|
PR BOTOX UNIT
|
Professional
|
Both
|
$13.00
|
|
|
Service Code
|
HCPCS 00084
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: BCBS Complete |
$5.20
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.45
|
| Rate for Payer: UMR Bronson Commercial |
$5.98
|
|
|
PR BRACHIOPLASTY
|
Professional
|
Both
|
$4,590.00
|
|
|
Service Code
|
HCPCS 00537
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,836.00 |
| Max. Negotiated Rate |
$2,983.50 |
| Rate for Payer: Aetna Medicare |
$2,295.00
|
| Rate for Payer: BCBS Complete |
$1,836.00
|
| Rate for Payer: Cash Price |
$3,672.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,983.50
|
| Rate for Payer: UMR Bronson Commercial |
$2,111.40
|
|
|
PR BREAST AUGMENTATION WITH IMPLANT
|
Professional
|
Both
|
$2,040.00
|
|
|
Service Code
|
HCPCS 19325
|
| Min. Negotiated Rate |
$399.38 |
| Max. Negotiated Rate |
$1,326.00 |
| Rate for Payer: Aetna Commercial |
$788.74
|
| Rate for Payer: Aetna Medicare |
$612.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$847.60
|
| Rate for Payer: BCBS Complete |
$419.35
|
| Rate for Payer: BCBS MAPPO |
$588.61
|
| Rate for Payer: BCBS Trust/PPO |
$630.49
|
| Rate for Payer: BCN Commercial |
$901.13
|
| Rate for Payer: BCN Medicare Advantage |
$588.61
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cofinity Commercial |
$788.74
|
| Rate for Payer: Cofinity Commercial |
$847.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$618.04
|
| Rate for Payer: Meridian Medicaid |
$419.35
|
| Rate for Payer: Nomi Health Commercial |
$706.33
|
| Rate for Payer: PACE SWMI |
$588.61
|
| Rate for Payer: PHP Commercial |
$824.05
|
| Rate for Payer: PHP Medicare Advantage |
$588.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$399.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$838.02
|
| Rate for Payer: Priority Health Medicare |
$588.61
|
| Rate for Payer: Priority Health Narrow Network |
$838.02
|
| Rate for Payer: Priority Health SBD |
$838.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$588.61
|
| Rate for Payer: UHC Medicare Advantage |
$588.61
|
| Rate for Payer: UHCCP Medicaid |
$399.38
|
| Rate for Payer: UMR Bronson Commercial |
$938.40
|
|
|
PR BREAST AUGMENT W MASTOPEXY-GEL 2.5
|
Professional
|
Both
|
$6,671.00
|
|
|
Service Code
|
HCPCS 00258
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,668.40 |
| Max. Negotiated Rate |
$4,336.15 |
| Rate for Payer: Aetna Medicare |
$3,335.50
|
| Rate for Payer: BCBS Complete |
$2,668.40
|
| Rate for Payer: Cash Price |
$5,336.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,336.15
|
| Rate for Payer: UMR Bronson Commercial |
$3,068.66
|
|
|
PR BREAST AUGMENT W MASTOPEXY-GEL 3.5
|
Professional
|
Both
|
$7,589.00
|
|
|
Service Code
|
HCPCS 00260
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$3,035.60 |
| Max. Negotiated Rate |
$4,932.85 |
| Rate for Payer: Aetna Medicare |
$3,794.50
|
| Rate for Payer: BCBS Complete |
$3,035.60
|
| Rate for Payer: Cash Price |
$6,071.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,932.85
|
| Rate for Payer: UMR Bronson Commercial |
$3,490.94
|
|
|
PR BREAST AUGMENT W MASTOPEXY-SALINE 2.5
|
Professional
|
Both
|
$5,610.00
|
|
|
Service Code
|
HCPCS 00257
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,244.00 |
| Max. Negotiated Rate |
$3,646.50 |
| Rate for Payer: Aetna Medicare |
$2,805.00
|
| Rate for Payer: BCBS Complete |
$2,244.00
|
| Rate for Payer: Cash Price |
$4,488.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,646.50
|
| Rate for Payer: UMR Bronson Commercial |
$2,580.60
|
|
|
PR BREAST AUGMENT W MASTOPEXY-SALINE 3.5
|
Professional
|
Both
|
$6,528.00
|
|
|
Service Code
|
HCPCS 00259
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,611.20 |
| Max. Negotiated Rate |
$4,243.20 |
| Rate for Payer: Aetna Medicare |
$3,264.00
|
| Rate for Payer: BCBS Complete |
$2,611.20
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,243.20
|
| Rate for Payer: UMR Bronson Commercial |
$3,002.88
|
|
|
PR BREAST IMPLANT WARRANTY
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 00523
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: UMR Bronson Commercial |
$164.22
|
|
|
PR BREAST RECONSTRUCTION 1PEDICLED TRAM FLAP ANAST
|
Professional
|
Both
|
$4,809.00
|
|
|
Service Code
|
HCPCS 19368
|
| Min. Negotiated Rate |
$1,327.27 |
| Max. Negotiated Rate |
$3,163.69 |
| Rate for Payer: Aetna Commercial |
$2,781.24
|
