Commercial |
$2,578.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,924.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,020.69
|
| Rate for Payer: Nomi Health Commercial |
$2,309.36
|
| Rate for Payer: PACE SWMI |
$1,924.47
|
| Rate for Payer: PHP Commercial |
$2,694.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,924.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,406.00
|
| Rate for Payer: Priority Health Medicare |
$1,924.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,924.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,924.47
|
| Rate for Payer: UMR Bronson Commercial |
$2,410.40
|
|
|
PR BSO W/TOT OMENTECTOMY & HYSTERECTOMY MALIGNANC
|
Professional
|
Both
|
$2,430.00
|
|
|
Service Code
|
HCPCS 58956
|
| Min. Negotiated Rate |
$972.00 |
| Max. Negotiated Rate |
$1,883.82 |
| Rate for Payer: Aetna Commercial |
$1,753.00
|
| Rate for Payer: Aetna Medicare |
$1,360.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,883.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,753.00
|
| Rate for Payer: BCBS Complete |
$972.00
|
| Rate for Payer: BCBS MAPPO |
$1,308.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,308.21
|
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cofinity Commercial |
$1,883.82
|
| Rate for Payer: Cofinity Commercial |
$1,753.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,308.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,373.62
|
| Rate for Payer: Nomi Health Commercial |
$1,569.85
|
| Rate for Payer: PACE SWMI |
$1,308.21
|
| Rate for Payer: PHP Commercial |
$1,831.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,308.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,579.50
|
| Rate for Payer: Priority Health Medicare |
$1,308.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,308.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,308.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,117.80
|
|
|
PR BUDESONIDE NON-COMP UNIT
|
Professional
|
Both
|
$9.00
|
|
|
Service Code
|
HCPCS J7626
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: Aetna Commercial |
$1.81
|
| Rate for Payer: Aetna Medicare |
$1.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: BCBS Complete |
$3.60
|
| Rate for Payer: BCBS MAPPO |
$1.35
|
| Rate for Payer: BCN Medicare Advantage |
$1.35
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.42
|
| Rate for Payer: Nomi Health Commercial |
$1.62
|
| Rate for Payer: PACE SWMI |
$1.35
|
| Rate for Payer: PHP Commercial |
$1.89
|
| Rate for Payer: PHP Medicare Advantage |
$1.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.85
|
| Rate for Payer: Priority Health Medicare |
$1.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.35
|
| Rate for Payer: UHC Medicare Advantage |
$1.35
|
| Rate for Payer: UMR Bronson Commercial |
$4.14
|
|
|
PR BURR HOLE FOR VENTRICULAR PUNCTURE
|
Professional
|
Both
|
$1,871.00
|
|
|
Service Code
|
HCPCS 61120
|
| Min. Negotiated Rate |
$744.17 |
| Max. Negotiated Rate |
$1,216.15 |
| Rate for Payer: Aetna Commercial |
$997.19
|
| Rate for Payer: Aetna Medicare |
$773.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$997.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,071.60
|
| Rate for Payer: BCBS Complete |
$748.40
|
| Rate for Payer: BCBS MAPPO |
$744.17
|
| Rate for Payer: BCN Medicare Advantage |
$744.17
|
| Rate for Payer: Cash Price |
$1,496.80
|
| Rate for Payer: Cash Price |
$1,496.80
|
| Rate for Payer: Cofinity Commercial |
$997.19
|
| Rate for Payer: Cofinity Commercial |
$1,071.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$744.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$781.38
|
| Rate for Payer: Nomi Health Commercial |
$893.00
|
| Rate for Payer: PACE SWMI |
$744.17
|
| Rate for Payer: PHP Commercial |
$1,041.84
|
| Rate for Payer: PHP Medicare Advantage |
$744.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,216.15
|
| Rate for Payer: Priority Health Medicare |
$744.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$744.17
|
| Rate for Payer: UHC Medicare Advantage |
$744.17
|
| Rate for Payer: UMR Bronson Commercial |
$860.66
|
|
|
PR BURR HOLE IMPLANT VENTRICULAR CATH/OTHER DEVICE
|
