|
PR CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 64617
|
| Min. Negotiated Rate |
$103.91 |
| Max. Negotiated Rate |
$209.30 |
| Rate for Payer: Aetna Commercial |
$139.24
|
| Rate for Payer: Aetna Medicare |
$108.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.24
|
| Rate for Payer: BCBS Complete |
$128.80
|
| Rate for Payer: BCBS MAPPO |
$103.91
|
| Rate for Payer: BCN Medicare Advantage |
$103.91
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$149.63
|
| Rate for Payer: Cofinity Commercial |
$139.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.11
|
| Rate for Payer: Nomi Health Commercial |
$124.69
|
| Rate for Payer: PACE SWMI |
$103.91
|
| Rate for Payer: PHP Commercial |
$145.47
|
| Rate for Payer: PHP Medicare Advantage |
$103.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health Medicare |
$103.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.91
|
| Rate for Payer: UHC Medicare Advantage |
$103.91
|
| Rate for Payer: UMR Bronson Commercial |
$148.12
|
|
|
PR CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
HCPCS 64616
|
| Min. Negotiated Rate |
$106.94 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Aetna Commercial |
$143.30
|
| Rate for Payer: Aetna Medicare |
$111.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.30
|
| Rate for Payer: BCBS Complete |
$144.40
|
| Rate for Payer: BCBS MAPPO |
$106.94
|
| Rate for Payer: BCN Medicare Advantage |
$106.94
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$153.99
|
| Rate for Payer: Cofinity Commercial |
$143.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.29
|
| Rate for Payer: Nomi Health Commercial |
$128.33
|
| Rate for Payer: PACE SWMI |
$106.94
|
| Rate for Payer: PHP Commercial |
$149.72
|
| Rate for Payer: PHP Medicare Advantage |
$106.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.65
|
| Rate for Payer: Priority Health Medicare |
$106.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.94
|
| Rate for Payer: UHC Medicare Advantage |
$106.94
|
| Rate for Payer: UMR Bronson Commercial |
$166.06
|
|
|
PR CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
HCPCS 64646
|
| Min. Negotiated Rate |
$113.15 |
| Max. Negotiated Rate |
$200.85 |
| Rate for Payer: Aetna Commercial |
$151.62
|
| Rate for Payer: Aetna Medicare |
$117.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.62
|
| Rate for Payer: BCBS Complete |
$123.60
|
| Rate for Payer: BCBS MAPPO |
$113.15
|
| Rate for Payer: BCN Medicare Advantage |
$113.15
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cofinity Commercial |
$162.94
|
| Rate for Payer: Cofinity Commercial |
$151.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.81
|
| Rate for Payer: Nomi Health Commercial |
$135.78
|
| Rate for Payer: PACE SWMI |
$113.15
|
| Rate for Payer: PHP Commercial |
$158.41
|
| Rate for Payer: PHP Medicare Advantage |
$113.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.85
|
| Rate for Payer: Priority Health Medicare |
$113.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.15
|
| Rate for Payer: UHC Medicare Advantage |
$113.15
|
| Rate for Payer: UMR Bronson Commercial |
$142.14
|
|
|
PR CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE
|
Professional
|
Both
|
$398.00
|
|
|
Service Code
|
HCPCS 64642
|
| Min. Negotiated Rate |
$103.24 |
| Max. Negotiated Rate |
$258.70 |
| Rate for Payer: Aetna Commercial |
$138.34
|
| Rate for Payer: Aetna Medicare |
$107.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.34
|
| Rate for Payer: BCBS Complete |
$159.20
|
| Rate for Payer: BCBS MAPPO |
$103.24
|
| Rate for Payer: BCN Medicare Advantage |
$103.24
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cofinity Commercial |
$148.67
|
| Rate for Payer: Cofinity Commercial |
$138.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.40
|
| Rate for Payer: Nomi Health Commercial |
$123.89
|
| Rate for Payer: PACE SWMI |
$103.24
|
| Rate for Payer: PHP Commercial |
$144.54
|
| Rate for Payer: PHP Medicare Advantage |
$103.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.70
|
| Rate for Payer: Priority Health Medicare |
$103.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.24
|
| Rate for Payer: UHC Medicare Advantage |
$103.24
|
| Rate for Payer: UMR Bronson Commercial |
$183.08
|
|
|
PR CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
HCPCS 64611
|
| Min. Negotiated Rate |
$85.60 |
| Max. Negotiated Rate |
$154.57 |
| Rate for Payer: Aetna Commercial |
$143.84
|
| Rate for Payer: Aetna Medicare |
$111.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.84
|
| Rate for Payer: BCBS Complete |
$85.60
|
| Rate for Payer: BCBS MAPPO |