| Rate for Payer: Aetna Medicare |
$2,158.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,781.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,988.79
|
| Rate for Payer: BCBS Complete |
$1,461.33
|
| Rate for Payer: BCBS MAPPO |
$2,075.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,327.27
|
| Rate for Payer: BCN Commercial |
$3,163.69
|
| Rate for Payer: BCN Medicare Advantage |
$2,075.55
|
| Rate for Payer: Cash Price |
$3,847.20
|
| Rate for Payer: Cash Price |
$3,847.20
|
| Rate for Payer: Cofinity Commercial |
$2,781.24
|
| Rate for Payer: Cofinity Commercial |
$2,988.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,075.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,179.33
|
| Rate for Payer: Meridian Medicaid |
$1,461.33
|
| Rate for Payer: Nomi Health Commercial |
$2,490.66
|
| Rate for Payer: PACE SWMI |
$2,075.55
|
| Rate for Payer: PHP Commercial |
$2,905.77
|
| Rate for Payer: PHP Medicare Advantage |
$2,075.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,391.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,125.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,926.28
|
| Rate for Payer: Priority Health Medicare |
$2,075.55
|
| Rate for Payer: Priority Health Narrow Network |
$2,926.28
|
| Rate for Payer: Priority Health SBD |
$2,926.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,075.55
|
| Rate for Payer: UHC Medicare Advantage |
$2,075.55
|
| Rate for Payer: UHCCP Medicaid |
$1,391.74
|
| Rate for Payer: UMR Bronson Commercial |
$2,212.14
|
|
|
PR BREAST RECONSTRUCTION BIPEDICLED TRAM FLAP
|
Professional
|
Both
|
$4,213.00
|
|
|
Service Code
|
HCPCS 19369
|
| Min. Negotiated Rate |
$199.98 |
| Max. Negotiated Rate |
$2,939.88 |
| Rate for Payer: Aetna Commercial |
$2,583.48
|
| Rate for Payer: Aetna Medicare |
$2,005.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,583.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,776.28
|
| Rate for Payer: BCBS Complete |
$1,358.01
|
| Rate for Payer: BCBS MAPPO |
$1,927.97
|
| Rate for Payer: BCBS Trust/PPO |
$199.98
|
| Rate for Payer: BCN Commercial |
$2,939.88
|
| 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 |
$2,583.48
|
| Rate for Payer: Cofinity Commercial |
$2,776.28
|
| 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: Meridian Medicaid |
$1,358.01
|
| 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 Choice Medicaid |
$1,293.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,738.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,719.49
|
| Rate for Payer: Priority Health Medicare |
$1,927.97
|
| Rate for Payer: Priority Health Narrow Network |
$2,719.49
|
| Rate for Payer: Priority Health SBD |
$2,719.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,927.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,927.97
|
| Rate for Payer: UHCCP Medicaid |
$1,293.34
|
| 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 |
$1,139.12 |
| Max. Negotiated Rate |
$2,583.15 |
| Rate for Payer: Aetna Commercial |
$2,270.88
|
| Rate for Payer: Aetna Medicare |
$1,762.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,270.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,440.35
|
| Rate for Payer: BCBS Complete |
$1,196.08
|
| Rate for Payer: BCBS MAPPO |
$1,694.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,327.27
|
| Rate for Payer: BCN Commercial |
$2,583.15
|
| 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 |
$2,270.88
|
| Rate for Payer: Cofinity Commercial |
$2,440.35
|
| 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: Meridian Medicaid |
$1,196.08
|
| 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 Choice Medicaid |
$1,139.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,970.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,392.58
|
| Rate for Payer: Priority Health Medicare |
$1,694.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,392.58
|
| Rate for Payer: Priority Health SBD |
$2,392.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,694.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,694.69
|
| Rate for Payer: UHCCP Medicaid |
$1,139.12
|
| 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 |
$312.59 |
| Max. Negotiated Rate |
$2,274.31 |
| Rate for Payer: Aetna Commercial |
$1,999.74
|
| Rate for Payer: Aetna Medicare |
$1,552.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,999.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,148.97
