|
PR CBHC RECASE ITE
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 00583
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Aetna Medicare |
$89.50
|
| Rate for Payer: BCBS Complete |
$71.60
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.35
|
| Rate for Payer: UMR Bronson Commercial |
$82.34
|
|
|
PR CBHC REPAIR 5 YRS AND OLDER
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
HCPCS 00589
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$282.10 |
| Rate for Payer: Aetna Medicare |
$217.00
|
| Rate for Payer: BCBS Complete |
$173.60
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.10
|
| Rate for Payer: UMR Bronson Commercial |
$199.64
|
|
|
PR CBHC REPAIR DIGITAL/CIC
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00588
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: UMR Bronson Commercial |
$140.76
|
|
|
PR CBHC REPAIR RECEIVER
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 00587
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
| Rate for Payer: UMR Bronson Commercial |
$58.88
|
|
|
PR CCIIV3 VACCINE ABX FREE 0.5 ML FOR IM USE
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 90661
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$49.38
|
| Rate for Payer: Aetna Medicare |
$38.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.06
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$36.85
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: BCN Medicare Advantage |
$36.85
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$53.06
|
| Rate for Payer: Cofinity Commercial |
$49.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.69
|
| Rate for Payer: Nomi Health Commercial |
$44.22
|
| Rate for Payer: PACE SWMI |
$36.85
|
| Rate for Payer: PHP Commercial |
$51.59
|
| Rate for Payer: PHP Medicare Advantage |
$36.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$36.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.85
|
| Rate for Payer: UHC Medicare Advantage |
$36.85
|
| Rate for Payer: UMR Bronson Commercial |
$19.78
|
|
|
PR CCIIV4 VACCINE ANTIBIOTIC FREE 0.5 ML DOS IM USE
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 90756
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: Aetna Commercial |
$32.37
|
| Rate for Payer: Aetna Medicare |
$34.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.37
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS Trust/PPO |
$33.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.20
|
| Rate for Payer: UMR Bronson Commercial |
$31.28
|
|
|
PR CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 90674
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Aetna Commercial |
$34.17
|
| Rate for Payer: Aetna Medicare |
$36.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.17
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: BCBS Trust/PPO |
$33.98
|
| Rate for Payer: BCN Commercial |
$33.98
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
| Rate for Payer: UMR Bronson Commercial |
$33.58
|
|
|
PR CCM/BHI BY RHC/FQHC 20MIN MO
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS G0511
|
| Min. Negotiated Rate |
$56.53 |
| Max. Negotiated Rate |
$589.58 |
| Rate for Payer: Aetna Commercial |
$63.19
|
| Rate for Payer: Aetna Medicare |
$125.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.19
|
| Rate for Payer: BCBS Complete |
$100.40
|
| Rate for Payer: BCBS Trust/PPO |
$589.58
|
| Rate for Payer: BCN Commercial |
$112.40
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.53
|
| Rate for Payer: Priority Health Narrow Network |
$56.53
|
| Rate for Payer: Priority Health SBD |
$56.53
|
| Rate for Payer: UMR Bronson Commercial |
$115.46
|
|
|
PR CEFTRIAXONE SODIUM INJECTION
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J0696
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$0.64
|
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.69
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.04
|
| Rate for Payer: BCN Medicare Advantage |
$0.48
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$0.64
|
| Rate for Payer: Cofinity Commercial |
$0.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.51
|
| Rate for Payer: Nomi Health Commercial |
$0.58
|
| Rate for Payer: PACE SWMI |
$0.48
|
| Rate for Payer: PHP Commercial |
$0.67
|
| Rate for Payer: PHP Medicare Advantage |
$0.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$0.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.48
|
| Rate for Payer: UHC Medicare Advantage |
$0.48
|
| Rate for Payer: UMR Bronson Commercial |
$9.20
|
|
|
PR CERCLAGE CERVIX PREGNANCY VAGINAL
|
Professional
|
Both
|
$734.00
|
|
|
Service Code
|
HCPCS 59320
|
| Min. Negotiated Rate |
$97.55 |
| Max. Negotiated Rate |
$477.10 |
| Rate for Payer: Aetna Commercial |
$199.04
|
| Rate for Payer: Aetna Medicare |