$107.34
|
| Rate for Payer: BCN Medicare Advantage |
$107.34
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cofinity Commercial |
$154.57
|
| Rate for Payer: Cofinity Commercial |
$143.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.71
|
| Rate for Payer: Nomi Health Commercial |
$128.81
|
| Rate for Payer: PACE SWMI |
$107.34
|
| Rate for Payer: PHP Commercial |
$150.28
|
| Rate for Payer: PHP Medicare Advantage |
$107.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.10
|
| Rate for Payer: Priority Health Medicare |
$107.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.34
|
| Rate for Payer: UHC Medicare Advantage |
$107.34
|
| Rate for Payer: UMR Bronson Commercial |
$98.44
|
|
|
PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS 64615
|
| Min. Negotiated Rate |
$119.99 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$160.79
|
| Rate for Payer: Aetna Medicare |
$124.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.79
|
| Rate for Payer: BCBS Complete |
$167.20
|
| Rate for Payer: BCBS MAPPO |
$119.99
|
| Rate for Payer: BCN Medicare Advantage |
$119.99
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cofinity Commercial |
$172.79
|
| Rate for Payer: Cofinity Commercial |
$160.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.99
|
| Rate for Payer: Nomi Health Commercial |
$143.99
|
| Rate for Payer: PACE SWMI |
$119.99
|
| Rate for Payer: PHP Commercial |
$167.99
|
| Rate for Payer: PHP Medicare Advantage |
$119.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health Medicare |
$119.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.99
|
| Rate for Payer: UHC Medicare Advantage |
$119.99
|
| Rate for Payer: UMR Bronson Commercial |
$192.28
|
|
|
PR CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 64612
|
| Min. Negotiated Rate |
$112.60 |
| Max. Negotiated Rate |
$211.25 |
| Rate for Payer: Aetna Commercial |
$150.88
|
| Rate for Payer: Aetna Medicare |
$117.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.88
|
| Rate for Payer: BCBS Complete |
$130.00
|
| Rate for Payer: BCBS MAPPO |
$112.60
|
| Rate for Payer: BCN Medicare Advantage |
$112.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$162.14
|
| Rate for Payer: Cofinity Commercial |
$150.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.23
|
| Rate for Payer: Nomi Health Commercial |
$135.12
|
| Rate for Payer: PACE SWMI |
$112.60
|
| Rate for Payer: PHP Commercial |
$157.64
|
| Rate for Payer: PHP Medicare Advantage |
$112.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.25
|
| Rate for Payer: Priority Health Medicare |
$112.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.60
|
| Rate for Payer: UHC Medicare Advantage |
$112.60
|
| Rate for Payer: UMR Bronson Commercial |
$149.50
|
|
|
PR CHEMOTHERAPY ADMN IV INFUSION TQ EA HR
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 96415
|
| Min. Negotiated Rate |
$23.91 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Aetna Commercial |
$32.04
|
| Rate for Payer: Aetna Medicare |
$24.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.04
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: BCBS MAPPO |
$23.91
|
| Rate for Payer: BCN Medicare Advantage |
$23.91
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$34.43
|
| Rate for Payer: Cofinity Commercial |
$32.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.11
|
| Rate for Payer: Nomi Health Commercial |
$28.69
|
| Rate for Payer: PACE SWMI |
$23.91
|
| Rate for Payer: PHP Commercial |
$33.47
|
| Rate for Payer: PHP Medicare Advantage |
$23.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health Medicare |
$23.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.91
|
| Rate for Payer: UHC Medicare Advantage |
$23.91
|
| Rate for Payer: UMR Bronson Commercial |
$61.18
|
|
|
PR CHEMOTX ADMN CNS REQ SPINAL PUNCTURE
|
Professional
|
Both
|
$733.00
|
|
|
Service Code
|
HCPCS 96450
|
| Min. Negotiated Rate |
$73.16 |
| Max. Negotiated Rate |
$476.45 |
| Rate for Payer: Aetna Commercial |
$98.03
|
| Rate for Payer: Aetna Medicare |
$76.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.35
|
| Rate for Payer: BCBS Complete |
$293.20
|
| Rate for Payer: BCBS MAPPO |
$73.16
|
| Rate for Payer: BCN Medicare Advantage |
$73.16
|
| Rate for Payer: Cash Price |
$586.40
|
| Rate for Payer: Cash Price |
$586.40
|
| Rate for Payer: Cofinity Commercial |
$98.03
|
| Rate for Payer: Cofinity Commercial |
$105.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.82
|
| Rate for Payer: Nomi Health Commercial |
$87.79
|
| Rate for Payer: PACE SWMI |
$73.16
|
| Rate for Payer: PHP Commercial |
$102.42
|
