|
PR CLOSURE CYSTOSTOMY SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 51880
|
| Min. Negotiated Rate |
$444.82 |
| Max. Negotiated Rate |
$923.00 |
| Rate for Payer: Aetna Commercial |
$596.06
|
| Rate for Payer: Aetna Medicare |
$462.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$640.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$596.06
|
| Rate for Payer: BCBS Complete |
$568.00
|
| Rate for Payer: BCBS MAPPO |
$444.82
|
| Rate for Payer: BCN Medicare Advantage |
$444.82
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$640.54
|
| Rate for Payer: Cofinity Commercial |
$596.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.06
|
| Rate for Payer: Nomi Health Commercial |
$533.78
|
| Rate for Payer: PACE SWMI |
$444.82
|
| Rate for Payer: PHP Commercial |
$622.75
|
| Rate for Payer: PHP Medicare Advantage |
$444.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.00
|
| Rate for Payer: Priority Health Medicare |
$444.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$444.82
|
| Rate for Payer: UHC Medicare Advantage |
$444.82
|
| Rate for Payer: UMR Bronson Commercial |
$653.20
|
|
|
PR CLOSURE ENTEROSTOMY LG/SMALL INTESTINE
|
Professional
|
Both
|
$2,261.00
|
|
|
Service Code
|
HCPCS 44620
|
| Min. Negotiated Rate |
$832.71 |
| Max. Negotiated Rate |
$1,469.65 |
| Rate for Payer: Aetna Commercial |
$1,115.83
|
| Rate for Payer: Aetna Medicare |
$866.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,199.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,115.83
|
| Rate for Payer: BCBS Complete |
$904.40
|
| Rate for Payer: BCBS MAPPO |
$832.71
|
| Rate for Payer: BCN Medicare Advantage |
$832.71
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cofinity Commercial |
$1,199.10
|
| Rate for Payer: Cofinity Commercial |
$1,115.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$832.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$874.35
|
| Rate for Payer: Nomi Health Commercial |
$999.25
|
| Rate for Payer: PACE SWMI |
$832.71
|
| Rate for Payer: PHP Commercial |
$1,165.79
|
| Rate for Payer: PHP Medicare Advantage |
$832.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,469.65
|
| Rate for Payer: Priority Health Medicare |
$832.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$832.71
|
| Rate for Payer: UHC Medicare Advantage |
$832.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,040.06
|
|
|
PR CLOSURE GASTROCOLIC FISTULA
|
Professional
|
Both
|
$3,893.00
|
|
|
Service Code
|
HCPCS 43880
|
| Min. Negotiated Rate |
$1,557.20 |
| Max. Negotiated Rate |
$2,530.45 |
| Rate for Payer: Aetna Commercial |
$2,095.77
|
| Rate for Payer: Aetna Medicare |
$1,626.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,252.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,095.77
|
| Rate for Payer: BCBS Complete |
$1,557.20
|
| Rate for Payer: BCBS MAPPO |
$1,564.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,564.01
|
| Rate for Payer: Cash Price |
$3,114.40
|
| Rate for Payer: Cash Price |
$3,114.40
|
| Rate for Payer: Cofinity Commercial |
$2,252.17
|
| Rate for Payer: Cofinity Commercial |
$2,095.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,564.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,642.21
|
| Rate for Payer: Nomi Health Commercial |
$1,876.81
|
| Rate for Payer: PACE SWMI |
$1,564.01
|
| Rate for Payer: PHP Commercial |
$2,189.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,564.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,530.45
|
| Rate for Payer: Priority Health Medicare |
$1,564.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,564.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,564.01
|
| Rate for Payer: UMR Bronson Commercial |
$1,790.78
|
|
|
PR CLOSURE GASTROSTOMY SURG
|
Professional
|
Both
|
$1,955.00
|
|
|
Service Code
|
HCPCS 43870
|
| Min. Negotiated Rate |
$687.43 |
| Max. Negotiated Rate |
$1,270.75 |
| Rate for Payer: Aetna Commercial |
$921.16
|
| Rate for Payer: Aetna Medicare |
$714.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$989.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.16
|
| Rate for Payer: BCBS Complete |
$782.00
|
| Rate for Payer: BCBS MAPPO |
$687.43
|
| Rate for Payer: BCN Medicare Advantage |
$687.43
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cofinity Commercial |
$989.90
|
| Rate for Payer: Cofinity Commercial |