|
| Rate for Payer: BCBS Complete |
$1,053.61
|
| Rate for Payer: BCBS MAPPO |
$1,492.34
|
| Rate for Payer: BCBS Trust/PPO |
$312.59
|
| Rate for Payer: BCN Commercial |
$2,274.31
|
| 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 |
$1,999.74
|
| Rate for Payer: Cofinity Commercial |
$2,148.97
|
| 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: Meridian Medicaid |
$1,053.61
|
| 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 Choice Medicaid |
$1,003.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,898.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,107.68
|
| Rate for Payer: Priority Health Medicare |
$1,492.34
|
| Rate for Payer: Priority Health Narrow Network |
$2,107.68
|
| Rate for Payer: Priority Health SBD |
$2,107.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,492.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,492.34
|
| Rate for Payer: UHCCP Medicaid |
$1,003.44
|
| 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
|
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
|
| Hospital Charge Code |
19318
|
| Min. Negotiated Rate |
$293.06 |
| Max. Negotiated Rate |
$1,597.97 |
| 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 |
$741.40
|
| Rate for Payer: BCBS MAPPO |
$1,048.34
|
| Rate for Payer: BCBS Trust/PPO |
$293.06
|
| Rate for Payer: BCN Commercial |
$1,597.97
|
| 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 |
$1,509.61
|
| Rate for Payer: Cofinity Commercial |
$1,404.78
|
| 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: Meridian Medicaid |
$741.40
|
| 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 Choice Medicaid |
$706.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,482.33
|
| Rate for Payer: Priority Health Medicare |
$1,048.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,482.33
|
| Rate for Payer: Priority Health SBD |
$1,482.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,048.34
|
| Rate for Payer: UHCCP Medicaid |
$706.10
|
| Rate for Payer: UMR Bronson Commercial |
$891.48
|
|
|
PR BREAST REDUCTION
|
Facility
|
OP
|
$1,938.00
|
|
|
Service Code
|
CPT 19318
|
| Hospital Charge Code |
19318
|
| Min. Negotiated Rate |
$717.06 |
| Max. Negotiated Rate |
$20,082.39 |
| Rate for Payer: Aetna American Axle |
$1,259.70
|
| Rate for Payer: Aetna Commercial |
$1,647.30
|
| Rate for Payer: Aetna Medicare |
$6,645.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,259.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,987.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,987.00
|
| Rate for Payer: BCBS Complete |
$3,596.07
|
| Rate for Payer: BCBS MAPPO |
$6,389.60
|
| Rate for Payer: BCBS Trust/PPO |
$6,817.13
|
| Rate for Payer: BCN Commercial |
$6,817.13
|
| Rate for Payer: BCN Medicare Advantage |
$6,389.60
|
| Rate for Payer: Cash Price |
$1,550.40
|
| 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 |
$6,389.60
|
| 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 |
$3,424.83
|
| Rate for Payer: Mclaren Medicare |
$6,389.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,709.08
|
| Rate for Payer: Meridian Medicaid |
$3,596.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,348.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,647.30
|
| Rate for Payer: Nomi Health Commercial |
$13,418.16
|
| Rate for Payer: PACE Medicare |
$6,070.12
|
| Rate for Payer: PACE SWMI |
$6,389.60
|
| Rate for Payer: PHP Commercial |
$1,647.30
|
| Rate for Payer: PHP Medicare Advantage |
$6,389.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,424.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,082.39
|
| Rate for Payer: Priority Health Medicare |
$6,389.60
|
| Rate for Payer: Priority Health Narrow Network |
$16,065.91
|
| Rate for Payer: Priority Health SBD |
$1,220.94
|
| Rate for Payer: Railroad Medicare Medicare |
$6,389.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,156.95
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,389.60
|
| Rate for Payer: UHC Exchange |
$1,051.77
|
| Rate for Payer: UHC Medicare Advantage |
$6,389.60
|
| Rate for Payer: UHCCP Medicaid |
$3,424.83
|
| Rate for Payer: UMR Bronson Commercial |
$717.06
|
| Rate for Payer: VA VA |
$6,389.60
|
| 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 |
$293.06 |
| Max. Negotiated Rate |
$1,597.97 |
| 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 |
$741.40
|
| Rate for Payer: BCBS MAPPO |
$1,048.34