$154.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.04
|
| Rate for Payer: BCBS Complete |
$102.43
|
| Rate for Payer: BCBS MAPPO |
$148.54
|
| Rate for Payer: BCBS Trust/PPO |
$213.43
|
| Rate for Payer: BCN Commercial |
$220.88
|
| Rate for Payer: BCN Medicare Advantage |
$148.54
|
| Rate for Payer: Cash Price |
$587.20
|
| Rate for Payer: Cash Price |
$587.20
|
| Rate for Payer: Cofinity Commercial |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$213.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.97
|
| Rate for Payer: Meridian Medicaid |
$102.43
|
| Rate for Payer: Nomi Health Commercial |
$178.25
|
| Rate for Payer: PACE SWMI |
$148.54
|
| Rate for Payer: PHP Commercial |
$207.96
|
| Rate for Payer: PHP Medicare Advantage |
$148.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.39
|
| Rate for Payer: Priority Health Medicare |
$148.54
|
| Rate for Payer: Priority Health Narrow Network |
$212.39
|
| Rate for Payer: Priority Health SBD |
$212.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.54
|
| Rate for Payer: UHC Medicare Advantage |
$148.54
|
| Rate for Payer: UHCCP Medicaid |
$97.55
|
| Rate for Payer: UMR Bronson Commercial |
$337.64
|
|
|
PR CERCLAGE UTERINE CERVIX NONOBSTETRICAL
|
Professional
|
Both
|
$827.00
|
|
|
Service Code
|
HCPCS 57700
|
| Min. Negotiated Rate |
$228.55 |
| Max. Negotiated Rate |
$915.54 |
| Rate for Payer: Aetna Commercial |
$448.65
|
| Rate for Payer: Aetna Medicare |
$348.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.13
|
| Rate for Payer: BCBS Complete |
$239.98
|
| Rate for Payer: BCBS MAPPO |
$334.81
|
| Rate for Payer: BCBS Trust/PPO |
$915.54
|
| Rate for Payer: BCN Commercial |
$526.80
|
| Rate for Payer: BCN Medicare Advantage |
$334.81
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Cofinity Commercial |
$482.13
|
| Rate for Payer: Cofinity Commercial |
$448.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$334.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$351.55
|
| Rate for Payer: Meridian Medicaid |
$239.98
|
| Rate for Payer: Nomi Health Commercial |
$401.77
|
| Rate for Payer: PACE SWMI |
$334.81
|
| Rate for Payer: PHP Commercial |
$468.73
|
| Rate for Payer: PHP Medicare Advantage |
$334.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$228.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$537.72
|
| Rate for Payer: Priority Health Medicare |
$334.81
|
| Rate for Payer: Priority Health Narrow Network |
$537.72
|
| Rate for Payer: Priority Health SBD |
$537.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$334.81
|
| Rate for Payer: UHC Medicare Advantage |
$334.81
|
| Rate for Payer: UHCCP Medicaid |
$228.55
|
| Rate for Payer: UMR Bronson Commercial |
$380.42
|
|
|
PR CERTOLIZUMAB PEGOL INJ 1MG
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J0717
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$6.01
|
| Rate for Payer: Aetna Medicare |
$4.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.46
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$4.49
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCN Commercial |
$5.06
|
| Rate for Payer: BCN Medicare Advantage |
$4.49
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$6.01
|
| Rate for Payer: Cofinity Commercial |
$6.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.71
|
| Rate for Payer: Nomi Health Commercial |
$5.38
|
| Rate for Payer: PACE SWMI |
$4.49
|
| Rate for Payer: PHP Commercial |
$6.28
|
| Rate for Payer: PHP Medicare Advantage |
$4.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$4.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.49
|
| Rate for Payer: UHC Medicare Advantage |
$4.49
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR CERV FLEX N/ADJ FOAM PRE OTS
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS L0120
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCN Commercial |
$25.11
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
| Rate for Payer: UMR Bronson Commercial |
$12.42
|
|
|
PR CERVICAL CAP CONTRACEPTIVE
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS A4261
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$1,481.35 |
| Rate for Payer: Aetna Commercial |
$26.50
|
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.50
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,481.35
|
| Rate for Payer: BCN Commercial |
$78.84
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: UMR Bronson Commercial |
$46.92
|
|
|
PR CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ
|
Professional
|
Both
|
$3,995.00
|
|
|
Service Code
|
HCPCS 38724
|
| Min. Negotiated Rate |
$931.88 |
| Max. Negotiated Rate |
$2,902.68 |
| Rate for Payer: Aetna Commercial |
$1,861.84
|
| Rate for Payer: Aetna Medicare |