$921.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$687.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$721.80
|
| Rate for Payer: Nomi Health Commercial |
$824.92
|
| Rate for Payer: PACE SWMI |
$687.43
|
| Rate for Payer: PHP Commercial |
$962.40
|
| Rate for Payer: PHP Medicare Advantage |
$687.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,270.75
|
| Rate for Payer: Priority Health Medicare |
$687.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$687.43
|
| Rate for Payer: UHC Medicare Advantage |
$687.43
|
| Rate for Payer: UMR Bronson Commercial |
$899.30
|
|
|
PR CLOSURE INTESTINAL CUTANEOUS FISTULA
|
Professional
|
Both
|
$2,546.00
|
|
|
Service Code
|
HCPCS 44640
|
| Min. Negotiated Rate |
$1,018.40 |
| Max. Negotiated Rate |
$1,940.73 |
| Rate for Payer: Aetna Commercial |
$1,805.96
|
| Rate for Payer: Aetna Medicare |
$1,401.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,940.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,805.96
|
| Rate for Payer: BCBS Complete |
$1,018.40
|
| Rate for Payer: BCBS MAPPO |
$1,347.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,347.73
|
| Rate for Payer: Cash Price |
$2,036.80
|
| Rate for Payer: Cash Price |
$2,036.80
|
| Rate for Payer: Cofinity Commercial |
$1,940.73
|
| Rate for Payer: Cofinity Commercial |
$1,805.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,347.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,415.12
|
| Rate for Payer: Nomi Health Commercial |
$1,617.28
|
| Rate for Payer: PACE SWMI |
$1,347.73
|
| Rate for Payer: PHP Commercial |
$1,886.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,347.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,654.90
|
| Rate for Payer: Priority Health Medicare |
$1,347.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,347.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,347.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,171.16
|
|
|
PR CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<
|
Professional
|
Both
|
$537.00
|
|
|
Service Code
|
HCPCS 40830
|
| Min. Negotiated Rate |
$138.15 |
| Max. Negotiated Rate |
$349.05 |
| Rate for Payer: Aetna Commercial |
$185.12
|
| Rate for Payer: Aetna Medicare |
$143.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.12
|
| Rate for Payer: BCBS Complete |
$214.80
|
| Rate for Payer: BCBS MAPPO |
$138.15
|
| Rate for Payer: BCN Medicare Advantage |
$138.15
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cofinity Commercial |
$198.94
|
| Rate for Payer: Cofinity Commercial |
$185.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.06
|
| Rate for Payer: Nomi Health Commercial |
$165.78
|
| Rate for Payer: PACE SWMI |
$138.15
|
| Rate for Payer: PHP Commercial |
$193.41
|
| Rate for Payer: PHP Medicare Advantage |
$138.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.05
|
| Rate for Payer: Priority Health Medicare |
$138.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.15
|
| Rate for Payer: UHC Medicare Advantage |
$138.15
|
| Rate for Payer: UMR Bronson Commercial |
$247.02
|
|
|
PR CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 40831
|
| Min. Negotiated Rate |
$191.08 |
| Max. Negotiated Rate |
$449.15 |
| Rate for Payer: Aetna Commercial |
$256.05
|
| Rate for Payer: Aetna Medicare |
$198.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.05
|
| Rate for Payer: BCBS Complete |
$276.40
|
| Rate for Payer: BCBS MAPPO |
$191.08
|
| Rate for Payer: BCN Medicare Advantage |
$191.08
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cofinity Commercial |
$275.16
|
| Rate for Payer: Cofinity Commercial |
$256.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.63
|
| Rate for Payer: Nomi Health Commercial |
$229.30
|
| Rate for Payer: PACE SWMI |
$191.08
|
| Rate for Payer: PHP Commercial |
$267.51
|
| Rate for Payer: PHP Medicare Advantage |
$191.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.15
|
| Rate for Payer: Priority Health Medicare |
$191.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.08
|
| Rate for Payer: UHC Medicare Advantage |
$191.08
|
| Rate for Payer: UMR Bronson Commercial |
$317.86
|
|
|
PR CLOSURE RECTOURETHRAL FISTULA
|
Professional
|
Both
|
$3,283.00
|
|
|
Service Code
|
HCPCS 45820
|
| Min. Negotiated Rate |
$1,237.34 |
| Max. Negotiated Rate |
$2,133.95 |
| Rate for Payer: Aetna Commercial |
$1,658.04
|
| Rate for Payer: Aetna Medicare |