| Rate for Payer: PHP Medicare Advantage |
$73.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.45
|
| Rate for Payer: Priority Health Medicare |
$73.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.16
|
| Rate for Payer: UHC Medicare Advantage |
$73.16
|
| Rate for Payer: UMR Bronson Commercial |
$337.18
|
|
|
PR CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 96417
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$85.80 |
| Rate for Payer: Aetna Commercial |
$73.02
|
| Rate for Payer: Aetna Medicare |
$56.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.02
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$54.49
|
| Rate for Payer: BCN Medicare Advantage |
$54.49
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$78.47
|
| Rate for Payer: Cofinity Commercial |
$73.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.21
|
| Rate for Payer: Nomi Health Commercial |
$65.39
|
| Rate for Payer: PACE SWMI |
$54.49
|
| Rate for Payer: PHP Commercial |
$76.29
|
| Rate for Payer: PHP Medicare Advantage |
$54.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health Medicare |
$54.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.49
|
| Rate for Payer: UHC Medicare Advantage |
$54.49
|
| Rate for Payer: UMR Bronson Commercial |
$60.72
|
|
|
PR CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS 96413
|
| Min. Negotiated Rate |
$99.20 |
| Max. Negotiated Rate |
$161.20 |
| Rate for Payer: Aetna Commercial |
$147.47
|
| Rate for Payer: Aetna Medicare |
$114.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.47
|
| Rate for Payer: BCBS Complete |
$99.20
|
| Rate for Payer: BCBS MAPPO |
$110.05
|
| Rate for Payer: BCN Medicare Advantage |
$110.05
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cofinity Commercial |
$158.47
|
| Rate for Payer: Cofinity Commercial |
$147.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.55
|
| Rate for Payer: Nomi Health Commercial |
$132.06
|
| Rate for Payer: PACE SWMI |
$110.05
|
| Rate for Payer: PHP Commercial |
$154.07
|
| Rate for Payer: PHP Medicare Advantage |
$110.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.20
|
| Rate for Payer: Priority Health Medicare |
$110.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.05
|
| Rate for Payer: UHC Medicare Advantage |
$110.05
|
| Rate for Payer: UMR Bronson Commercial |
$114.08
|
|
|
PR CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 96409
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$134.55 |
| Rate for Payer: Aetna Commercial |
$114.42
|
| Rate for Payer: Aetna Medicare |
$88.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.42
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: BCBS MAPPO |
$85.39
|
| Rate for Payer: BCN Medicare Advantage |
$85.39
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cofinity Commercial |
$122.96
|
| Rate for Payer: Cofinity Commercial |
$114.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.66
|
| Rate for Payer: Nomi Health Commercial |
$102.47
|
| Rate for Payer: PACE SWMI |
$85.39
|
| Rate for Payer: PHP Commercial |
$119.55
|
| Rate for Payer: PHP Medicare Advantage |
$85.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
| Rate for Payer: Priority Health Medicare |
$85.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.39
|
| Rate for Payer: UHC Medicare Advantage |
$85.39
|
| Rate for Payer: UMR Bronson Commercial |
$95.22
|
|
|
PR CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 96411
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$76.05 |
| Rate for Payer: Aetna Commercial |
$63.10
|
| Rate for Payer: Aetna Medicare |
$48.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.10
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS MAPPO |
$47.09
|
| Rate for Payer: BCN Medicare Advantage |
$47.09
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$67.81
|
| Rate for Payer: Cofinity Commercial |
$63.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.44
|
| Rate for Payer: Nomi Health Commercial |
$56.51
|
| Rate for Payer: PACE SWMI |
$47.09
|
| Rate for Payer: PHP Commercial |
$65.93
|
| Rate for Payer: PHP Medicare Advantage |
$47.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health Medicare |
$47.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.09
|
| Rate for Payer: UHC Medicare Advantage |
$47.09
|
| Rate for Payer: UMR Bronson Commercial |
$53.82
|
|
|
PR CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 96402
|
| Min. Negotiated Rate |
$32.54 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Aetna Commercial |
$43.60
|
| Rate for Payer: Aetna Medicare |
$33.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.60