|
| Rate for Payer: BCBS Trust/PPO |
$293.06
|
| Rate for Payer: BCN Commercial |
$1,597.97
|
| 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: Meridian Medicaid |
$741.40
|
| 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 Choice Medicaid |
$706.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,482.33
|
| Rate for Payer: Priority Health Medicare |
$1,048.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,482.33
|
| Rate for Payer: Priority Health SBD |
$1,482.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,048.34
|
| Rate for Payer: UHCCP Medicaid |
$706.10
|
| Rate for Payer: UMR Bronson Commercial |
$891.48
|
|
|
PR BREATH HYDROGEN/METHANE TEST
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 91065
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$1,135.85 |
| Rate for Payer: Aetna Commercial |
$78.39
|
| Rate for Payer: Aetna Medicare |
$60.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.24
|
| Rate for Payer: BCBS Complete |
$6.26
|
| Rate for Payer: BCBS MAPPO |
$58.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,135.85
|
| Rate for Payer: BCN Commercial |
$123.15
|
| 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 |
$78.39
|
| Rate for Payer: Cofinity Commercial |
$84.24
|
| 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: Meridian Medicaid |
$6.26
|
| 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 Choice Medicaid |
$5.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.42
|
| Rate for Payer: Priority Health Medicare |
$58.50
|
| Rate for Payer: Priority Health Narrow Network |
$100.42
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.50
|
| Rate for Payer: UHC Medicare Advantage |
$58.50
|
| Rate for Payer: UHCCP Medicaid |
$5.96
|
| Rate for Payer: UMR Bronson Commercial |
$76.82
|
|
|
PR BREATHING RESPONSE TO HYPOXIA
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 94450
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$1,113.66 |
| Rate for Payer: Aetna Commercial |
$105.85
|
| Rate for Payer: Aetna Medicare |
$82.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$78.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,113.66
|
| Rate for Payer: BCN Commercial |
$119.72
|
| 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: Meridian Medicaid |
$13.20
|
| 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 Choice Medicaid |
$12.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.11
|
| Rate for Payer: Priority Health Medicare |
$78.99
|
| Rate for Payer: Priority Health Narrow Network |
$108.11
|
| Rate for Payer: Priority Health SBD |
$25.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.99
|
| Rate for Payer: UHC Medicare Advantage |
$78.99
|
| Rate for Payer: UHCCP Medicaid |
$12.57
|
| 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 |
$403.09 |
| Rate for Payer: Aetna Commercial |
$13.03
|
| Rate for Payer: Aetna Medicare |
$15.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.03
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$403.09
|
| Rate for Payer: BCN Commercial |
$20.53
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.05
|
| Rate for Payer: Priority Health Narrow Network |
$17.05
|
| Rate for Payer: Priority Health SBD |
$17.05
|
| 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 |
$9.59 |
| 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 |
$10.07
|
| 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 |
$19.15
|
| Rate for Payer: Cofinity Commercial |
$20.58
|
| 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: Meridian Medicaid |
$10.07
|
| 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 Choice Medicaid |
$9.59
|
| 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: UHCCP Medicaid |
$9.59
|
| 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 |
$6.39 |
| Max. Negotiated Rate |
$1,399.47 |
| 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) |
$50.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.28
|
| Rate for Payer: BCBS Complete |
$6.71
|
| Rate for Payer: BCBS Complete |
$6.71
|
| Rate for Payer: BCBS MAPPO |
$35.28
|
| Rate for Payer: BCBS MAPPO |
$35.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,399.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,399.47
|
| Rate for Payer: BCN Commercial |
$56.19
|
| Rate for Payer: BCN Commercial |
$56.19
|
| 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 |
$50.80
|
| Rate for Payer: Cofinity Commercial |