$1,286.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,781.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,658.04
|
| Rate for Payer: BCBS Complete |
$1,313.20
|
| Rate for Payer: BCBS MAPPO |
$1,237.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,237.34
|
| Rate for Payer: Cash Price |
$2,626.40
|
| Rate for Payer: Cash Price |
$2,626.40
|
| Rate for Payer: Cofinity Commercial |
$1,781.77
|
| Rate for Payer: Cofinity Commercial |
$1,658.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,237.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,299.21
|
| Rate for Payer: Nomi Health Commercial |
$1,484.81
|
| Rate for Payer: PACE SWMI |
$1,237.34
|
| Rate for Payer: PHP Commercial |
$1,732.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,237.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,133.95
|
| Rate for Payer: Priority Health Medicare |
$1,237.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,237.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,237.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,510.18
|
|
|
PR CLOSURE RECTOVESICAL FISTULA
|
Professional
|
Both
|
$2,859.00
|
|
|
Service Code
|
HCPCS 45800
|
| Min. Negotiated Rate |
$1,143.60 |
| Max. Negotiated Rate |
$1,858.35 |
| Rate for Payer: Aetna Commercial |
$1,654.14
|
| Rate for Payer: Aetna Medicare |
$1,283.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,777.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,654.14
|
| Rate for Payer: BCBS Complete |
$1,143.60
|
| Rate for Payer: BCBS MAPPO |
$1,234.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,234.43
|
| Rate for Payer: Cash Price |
$2,287.20
|
| Rate for Payer: Cash Price |
$2,287.20
|
| Rate for Payer: Cofinity Commercial |
$1,777.58
|
| Rate for Payer: Cofinity Commercial |
$1,654.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,234.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,296.15
|
| Rate for Payer: Nomi Health Commercial |
$1,481.32
|
| Rate for Payer: PACE SWMI |
$1,234.43
|
| Rate for Payer: PHP Commercial |
$1,728.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,234.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,858.35
|
| Rate for Payer: Priority Health Medicare |
$1,234.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,234.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,234.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,315.14
|
|
|
PR CLOSURE SALIVARY FISTULA
|
Professional
|
Both
|
$818.00
|
|
|
Service Code
|
HCPCS 42600
|
| Min. Negotiated Rate |
$327.20 |
| Max. Negotiated Rate |
$531.70 |
| Rate for Payer: Aetna Commercial |
$455.55
|
| Rate for Payer: Aetna Medicare |
$353.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$489.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.55
|
| Rate for Payer: BCBS Complete |
$327.20
|
| Rate for Payer: BCBS MAPPO |
$339.96
|
| Rate for Payer: BCN Medicare Advantage |
$339.96
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cofinity Commercial |
$489.54
|
| Rate for Payer: Cofinity Commercial |
$455.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.96
|
| Rate for Payer: Nomi Health Commercial |
$407.95
|
| Rate for Payer: PACE SWMI |
$339.96
|
| Rate for Payer: PHP Commercial |
$475.94
|
| Rate for Payer: PHP Medicare Advantage |
$339.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.70
|
| Rate for Payer: Priority Health Medicare |
$339.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.96
|
| Rate for Payer: UHC Medicare Advantage |
$339.96
|
| Rate for Payer: UMR Bronson Commercial |
$376.28
|
|
|
PR CLOSURE VESICOVAGINAL FISTULA VAGINAL APPROACH
|
Professional
|
Both
|
$963.00
|
|
|
Service Code
|
HCPCS 57320
|
| Min. Negotiated Rate |
$385.20 |
| Max. Negotiated Rate |
$776.55 |
| Rate for Payer: Aetna Commercial |
$722.62
|
| Rate for Payer: Aetna Medicare |
$560.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$776.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$722.62
|
| Rate for Payer: BCBS Complete |
$385.20
|
| Rate for Payer: BCBS MAPPO |
$539.27
|
| Rate for Payer: BCN Medicare Advantage |
$539.27
|
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Cofinity Commercial |
$776.55
|
| Rate for Payer: Cofinity Commercial |
$722.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$539.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$566.23
|
| Rate for Payer: Nomi Health Commercial |