$1,445.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,861.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,000.78
|
| Rate for Payer: BCBS Complete |
$978.47
|
| Rate for Payer: BCBS MAPPO |
$1,389.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,321.28
|
| Rate for Payer: BCN Commercial |
$2,122.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,389.43
|
| Rate for Payer: Cash Price |
$3,196.00
|
| Rate for Payer: Cash Price |
$3,196.00
|
| Rate for Payer: Cofinity Commercial |
$2,000.78
|
| Rate for Payer: Cofinity Commercial |
$1,861.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,389.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,458.90
|
| Rate for Payer: Meridian Medicaid |
$978.47
|
| Rate for Payer: Nomi Health Commercial |
$1,667.32
|
| Rate for Payer: PACE SWMI |
$1,389.43
|
| Rate for Payer: PHP Commercial |
$1,945.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,389.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$931.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,596.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,902.68
|
| Rate for Payer: Priority Health Medicare |
$1,389.43
|
| Rate for Payer: Priority Health Narrow Network |
$2,902.68
|
| Rate for Payer: Priority Health SBD |
$2,902.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,389.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,389.43
|
| Rate for Payer: UHCCP Medicaid |
$931.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,837.70
|
|
|
PR CERVICAL LYMPHADENECTOMY
|
Professional
|
Both
|
$2,444.00
|
|
|
Service Code
|
HCPCS 38720
|
| Min. Negotiated Rate |
$671.47 |
| Max. Negotiated Rate |
$2,689.64 |
| Rate for Payer: Aetna Commercial |
$1,729.58
|
| Rate for Payer: Aetna Medicare |
$1,342.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,729.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,858.65
|
| Rate for Payer: BCBS Complete |
$907.35
|
| Rate for Payer: BCBS MAPPO |
$1,290.73
|
| Rate for Payer: BCBS Trust/PPO |
$671.47
|
| Rate for Payer: BCN Commercial |
$1,958.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,290.73
|
| Rate for Payer: Cash Price |
$1,955.20
|
| Rate for Payer: Cash Price |
$1,955.20
|
| Rate for Payer: Cofinity Commercial |
$1,729.58
|
| Rate for Payer: Cofinity Commercial |
$1,858.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,290.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,355.27
|
| Rate for Payer: Meridian Medicaid |
$907.35
|
| Rate for Payer: Nomi Health Commercial |
$1,548.88
|
| Rate for Payer: PACE SWMI |
$1,290.73
|
| Rate for Payer: PHP Commercial |
$1,807.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,290.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$864.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,588.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,689.64
|
| Rate for Payer: Priority Health Medicare |
$1,290.73
|
| Rate for Payer: Priority Health Narrow Network |
$2,689.64
|
| Rate for Payer: Priority Health SBD |
$2,689.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,290.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,290.73
|
| Rate for Payer: UHCCP Medicaid |
$864.14
|
| Rate for Payer: UMR Bronson Commercial |
$1,124.24
|
|
|
PR CESAREAN DELIVERY ATTEMPTED VBAC
|
Professional
|
Both
|
$2,499.00
|
|
|
Service Code
|
HCPCS 59620
|
| Min. Negotiated Rate |
$874.34 |
| Max. Negotiated Rate |
$1,636.60 |
| Rate for Payer: Aetna Commercial |
$1,233.28
|
| Rate for Payer: Aetna Medicare |
$957.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,233.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,325.32
|
| Rate for Payer: BCBS Complete |
$918.06
|
| Rate for Payer: BCBS MAPPO |
$920.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.64
|
| Rate for Payer: BCN Commercial |
$1,636.60
|
| Rate for Payer: BCN Medicare Advantage |
$920.36
|
| Rate for Payer: Cash Price |
$1,999.20
|
| Rate for Payer: Cash Price |
$1,999.20
|
| Rate for Payer: Cofinity Commercial |
$1,233.28
|
| Rate for Payer: Cofinity Commercial |
$1,325.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$920.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$966.38
|
| Rate for Payer: Meridian Medicaid |
$918.06
|
| Rate for Payer: Nomi Health Commercial |
$1,104.43
|
| Rate for Payer: PACE SWMI |
$920.36
|
| Rate for Payer: PHP Commercial |
$1,288.50
|
| Rate for Payer: PHP Medicare Advantage |
$920.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$874.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,624.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,312.97
|
| Rate for Payer: Priority Health Medicare |
$920.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,312.97
|
| Rate for Payer: Priority Health SBD |
$1,312.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$920.36
|