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS MAPPO |
$32.54
|
| Rate for Payer: BCN Medicare Advantage |
$32.54
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$46.86
|
| Rate for Payer: Cofinity Commercial |
$43.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.17
|
| Rate for Payer: Nomi Health Commercial |
$39.05
|
| Rate for Payer: PACE SWMI |
$32.54
|
| Rate for Payer: PHP Commercial |
$45.56
|
| Rate for Payer: PHP Medicare Advantage |
$32.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
| Rate for Payer: Priority Health Medicare |
$32.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.54
|
| Rate for Payer: UHC Medicare Advantage |
$32.54
|
| Rate for Payer: UMR Bronson Commercial |
$38.18
|
|
|
PR CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 96401
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$88.34 |
| Rate for Payer: Aetna Commercial |
$82.21
|
| Rate for Payer: Aetna Medicare |
$63.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.21
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: BCBS MAPPO |
$61.35
|
| Rate for Payer: BCN Medicare Advantage |
$61.35
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cofinity Commercial |
$88.34
|
| Rate for Payer: Cofinity Commercial |
$82.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.42
|
| Rate for Payer: Nomi Health Commercial |
$73.62
|
| Rate for Payer: PACE SWMI |
$61.35
|
| Rate for Payer: PHP Commercial |
$85.89
|
| Rate for Payer: PHP Medicare Advantage |
$61.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.40
|
| Rate for Payer: Priority Health Medicare |
$61.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.35
|
| Rate for Payer: UHC Medicare Advantage |
$61.35
|
| Rate for Payer: UMR Bronson Commercial |
$53.36
|
|
|
PR CHEMOTX NJX SUBARACHND/INTRAVENTR RSVR 1/MULT
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
HCPCS 96542
|
| Min. Negotiated Rate |
$38.83 |
| Max. Negotiated Rate |
$184.60 |
| Rate for Payer: Aetna Commercial |
$52.03
|
| Rate for Payer: Aetna Medicare |
$40.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.03
|
| Rate for Payer: BCBS Complete |
$113.60
|
| Rate for Payer: BCBS MAPPO |
$38.83
|
| Rate for Payer: BCN Medicare Advantage |
$38.83
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cofinity Commercial |
$55.92
|
| Rate for Payer: Cofinity Commercial |
$52.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.77
|
| Rate for Payer: Nomi Health Commercial |
$46.60
|
| Rate for Payer: PACE SWMI |
$38.83
|
| Rate for Payer: PHP Commercial |
$54.36
|
| Rate for Payer: PHP Medicare Advantage |
$38.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.60
|
| Rate for Payer: Priority Health Medicare |
$38.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.83
|
| Rate for Payer: UHC Medicare Advantage |
$38.83
|
| Rate for Payer: UMR Bronson Commercial |
$130.64
|
|
|
PR CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 98941
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$45.92 |
| Rate for Payer: Aetna Commercial |
$42.73
|
| Rate for Payer: Aetna Medicare |
$33.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.73
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCBS MAPPO |
$31.89
|
| Rate for Payer: BCN Medicare Advantage |
$31.89
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$45.92
|
| Rate for Payer: Cofinity Commercial |
$42.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.48
|
| Rate for Payer: Nomi Health Commercial |
$38.27
|
| Rate for Payer: PACE SWMI |
$31.89
|
| Rate for Payer: PHP Commercial |
$44.65
|
| Rate for Payer: PHP Medicare Advantage |
$31.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.30
|
| Rate for Payer: Priority Health Medicare |
$31.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.89
|
| Rate for Payer: UHC Medicare Advantage |
$31.89
|
| Rate for Payer: UMR Bronson Commercial |
$28.52
|
|
|
PR CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 50688
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$106.29 |
| Rate for Payer: Aetna Commercial |
$98.91
|
| Rate for Payer: Aetna Medicare |
$76.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.29
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS MAPPO |
$73.81
|
| Rate for Payer: BCN Medicare Advantage |
$73.81
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$98.91
|
| Rate for Payer: Cofinity Commercial |
$106.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.50
|
| Rate for Payer: Nomi Health Commercial |
$88.57
|
| Rate for Payer: PACE SWMI |
$73.81
|
| Rate for Payer: PHP Commercial |
$103.33
|
| Rate for Payer: PHP Medicare Advantage |