$647.12
|
| Rate for Payer: PACE SWMI |
$539.27
|
| Rate for Payer: PHP Commercial |
$754.98
|
| Rate for Payer: PHP Medicare Advantage |
$539.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$625.95
|
| Rate for Payer: Priority Health Medicare |
$539.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$539.27
|
| Rate for Payer: UHC Medicare Advantage |
$539.27
|
| Rate for Payer: UMR Bronson Commercial |
$442.98
|
|
|
PR CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION
|
Professional
|
Both
|
$598.00
|
|
|
Service Code
|
HCPCS 23540
|
| Min. Negotiated Rate |
$231.66 |
| Max. Negotiated Rate |
$388.70 |
| Rate for Payer: Aetna Commercial |
$310.42
|
| Rate for Payer: Aetna Medicare |
$240.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.42
|
| Rate for Payer: BCBS Complete |
$239.20
|
| Rate for Payer: BCBS MAPPO |
$231.66
|
| Rate for Payer: BCN Medicare Advantage |
$231.66
|
| Rate for Payer: Cash Price |
$478.40
|
| Rate for Payer: Cash Price |
$478.40
|
| Rate for Payer: Cofinity Commercial |
$333.59
|
| Rate for Payer: Cofinity Commercial |
$310.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.24
|
| Rate for Payer: Nomi Health Commercial |
$277.99
|
| Rate for Payer: PACE SWMI |
$231.66
|
| Rate for Payer: PHP Commercial |
$324.32
|
| Rate for Payer: PHP Medicare Advantage |
$231.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.70
|
| Rate for Payer: Priority Health Medicare |
$231.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.66
|
| Rate for Payer: UHC Medicare Advantage |
$231.66
|
| Rate for Payer: UMR Bronson Commercial |
$275.08
|
|
|
PR CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
HCPCS 23500
|
| Min. Negotiated Rate |
$206.40 |
| Max. Negotiated Rate |
$335.40 |
| Rate for Payer: Aetna Commercial |
$302.12
|
| Rate for Payer: Aetna Medicare |
$234.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.12
|
| Rate for Payer: BCBS Complete |
$206.40
|
| Rate for Payer: BCBS MAPPO |
$225.46
|
| Rate for Payer: BCN Medicare Advantage |
$225.46
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$324.66
|
| Rate for Payer: Cofinity Commercial |
$302.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$236.73
|
| Rate for Payer: Nomi Health Commercial |
$270.55
|
| Rate for Payer: PACE SWMI |
$225.46
|
| Rate for Payer: PHP Commercial |
$315.64
|
| Rate for Payer: PHP Medicare Advantage |
$225.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.40
|
| Rate for Payer: Priority Health Medicare |
$225.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.46
|
| Rate for Payer: UHC Medicare Advantage |
$225.46
|
| Rate for Payer: UMR Bronson Commercial |
$237.36
|
|
|
PR CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$844.00
|
|
|
Service Code
|
HCPCS 24500
|
| Min. Negotiated Rate |
$326.97 |
| Max. Negotiated Rate |
$548.60 |
| Rate for Payer: Aetna Commercial |
$438.14
|
| Rate for Payer: Aetna Medicare |
$340.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$470.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.14
|
| Rate for Payer: BCBS Complete |
$337.60
|
| Rate for Payer: BCBS MAPPO |
$326.97
|
| Rate for Payer: BCN Medicare Advantage |
$326.97
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cofinity Commercial |
$470.84
|
| Rate for Payer: Cofinity Commercial |
$438.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.32
|
| Rate for Payer: Nomi Health Commercial |
$392.36
|
| Rate for Payer: PACE SWMI |
$326.97
|
| Rate for Payer: PHP Commercial |
$457.76
|
| Rate for Payer: PHP Medicare Advantage |
$326.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$548.60
|
| Rate for Payer: Priority Health Medicare |
$326.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$326.97
|
| Rate for Payer: UHC Medicare Advantage |
$326.97
|
| Rate for Payer: UMR Bronson Commercial |
$388.24
|
|
|
PR CLSD TX PELVIC RING FX W/MANIPULATION W/ANES
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS 27198
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$438.88 |
| Rate for Payer: Aetna Commercial |
$408.41
|
| Rate for Payer: Aetna Medicare |
$316.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.41
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: BCBS MAPPO |
$304.78
|
| Rate for Payer: BCN Medicare Advantage |
$304.78
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$438.88
|
| Rate for Payer: Cofinity Commercial |