Professional
|
Both
|
$2,554.00
|
|
|
Service Code
|
HCPCS 61210
|
| Min. Negotiated Rate |
$363.16 |
| Max. Negotiated Rate |
$1,660.10 |
| Rate for Payer: Aetna Commercial |
$486.63
|
| Rate for Payer: Aetna Medicare |
$377.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.63
|
| Rate for Payer: BCBS Complete |
$1,021.60
|
| Rate for Payer: BCBS MAPPO |
$363.16
|
| Rate for Payer: BCN Medicare Advantage |
$363.16
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Cofinity Commercial |
$522.95
|
| Rate for Payer: Cofinity Commercial |
$486.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.32
|
| Rate for Payer: Nomi Health Commercial |
$435.79
|
| Rate for Payer: PACE SWMI |
$363.16
|
| Rate for Payer: PHP Commercial |
$508.42
|
| Rate for Payer: PHP Medicare Advantage |
$363.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,660.10
|
| Rate for Payer: Priority Health Medicare |
$363.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.16
|
| Rate for Payer: UHC Medicare Advantage |
$363.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,174.84
|
|
|
PR BURR HOLE/TREPHINE STTL EXPL N/FLWD OTH SURG
|
Professional
|
Both
|
$2,725.00
|
|
|
Service Code
|
HCPCS 61250
|
| Min. Negotiated Rate |
$862.39 |
| Max. Negotiated Rate |
$1,771.25 |
| Rate for Payer: Aetna Commercial |
$1,155.60
|
| Rate for Payer: Aetna Medicare |
$896.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,241.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,155.60
|
| Rate for Payer: BCBS Complete |
$1,090.00
|
| Rate for Payer: BCBS MAPPO |
$862.39
|
| Rate for Payer: BCN Medicare Advantage |
$862.39
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cofinity Commercial |
$1,241.84
|
| Rate for Payer: Cofinity Commercial |
$1,155.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$862.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$905.51
|
| Rate for Payer: Nomi Health Commercial |
$1,034.87
|
| Rate for Payer: PACE SWMI |
$862.39
|
| Rate for Payer: PHP Commercial |
$1,207.35
|
| Rate for Payer: PHP Medicare Advantage |
$862.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,771.25
|
| Rate for Payer: Priority Health Medicare |
$862.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$862.39
|
| Rate for Payer: UHC Medicare Advantage |
$862.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,253.50
|
|
|
PR BURR HOLE/TREPHINE W/BX BRAIN/INTRACRNIAL LESION
|
Professional
|
Both
|
$4,613.00
|
|
|
Service Code
|
HCPCS 61140
|
| Min. Negotiated Rate |
$1,261.54 |
| Max. Negotiated Rate |
$2,998.45 |
| Rate for Payer: Aetna Commercial |
$1,690.46
|
| Rate for Payer: Aetna Medicare |
$1,312.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,816.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,690.46
|
| Rate for Payer: BCBS Complete |
$1,845.20
|
| Rate for Payer: BCBS MAPPO |
$1,261.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,261.54
|
| Rate for Payer: Cash Price |
$3,690.40
|
| Rate for Payer: Cash Price |
$3,690.40
|
| Rate for Payer: Cofinity Commercial |
$1,816.62
|
| Rate for Payer: Cofinity Commercial |
$1,690.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,261.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,324.62
|
| Rate for Payer: Nomi Health Commercial |
$1,513.85
|
| Rate for Payer: PACE SWMI |
$1,261.54
|
| Rate for Payer: PHP Commercial |
$1,766.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,261.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,998.45
|
| Rate for Payer: Priority Health Medicare |
$1,261.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,261.54
|
| Rate for Payer: UHC Medicare Advantage |
$1,261.54
|
| Rate for Payer: UMR Bronson Commercial |
$2,121.98
|
|
|
PR BURR HOLE/TREPHINE W/DRG BRAIN ABSCESS/CYST
|
Professional
|
Both
|
$4,121.00
|
|
|
Service Code
|
HCPCS 61150
|
| Min. Negotiated Rate |
$1,342.16 |
| Max. Negotiated Rate |
$2,678.65 |
| Rate for Payer: Aetna Commercial |
$1,798.49
|
| Rate for Payer: Aetna Medicare |
$1,395.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,932.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,798.49
|
| Rate for Payer: BCBS Complete |
$1,648.40
|
| Rate for Payer: BCBS MAPPO |