$73.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
| Rate for Payer: Priority Health Medicare |
$73.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.81
|
| Rate for Payer: UHC Medicare Advantage |
$73.81
|
| Rate for Payer: UMR Bronson Commercial |
$69.00
|
|
|
PR CHOLECSTC EXPL DUX SPHNCTROTOMY/SPHNCTROP
|
Professional
|
Both
|
$2,120.00
|
|
|
Service Code
|
HCPCS 47620
|
| Min. Negotiated Rate |
$848.00 |
| Max. Negotiated Rate |
$1,924.56 |
| Rate for Payer: Aetna Commercial |
$1,790.91
|
| Rate for Payer: Aetna Medicare |
$1,389.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,924.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,790.91
|
| Rate for Payer: BCBS Complete |
$848.00
|
| Rate for Payer: BCBS MAPPO |
$1,336.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,336.50
|
| Rate for Payer: Cash Price |
$1,696.00
|
| Rate for Payer: Cash Price |
$1,696.00
|
| Rate for Payer: Cofinity Commercial |
$1,924.56
|
| Rate for Payer: Cofinity Commercial |
$1,790.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,336.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,403.33
|
| Rate for Payer: Nomi Health Commercial |
$1,603.80
|
| Rate for Payer: PACE SWMI |
$1,336.50
|
| Rate for Payer: PHP Commercial |
$1,871.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,336.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,378.00
|
| Rate for Payer: Priority Health Medicare |
$1,336.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,336.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,336.50
|
| Rate for Payer: UMR Bronson Commercial |
$975.20
|
|
|
PR CHOLECSTONTRSTM ROUX-EN-Y W/GASTRONTRSTM
|
Professional
|
Both
|
$2,644.00
|
|
|
Service Code
|
HCPCS 47741
|
| Min. Negotiated Rate |
$1,057.60 |
| Max. Negotiated Rate |
$2,063.10 |
| Rate for Payer: Aetna Commercial |
$1,919.83
|
| Rate for Payer: Aetna Medicare |
$1,490.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,063.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,919.83
|
| Rate for Payer: BCBS Complete |
$1,057.60
|
| Rate for Payer: BCBS MAPPO |
$1,432.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,432.71
|
| Rate for Payer: Cash Price |
$2,115.20
|
| Rate for Payer: Cash Price |
$2,115.20
|
| Rate for Payer: Cofinity Commercial |
$2,063.10
|
| Rate for Payer: Cofinity Commercial |
$1,919.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,432.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,504.35
|
| Rate for Payer: Nomi Health Commercial |
$1,719.25
|
| Rate for Payer: PACE SWMI |
$1,432.71
|
| Rate for Payer: PHP Commercial |
$2,005.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,432.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,718.60
|
| Rate for Payer: Priority Health Medicare |
$1,432.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,432.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,432.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,216.24
|
|
|
PR CHOLECSTOT/CHOLECSTOST W/EXPL DRG/RMVL ST1 SPX
|
Professional
|
Both
|
$2,623.00
|
|
|
Service Code
|
HCPCS 47480
|
| Min. Negotiated Rate |
$849.48 |
| Max. Negotiated Rate |
$1,704.95 |
| Rate for Payer: Aetna Commercial |
$1,138.30
|
| Rate for Payer: Aetna Medicare |
$883.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,223.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,138.30
|
| Rate for Payer: BCBS Complete |
$1,049.20
|
| Rate for Payer: BCBS MAPPO |
$849.48
|
| Rate for Payer: BCN Medicare Advantage |
$849.48
|
| Rate for Payer: Cash Price |
$2,098.40
|
| Rate for Payer: Cash Price |
$2,098.40
|
| Rate for Payer: Cofinity Commercial |
$1,223.25
|
| Rate for Payer: Cofinity Commercial |
$1,138.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$849.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$891.95
|
| Rate for Payer: Nomi Health Commercial |
$1,019.38
|
| Rate for Payer: PACE SWMI |
$849.48
|
| Rate for Payer: PHP Commercial |
$1,189.27
|
| Rate for Payer: PHP Medicare Advantage |
$849.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,704.95
|
| Rate for Payer: Priority Health Medicare |
$849.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$849.48
|
| Rate for Payer: UHC Medicare Advantage |
$849.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,206.58
|
|
|
PR CHOLECYSTECTOMY
|
Facility
|
OP
|
$2,617.00
|
|
|
Service Code
|
CPT 47600
|
| Hospital Charge Code |
47600
|
| Min. Negotiated Rate |
$968.29 |
| Max. Negotiated Rate |
$2,355.30 |
| Rate for Payer: Aetna American Axle |
$1,701.05
|
| Rate for Payer: Aetna Commercial |
$2,224.45
|
| Rate for Payer: Aetna Medicare |