$408.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$304.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.02
|
| Rate for Payer: Nomi Health Commercial |
$365.74
|
| Rate for Payer: PACE SWMI |
$304.78
|
| Rate for Payer: PHP Commercial |
$426.69
|
| Rate for Payer: PHP Medicare Advantage |
$304.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health Medicare |
$304.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$304.78
|
| Rate for Payer: UHC Medicare Advantage |
$304.78
|
| Rate for Payer: UMR Bronson Commercial |
$211.14
|
|
|
PR CLSD TX PELVIC RING FX W/O MANIPULATION
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
HCPCS 27197
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$180.89 |
| Rate for Payer: Aetna Commercial |
$168.33
|
| Rate for Payer: Aetna Medicare |
$130.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.33
|
| Rate for Payer: BCBS Complete |
$94.40
|
| Rate for Payer: BCBS MAPPO |
$125.62
|
| Rate for Payer: BCN Medicare Advantage |
$125.62
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cofinity Commercial |
$180.89
|
| Rate for Payer: Cofinity Commercial |
$168.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.90
|
| Rate for Payer: Nomi Health Commercial |
$150.74
|
| Rate for Payer: PACE SWMI |
$125.62
|
| Rate for Payer: PHP Commercial |
$175.87
|
| Rate for Payer: PHP Medicare Advantage |
$125.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.40
|
| Rate for Payer: Priority Health Medicare |
$125.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.62
|
| Rate for Payer: UHC Medicare Advantage |
$125.62
|
| Rate for Payer: UMR Bronson Commercial |
$108.56
|
|
|
PR CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 23655
|
| Min. Negotiated Rate |
$395.87 |
| Max. Negotiated Rate |
$670.15 |
| Rate for Payer: Aetna Commercial |
$530.47
|
| Rate for Payer: Aetna Medicare |
$411.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$530.47
|
| Rate for Payer: BCBS Complete |
$412.40
|
| Rate for Payer: BCBS MAPPO |
$395.87
|
| Rate for Payer: BCN Medicare Advantage |
$395.87
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cofinity Commercial |
$570.05
|
| Rate for Payer: Cofinity Commercial |
$530.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$395.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$415.66
|
| Rate for Payer: Nomi Health Commercial |
$475.04
|
| Rate for Payer: PACE SWMI |
$395.87
|
| Rate for Payer: PHP Commercial |
$554.22
|
| Rate for Payer: PHP Medicare Advantage |
$395.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.15
|
| Rate for Payer: Priority Health Medicare |
$395.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$395.87
|
| Rate for Payer: UHC Medicare Advantage |
$395.87
|
| Rate for Payer: UMR Bronson Commercial |
$474.26
|
|
|
PR CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
HCPCS 23650
|
| Min. Negotiated Rate |
$277.60 |
| Max. Negotiated Rate |
$451.10 |
| Rate for Payer: Aetna Commercial |
$397.31
|
| Rate for Payer: Aetna Medicare |
$308.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.31
|
| Rate for Payer: BCBS Complete |
$277.60
|
| Rate for Payer: BCBS MAPPO |
$296.50
|
| Rate for Payer: BCN Medicare Advantage |
$296.50
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cofinity Commercial |
$426.96
|
| Rate for Payer: Cofinity Commercial |
$397.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.32
|
| Rate for Payer: Nomi Health Commercial |
$355.80
|
| Rate for Payer: PACE SWMI |
$296.50
|
| Rate for Payer: PHP Commercial |
$415.10
|
| Rate for Payer: PHP Medicare Advantage |
$296.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$451.10
|
| Rate for Payer: Priority Health Medicare |
$296.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.50
|
| Rate for Payer: UHC Medicare Advantage |
$296.50
|
| Rate for Payer: UMR Bronson Commercial |
$319.24
|
|
|
PR CLSR ANAL FSTL W/RCT ADVMNT FLAP
|
Professional
|
Both
|
$1,678.00
|
|
|
Service Code
|
HCPCS 46288
|
| Min. Negotiated Rate |
$535.63 |
| Max. Negotiated Rate |
$1,090.70 |
| Rate for Payer: Aetna Commercial |
$717.74
|
| Rate for Payer: Aetna Medicare |
$557.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$771.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.74
|
| Rate for Payer: BCBS Complete |
$671.20
|
| Rate for Payer: BCBS MAPPO |
$535.63
|