$1,342.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,342.16
|
| Rate for Payer: Cash Price |
$3,296.80
|
| Rate for Payer: Cash Price |
$3,296.80
|
| Rate for Payer: Cofinity Commercial |
$1,932.71
|
| Rate for Payer: Cofinity Commercial |
$1,798.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,342.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,409.27
|
| Rate for Payer: Nomi Health Commercial |
$1,610.59
|
| Rate for Payer: PACE SWMI |
$1,342.16
|
| Rate for Payer: PHP Commercial |
$1,879.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,342.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,678.65
|
| Rate for Payer: Priority Health Medicare |
$1,342.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,342.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,342.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,895.66
|
|
|
PR BURR HOLE W/ASPIR HEMATOMA/CYST INTRACEREBRAL
|
Professional
|
Both
|
$3,685.00
|
|
|
Service Code
|
HCPCS 61156
|
| Min. Negotiated Rate |
$1,233.42 |
| Max. Negotiated Rate |
$2,395.25 |
| Rate for Payer: Aetna Commercial |
$1,652.78
|
| Rate for Payer: Aetna Medicare |
$1,282.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,776.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,652.78
|
| Rate for Payer: BCBS Complete |
$1,474.00
|
| Rate for Payer: BCBS MAPPO |
$1,233.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,233.42
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Cofinity Commercial |
$1,776.12
|
| Rate for Payer: Cofinity Commercial |
$1,652.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,233.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,295.09
|
| Rate for Payer: Nomi Health Commercial |
$1,480.10
|
| Rate for Payer: PACE SWMI |
$1,233.42
|
| Rate for Payer: PHP Commercial |
$1,726.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,233.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,395.25
|
| Rate for Payer: Priority Health Medicare |
$1,233.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,233.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,233.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,695.10
|
|
|
PR BURR HOLE W/EVAC&/DRG HEMATOMA EXTRADURAL/SDRL
|
Professional
|
Both
|
$4,188.00
|
|
|
Service Code
|
HCPCS 61154
|
| Min. Negotiated Rate |
$1,266.67 |
| Max. Negotiated Rate |
$2,722.20 |
| Rate for Payer: Aetna Commercial |
$1,697.34
|
| Rate for Payer: Aetna Medicare |
$1,317.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,824.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,697.34
|
| Rate for Payer: BCBS Complete |
$1,675.20
|
| Rate for Payer: BCBS MAPPO |
$1,266.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,266.67
|
| Rate for Payer: Cash Price |
$3,350.40
|
| Rate for Payer: Cash Price |
$3,350.40
|
| Rate for Payer: Cofinity Commercial |
$1,824.00
|
| Rate for Payer: Cofinity Commercial |
$1,697.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,266.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,330.00
|
| Rate for Payer: Nomi Health Commercial |
$1,520.00
|
| Rate for Payer: PACE SWMI |
$1,266.67
|
| Rate for Payer: PHP Commercial |
$1,773.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,266.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,722.20
|
| Rate for Payer: Priority Health Medicare |
$1,266.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,266.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,266.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,926.48
|
|
|
PR BUTORPHANOL TARTRATE 1 MG
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J0595
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$9.26 |
| Rate for Payer: Aetna Commercial |
$8.62
|
| Rate for Payer: Aetna Medicare |
$6.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.62
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS MAPPO |
$6.43
|
| Rate for Payer: BCN Medicare Advantage |
$6.43
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Cofinity Commercial |
$8.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.75
|
| Rate for Payer: Nomi Health Commercial |
$7.72
|
| Rate for Payer: PACE SWMI |
$6.43
|