| Rate for Payer: UHC Medicare Advantage |
$920.36
|
| Rate for Payer: UHCCP Medicaid |
$874.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,149.54
|
|
|
PR CESAREAN DELIVERY ONLY
|
Professional
|
Both
|
$2,321.00
|
|
|
Service Code
|
HCPCS 59514
|
| Min. Negotiated Rate |
$164.30 |
| Max. Negotiated Rate |
$1,558.66 |
| Rate for Payer: Aetna Commercial |
$1,190.60
|
| Rate for Payer: Aetna Medicare |
$924.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,190.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,279.45
|
| Rate for Payer: BCBS Complete |
$886.28
|
| Rate for Payer: BCBS MAPPO |
$888.51
|
| Rate for Payer: BCBS Trust/PPO |
$164.30
|
| Rate for Payer: BCN Commercial |
$1,558.66
|
| Rate for Payer: BCN Medicare Advantage |
$888.51
|
| Rate for Payer: Cash Price |
$1,856.80
|
| Rate for Payer: Cash Price |
$1,856.80
|
| Rate for Payer: Cofinity Commercial |
$1,190.60
|
| Rate for Payer: Cofinity Commercial |
$1,279.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$888.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$932.94
|
| Rate for Payer: Meridian Medicaid |
$886.28
|
| Rate for Payer: Nomi Health Commercial |
$1,066.21
|
| Rate for Payer: PACE SWMI |
$888.51
|
| Rate for Payer: PHP Commercial |
$1,243.91
|
| Rate for Payer: PHP Medicare Advantage |
$888.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$844.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,508.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,268.27
|
| Rate for Payer: Priority Health Medicare |
$888.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,268.27
|
| Rate for Payer: Priority Health SBD |
$1,268.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$888.51
|
| Rate for Payer: UHC Medicare Advantage |
$888.51
|
| Rate for Payer: UHCCP Medicaid |
$844.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,067.66
|
|
|
PR CESAREAN DELIVERY ONLY W/POSTPARTUM CARE
|
Professional
|
Both
|
$2,593.00
|
|
|
Service Code
|
HCPCS 59515
|
| Min. Negotiated Rate |
$181.74 |
| Max. Negotiated Rate |
$1,888.01 |
| Rate for Payer: Aetna Commercial |
$1,756.90
|
| Rate for Payer: Aetna Medicare |
$1,363.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,756.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,888.01
|
| Rate for Payer: BCBS Complete |
$1,307.84
|
| Rate for Payer: BCBS MAPPO |
$1,311.12
|
| Rate for Payer: BCBS Trust/PPO |
$181.74
|
| Rate for Payer: BCN Commercial |
$1,809.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,311.12
|
| Rate for Payer: Cash Price |
$2,074.40
|
| Rate for Payer: Cash Price |
$2,074.40
|
| Rate for Payer: Cofinity Commercial |
$1,756.90
|
| Rate for Payer: Cofinity Commercial |
$1,888.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,311.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,376.68
|
| Rate for Payer: Meridian Medicaid |
$1,307.84
|
| Rate for Payer: Nomi Health Commercial |
$1,573.34
|
| Rate for Payer: PACE SWMI |
$1,311.12
|
| Rate for Payer: PHP Commercial |
$1,835.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,311.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,245.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,685.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,880.28
|
| Rate for Payer: Priority Health Medicare |
$1,311.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,880.28
|
| Rate for Payer: Priority Health SBD |
$1,880.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,311.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,311.12
|
| Rate for Payer: UHCCP Medicaid |
$1,245.56
|
| Rate for Payer: UMR Bronson Commercial |
$1,192.78
|
|
|
PR CESAREAN DLVRY & POSTPARTUM CARE ATTEMPTED VBA
|
Professional
|
Both
|
$2,771.00
|
|
|
Service Code
|
HCPCS 59622
|
| Min. Negotiated Rate |
$1,128.98 |
| Max. Negotiated Rate |
$1,952.31 |
| Rate for Payer: Aetna Commercial |
$1,816.73
|
| Rate for Payer: Aetna Medicare |
$1,410.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,816.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,952.31
|
| Rate for Payer: BCBS Complete |
$1,352.38
|
| Rate for Payer: BCBS MAPPO |
$1,355.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,128.98
|
| Rate for Payer: BCN Commercial |
$1,899.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,355.77
|
| Rate for Payer: Cash Price |
$2,216.80
|
| Rate for Payer: Cash Price |
$2,216.80
|
| Rate for Payer: Cofinity Commercial |
$1,816.73
|
| Rate for Payer: Cofinity Commercial |
$1,952.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,355.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,423.56
|
| Rate for Payer: Meridian Medicaid |
$1,352.38
|
| Rate for Payer: Nomi Health Commercial |
$1,626.92
|
| Rate for Payer: PACE SWMI |
$1,355.77
|
| Rate for Payer: PHP Commercial |