| Rate for Payer: BCN Medicare Advantage |
$535.63
|
| Rate for Payer: Cash Price |
$1,342.40
|
| Rate for Payer: Cash Price |
$1,342.40
|
| Rate for Payer: Cofinity Commercial |
$771.31
|
| Rate for Payer: Cofinity Commercial |
$717.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$535.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$562.41
|
| Rate for Payer: Nomi Health Commercial |
$642.76
|
| Rate for Payer: PACE SWMI |
$535.63
|
| Rate for Payer: PHP Commercial |
$749.88
|
| Rate for Payer: PHP Medicare Advantage |
$535.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.70
|
| Rate for Payer: Priority Health Medicare |
$535.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$535.63
|
| Rate for Payer: UHC Medicare Advantage |
$535.63
|
| Rate for Payer: UMR Bronson Commercial |
$771.88
|
|
|
PR CLSR CH WALL FLWG OPN FLAP DRG EMPYEMA
|
Professional
|
Both
|
$1,872.00
|
|
|
Service Code
|
HCPCS 32810
|
| Min. Negotiated Rate |
$748.80 |
| Max. Negotiated Rate |
$1,248.41 |
| Rate for Payer: Aetna Commercial |
$1,161.71
|
| Rate for Payer: Aetna Medicare |
$901.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,248.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,161.71
|
| Rate for Payer: BCBS Complete |
$748.80
|
| Rate for Payer: BCBS MAPPO |
$866.95
|
| Rate for Payer: BCN Medicare Advantage |
$866.95
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cofinity Commercial |
$1,248.41
|
| Rate for Payer: Cofinity Commercial |
$1,161.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$866.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$910.30
|
| Rate for Payer: Nomi Health Commercial |
$1,040.34
|
| Rate for Payer: PACE SWMI |
$866.95
|
| Rate for Payer: PHP Commercial |
$1,213.73
|
| Rate for Payer: PHP Medicare Advantage |
$866.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,216.80
|
| Rate for Payer: Priority Health Medicare |
$866.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$866.95
|
| Rate for Payer: UHC Medicare Advantage |
$866.95
|
| Rate for Payer: UMR Bronson Commercial |
$861.12
|
|
|
PR CLSR ENTEROENTERIC/ENTEROCOLIC FSTL
|
Professional
|
Both
|
$2,579.00
|
|
|
Service Code
|
HCPCS 44650
|
| Min. Negotiated Rate |
$1,031.60 |
| Max. Negotiated Rate |
$1,995.39 |
| Rate for Payer: Aetna Commercial |
$1,856.82
|
| Rate for Payer: Aetna Medicare |
$1,441.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,995.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,856.82
|
| Rate for Payer: BCBS Complete |
$1,031.60
|
| Rate for Payer: BCBS MAPPO |
$1,385.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,385.69
|
| Rate for Payer: Cash Price |
$2,063.20
|
| Rate for Payer: Cash Price |
$2,063.20
|
| Rate for Payer: Cofinity Commercial |
$1,995.39
|
| Rate for Payer: Cofinity Commercial |
$1,856.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,385.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,454.97
|
| Rate for Payer: Nomi Health Commercial |
$1,662.83
|
| Rate for Payer: PACE SWMI |
$1,385.69
|
| Rate for Payer: PHP Commercial |
$1,939.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,385.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,676.35
|
| Rate for Payer: Priority Health Medicare |
$1,385.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,385.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,385.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,186.34
|
|
|
PR CLSR ENTEROVES FSTL W/INTESTINE&/BLADDER RESCJ
|
Professional
|
Both
|
$3,576.00
|
|
|
Service Code
|
HCPCS 44661
|
| Min. Negotiated Rate |
$1,430.40 |
| Max. Negotiated Rate |
$2,324.40 |
| Rate for Payer: Aetna Commercial |
$1,995.19
|
| Rate for Payer: Aetna Medicare |
$1,548.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,144.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,995.19
|
| Rate for Payer: BCBS Complete |
$1,430.40
|
| Rate for Payer: BCBS MAPPO |
$1,488.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,488.95
|
| Rate for Payer: Cash Price |
$2,860.80
|
| Rate for Payer: Cash Price |
$2,860.80
|
| Rate for Payer: Cofinity Commercial |
$2,144.09
|
| Rate for Payer: Cofinity Commercial |
$1,995.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,488.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,563.40
|
| Rate for Payer: Nomi Health Commercial |
$1,786.74
|
| Rate for Payer: PACE SWMI |
$1,488.95
|
| Rate for Payer: PHP Commercial |