| Rate for Payer: PHP Commercial |
$9.00
|
| Rate for Payer: PHP Medicare Advantage |
$6.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: Priority Health Medicare |
$6.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.43
|
| Rate for Payer: UHC Medicare Advantage |
$6.43
|
| Rate for Payer: UMR Bronson Commercial |
$3.22
|
|
|
PR BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 49180
|
| Min. Negotiated Rate |
$78.32 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$104.95
|
| Rate for Payer: Aetna Medicare |
$81.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.95
|
| Rate for Payer: BCBS Complete |
$136.00
|
| Rate for Payer: BCBS MAPPO |
$78.32
|
| Rate for Payer: BCN Medicare Advantage |
$78.32
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$112.78
|
| Rate for Payer: Cofinity Commercial |
$104.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.24
|
| Rate for Payer: Nomi Health Commercial |
$93.98
|
| Rate for Payer: PACE SWMI |
$78.32
|
| Rate for Payer: PHP Commercial |
$109.65
|
| Rate for Payer: PHP Medicare Advantage |
$78.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.00
|
| Rate for Payer: Priority Health Medicare |
$78.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.32
|
| Rate for Payer: UHC Medicare Advantage |
$78.32
|
| Rate for Payer: UMR Bronson Commercial |
$156.40
|
|
|
PR BX ANORECTAL WALL ANAL APPROACH
|
Professional
|
Both
|
$769.00
|
|
|
Service Code
|
HCPCS 45100
|
| Min. Negotiated Rate |
$290.18 |
| Max. Negotiated Rate |
$499.85 |
| Rate for Payer: Aetna Commercial |
$388.84
|
| Rate for Payer: Aetna Medicare |
$301.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.84
|
| Rate for Payer: BCBS Complete |
$307.60
|
| Rate for Payer: BCBS MAPPO |
$290.18
|
| Rate for Payer: BCN Medicare Advantage |
$290.18
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cofinity Commercial |
$417.86
|
| Rate for Payer: Cofinity Commercial |
$388.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$290.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$304.69
|
| Rate for Payer: Nomi Health Commercial |
$348.22
|
| Rate for Payer: PACE SWMI |
$290.18
|
| Rate for Payer: PHP Commercial |
$406.25
|
| Rate for Payer: PHP Medicare Advantage |
$290.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.85
|
| Rate for Payer: Priority Health Medicare |
$290.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$290.18
|
| Rate for Payer: UHC Medicare Advantage |
$290.18
|
| Rate for Payer: UMR Bronson Commercial |
$353.74
|
|
|
PR BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
19100
|
| Min. Negotiated Rate |
$131.56 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna American Axle |
$194.35
|
| Rate for Payer: Aetna Commercial |
$254.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.35
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$209.30
|
| Rate for Payer: Cofinity Commercial |
$257.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.20
|
| Rate for Payer: Healthscope Commercial |
$269.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.15
|
| Rate for Payer: PHP Commercial |
$254.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health SBD |
$188.37
|
| Rate for Payer: UMR Bronson Commercial |
$131.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.25
|
|
|
PR BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
19100
|
| Min. Negotiated Rate |
$110.63 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna American Axle |
$194.35
|
| Rate for Payer: Aetna Commercial |
$254.15
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$257.14
|
| Rate for Payer: Cofinity Commercial |
$209.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$269.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.25
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.15
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$254.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$188.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$3,019.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: UMR Bronson Commercial |
$110.63
|
| Rate for Payer: VA VA |
$1,580.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.25
|
|