$47.28
|
| Rate for Payer: Cofinity Commercial |
$50.80
|
| Rate for Payer: Cofinity Commercial |
$47.28
|
| 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: Meridian Medicaid |
$6.71
|
| Rate for Payer: Meridian Medicaid |
$6.71
|
| 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 Choice Medicaid |
$6.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.70
|
| Rate for Payer: Priority Health Medicare |
$35.28
|
| Rate for Payer: Priority Health Medicare |
$35.28
|
| Rate for Payer: Priority Health Narrow Network |
$85.70
|
| Rate for Payer: Priority Health Narrow Network |
$85.70
|
| Rate for Payer: Priority Health SBD |
$18.98
|
| Rate for Payer: Priority Health SBD |
$18.98
|
| 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: UHCCP Medicaid |
$6.39
|
| Rate for Payer: UHCCP Medicaid |
$6.39
|
| Rate for Payer: UMR Bronson Commercial |
$12.88
|
| Rate for Payer: UMR Bronson Commercial |
$56.58
|
|
|
PR BRNCHSC BRUSHING/PROTECTED BRUSHINGS
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
HCPCS 31623
|
| Min. Negotiated Rate |
$82.64 |
| Max. Negotiated Rate |
$720.60 |
| Rate for Payer: Aetna Commercial |
$165.97
|
| Rate for Payer: Aetna Medicare |
$128.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.36
|
| Rate for Payer: BCBS Complete |
$86.77
|
| Rate for Payer: BCBS MAPPO |
$123.86
|
| Rate for Payer: BCBS Trust/PPO |
$720.60
|
| Rate for Payer: BCN Commercial |
$399.74
|
| 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 |
$165.97
|
| Rate for Payer: Cofinity Commercial |
$178.36
|
| 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: Meridian Medicaid |
$86.77
|
| 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 Choice Medicaid |
$82.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$421.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.36
|
| Rate for Payer: Priority Health Medicare |
$123.86
|
| Rate for Payer: Priority Health Narrow Network |
$179.36
|
| Rate for Payer: Priority Health SBD |
$179.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.86
|
| Rate for Payer: UHC Medicare Advantage |
$123.86
|
| Rate for Payer: UHCCP Medicaid |
$82.64
|
| 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 |
$138.02 |
| Max. Negotiated Rate |
$1,843.29 |
| Rate for Payer: Aetna Commercial |
$277.96
|
| Rate for Payer: Aetna Medicare |
$215.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.70
|
| Rate for Payer: BCBS Complete |
$144.92
|
| Rate for Payer: BCBS MAPPO |
$207.43
|
| Rate for Payer: BCBS Trust/PPO |
$853.73
|
| Rate for Payer: BCN Commercial |
$1,843.29
|
| 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 |
$277.96
|
| Rate for Payer: Cofinity Commercial |
$298.70
|
| 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: Meridian Medicaid |
$144.92
|
| 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 Choice Medicaid |
$138.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.93
|
| Rate for Payer: Priority Health Medicare |
$207.43
|
| Rate for Payer: Priority Health Narrow Network |
$298.93
|
| Rate for Payer: Priority Health SBD |
$298.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$207.43
|
| Rate for Payer: UHC Medicare Advantage |
$207.43
|
| Rate for Payer: UHCCP Medicaid |
$138.02
|
| 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 |
$152.93 |
| Max. Negotiated Rate |
$1,916.10 |
| Rate for Payer: Aetna Commercial |
$308.21
|
| Rate for Payer: Aetna Medicare |
$239.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.21
|
| Rate for Payer: BCBS Complete |
$160.58
|
| Rate for Payer: BCBS MAPPO |
$230.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,172.30
|
| Rate for Payer: BCN Commercial |
$1,916.10
|
| 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 |
$308.21
|
| Rate for Payer: Cofinity Commercial |
$331.21
|
| 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: Meridian Medicaid |
$160.58
|
| 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 Choice Medicaid |
$152.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.38
|
| Rate for Payer: Priority Health Medicare |
$230.01
|
| Rate for Payer: Priority Health Narrow Network |
$331.38
|
| Rate for Payer: Priority Health SBD |
$331.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.01
|
| Rate for Payer: UHC Medicare Advantage |
$230.01
|
| Rate for Payer: UHCCP Medicaid |
$152.93
|
| Rate for Payer: UMR Bronson Commercial |
$244.72
|
|