$2,084.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,488.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,324.40
|
| Rate for Payer: Priority Health Medicare |
$1,488.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,488.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,488.95
|
| Rate for Payer: UMR Bronson Commercial |
$1,644.96
|
|
|
PR CLSR ENTEROVES FSTL W/O INTSTINAL/BLADDER RESCJ
|
Professional
|
Both
|
$2,662.00
|
|
|
Service Code
|
HCPCS 44660
|
| Min. Negotiated Rate |
$1,064.80 |
| Max. Negotiated Rate |
$1,856.22 |
| Rate for Payer: Aetna Commercial |
$1,727.31
|
| Rate for Payer: Aetna Medicare |
$1,340.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,856.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,727.31
|
| Rate for Payer: BCBS Complete |
$1,064.80
|
| Rate for Payer: BCBS MAPPO |
$1,289.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,289.04
|
| Rate for Payer: Cash Price |
$2,129.60
|
| Rate for Payer: Cash Price |
$2,129.60
|
| Rate for Payer: Cofinity Commercial |
$1,856.22
|
| Rate for Payer: Cofinity Commercial |
$1,727.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,289.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,353.49
|
| Rate for Payer: Nomi Health Commercial |
$1,546.85
|
| Rate for Payer: PACE SWMI |
$1,289.04
|
| Rate for Payer: PHP Commercial |
$1,804.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,289.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,730.30
|
| Rate for Payer: Priority Health Medicare |
$1,289.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,289.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,289.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,224.52
|
|
|
PR CLSR ESOPHAGOSTOMY/FSTL CRV APPR
|
Professional
|
Both
|
$2,693.00
|
|
|
Service Code
|
HCPCS 43420
|
| Min. Negotiated Rate |
$973.77 |
| Max. Negotiated Rate |
$1,750.45 |
| Rate for Payer: Aetna Commercial |
$1,304.85
|
| Rate for Payer: Aetna Medicare |
$1,012.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,402.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,304.85
|
| Rate for Payer: BCBS Complete |
$1,077.20
|
| Rate for Payer: BCBS MAPPO |
$973.77
|
| Rate for Payer: BCN Medicare Advantage |
$973.77
|
| Rate for Payer: Cash Price |
$2,154.40
|
| Rate for Payer: Cash Price |
$2,154.40
|
| Rate for Payer: Cofinity Commercial |
$1,402.23
|
| Rate for Payer: Cofinity Commercial |
$1,304.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$973.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,022.46
|
| Rate for Payer: Nomi Health Commercial |
$1,168.52
|
| Rate for Payer: PACE SWMI |
$973.77
|
| Rate for Payer: PHP Commercial |
$1,363.28
|
| Rate for Payer: PHP Medicare Advantage |
$973.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,750.45
|
| Rate for Payer: Priority Health Medicare |
$973.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$973.77
|
| Rate for Payer: UHC Medicare Advantage |
$973.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,238.78
|
|
|
PR CLSR ESOPHAGOSTOMY/FSTL TTHRC/TABDL APPR
|
Professional
|
Both
|
$4,177.00
|
|
|
Service Code
|
HCPCS 43425
|
| Min. Negotiated Rate |
$1,389.59 |
| Max. Negotiated Rate |
$2,715.05 |
| Rate for Payer: Aetna Commercial |
$1,862.05
|
| Rate for Payer: Aetna Medicare |
$1,445.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,001.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,862.05
|
| Rate for Payer: BCBS Complete |
$1,670.80
|
| Rate for Payer: BCBS MAPPO |
$1,389.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,389.59
|
| Rate for Payer: Cash Price |
$3,341.60
|
| Rate for Payer: Cash Price |
$3,341.60
|
| Rate for Payer: Cofinity Commercial |
$2,001.01
|
| Rate for Payer: Cofinity Commercial |
$1,862.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,389.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,459.07
|
| Rate for Payer: Nomi Health Commercial |
$1,667.51
|
| Rate for Payer: PACE SWMI |
$1,389.59
|
| Rate for Payer: PHP Commercial |
$1,945.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,389.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,715.05
|
| Rate for Payer: Priority Health Medicare |
$1,389.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,389.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,389.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,921.42
|
|