$1,308.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,701.05
|
| Rate for Payer: BCBS Complete |
$1,046.80
|
| Rate for Payer: Cash Price |
$2,093.60
|
| Rate for Payer: Cofinity Commercial |
$1,831.90
|
| Rate for Payer: Cofinity Commercial |
$2,250.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,831.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,093.60
|
| Rate for Payer: Healthscope Commercial |
$2,355.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,831.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,962.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,224.45
|
| Rate for Payer: PHP Commercial |
$2,224.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,701.05
|
| Rate for Payer: Priority Health SBD |
$1,648.71
|
| Rate for Payer: UMR Bronson Commercial |
$968.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,962.75
|
|
|
PR CHOLECYSTECTOMY
|
Professional
|
Both
|
$2,617.00
|
|
|
Service Code
|
HCPCS 47600
|
| Min. Negotiated Rate |
$1,041.60 |
| Max. Negotiated Rate |
$1,701.05 |
| Rate for Payer: Aetna Commercial |
$1,395.74
|
| Rate for Payer: Aetna Medicare |
$1,083.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,499.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,395.74
|
| Rate for Payer: BCBS Complete |
$1,046.80
|
| Rate for Payer: BCBS MAPPO |
$1,041.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,041.60
|
| Rate for Payer: Cash Price |
$2,093.60
|
| Rate for Payer: Cash Price |
$2,093.60
|
| Rate for Payer: Cofinity Commercial |
$1,499.90
|
| Rate for Payer: Cofinity Commercial |
$1,395.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,041.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,093.68
|
| Rate for Payer: Nomi Health Commercial |
$1,249.92
|
| Rate for Payer: PACE SWMI |
$1,041.60
|
| Rate for Payer: PHP Commercial |
$1,458.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,041.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,701.05
|
| Rate for Payer: Priority Health Medicare |
$1,041.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,041.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,041.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,203.82
|
|
|
PR CHOLECYSTECTOMY
|
Facility
|
IP
|
$2,617.00
|
|
|
Service Code
|
CPT 47600
|
| Hospital Charge Code |
47600
|
| Min. Negotiated Rate |
$1,151.48 |
| Max. Negotiated Rate |
$2,355.30 |
| Rate for Payer: Aetna American Axle |
$1,701.05
|
| Rate for Payer: Aetna Commercial |
$2,224.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,701.05
|
| Rate for Payer: Cash Price |
$2,093.60
|
| Rate for Payer: Cofinity Commercial |
$1,831.90
|
| Rate for Payer: Cofinity Commercial |
$2,250.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,831.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,093.60
|
| Rate for Payer: Healthscope Commercial |
$2,355.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,831.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,962.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,224.45
|
| Rate for Payer: PHP Commercial |
$2,224.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,701.05
|
| Rate for Payer: Priority Health SBD |
$1,648.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,151.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,962.75
|
|
|
PR CHOLECYSTECTOMY
|
Professional
|
Both
|
$2,617.00
|
|
|
Service Code
|
HCPCS 47600
|
| Hospital Charge Code |
47600
|
| Min. Negotiated Rate |
$1,041.60 |
| Max. Negotiated Rate |
$1,701.05 |
| Rate for Payer: Aetna Commercial |
$1,395.74
|
| Rate for Payer: Aetna Medicare |
$1,083.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,499.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,395.74
|
| Rate for Payer: BCBS Complete |
$1,046.80
|
| Rate for Payer: BCBS MAPPO |
$1,041.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,041.60
|
| Rate for Payer: Cash Price |
$2,093.60
|
| Rate for Payer: Cash Price |
$2,093.60
|
| Rate for Payer: Cofinity Commercial |
$1,395.74
|
| Rate for Payer: Cofinity Commercial |
$1,499.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,041.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,093.68
|
| Rate for Payer: Nomi Health Commercial |
$1,249.92
|
| Rate for Payer: PACE SWMI |
$1,041.60
|
| Rate for Payer: PHP Commercial |
$1,458.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,041.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,701.05
|
| Rate for Payer: Priority Health Medicare |
$1,041.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,041.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,041.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,203.82
|
|