$1,898.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,355.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,287.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,801.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,949.21
|
| Rate for Payer: Priority Health Medicare |
$1,355.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,949.21
|
| Rate for Payer: Priority Health SBD |
$1,949.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,355.77
|
| Rate for Payer: UHC Medicare Advantage |
$1,355.77
|
| Rate for Payer: UHCCP Medicaid |
$1,287.98
|
| Rate for Payer: UMR Bronson Commercial |
$1,274.66
|
|
|
PR CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 37214
|
| Min. Negotiated Rate |
$76.47 |
| Max. Negotiated Rate |
$705.28 |
| Rate for Payer: Aetna Commercial |
$156.82
|
| Rate for Payer: Aetna Medicare |
$121.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.52
|
| Rate for Payer: BCBS Complete |
$80.29
|
| Rate for Payer: BCBS MAPPO |
$117.03
|
| Rate for Payer: BCBS Trust/PPO |
$705.28
|
| Rate for Payer: BCN Commercial |
$173.96
|
| Rate for Payer: BCN Medicare Advantage |
$117.03
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$156.82
|
| Rate for Payer: Cofinity Commercial |
$168.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.88
|
| Rate for Payer: Meridian Medicaid |
$80.29
|
| Rate for Payer: Nomi Health Commercial |
$140.44
|
| Rate for Payer: PACE SWMI |
$117.03
|
| Rate for Payer: PHP Commercial |
$163.84
|
| Rate for Payer: PHP Medicare Advantage |
$117.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.80
|
| Rate for Payer: Priority Health Medicare |
$117.03
|
| Rate for Payer: Priority Health Narrow Network |
$188.80
|
| Rate for Payer: Priority Health SBD |
$188.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.03
|
| Rate for Payer: UHC Medicare Advantage |
$117.03
|
| Rate for Payer: UHCCP Medicaid |
$76.47
|
| Rate for Payer: UMR Bronson Commercial |
$113.62
|
|
|
PR CHANGE CYSTOSTOMY TUBE COMPLICATED
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
HCPCS 51710
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$2,051.39 |
| Rate for Payer: Aetna Commercial |
$101.79
|
| Rate for Payer: Aetna Medicare |
$79.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.38
|
| Rate for Payer: BCBS Complete |
$53.68
|
| Rate for Payer: BCBS MAPPO |
$75.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,051.39
|
| Rate for Payer: BCN Commercial |
$198.89
|
| Rate for Payer: BCN Medicare Advantage |
$75.96
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cofinity Commercial |
$101.79
|
| Rate for Payer: Cofinity Commercial |
$109.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.76
|
| Rate for Payer: Meridian Medicaid |
$53.68
|
| Rate for Payer: Nomi Health Commercial |
$91.15
|
| Rate for Payer: PACE SWMI |
$75.96
|
| Rate for Payer: PHP Commercial |
$106.34
|
| Rate for Payer: PHP Medicare Advantage |
$75.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.30
|
| Rate for Payer: Priority Health Medicare |
$75.96
|
| Rate for Payer: Priority Health Narrow Network |
$127.30
|
| Rate for Payer: Priority Health SBD |
$127.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.96
|
| Rate for Payer: UHC Medicare Advantage |
$75.96
|
| Rate for Payer: UHCCP Medicaid |
$51.12
|
| Rate for Payer: UMR Bronson Commercial |
$156.86
|
|
|
PR CHANGE CYSTOSTOMY TUBE SIMPLE
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 51705
|
| Min. Negotiated Rate |
$33.44 |
| Max. Negotiated Rate |
$1,992.75 |
| Rate for Payer: Aetna Commercial |
$66.83
|
| Rate for Payer: Aetna Medicare |
$51.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.81
|
| Rate for Payer: BCBS Complete |
$35.11
|
| Rate for Payer: BCBS MAPPO |
$49.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,992.75
|
| Rate for Payer: BCN Commercial |
$141.72
|
| Rate for Payer: BCN Medicare Advantage |
$49.87
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Commercial |
$66.83
|
| Rate for Payer: Cofinity Commercial |
$71.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.36
|
| Rate for Payer: Meridian Medicaid |
$35.11
|
| Rate for Payer: Nomi Health Commercial |
$59.84
|
| Rate for Payer: PACE SWMI |
$49.87
|
| Rate for Payer: PHP Commercial |
$69.82
|
| Rate for Payer: PHP Medicare Advantage |
$49.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.02
|
| Rate for Payer: Priority Health Medicare |
$49.87
|
| Rate for Payer: Priority Health Narrow Network |
$82.02
|
| Rate for Payer: Priority Health SBD |
$82.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.87
|
| Rate for Payer: UHC Medicare Advantage |
$49.87
|
| Rate for Payer: UHCCP Medicaid |
$33.44
|
| Rate for Payer: UMR Bronson Commercial |
$91.08
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Facility
|
OP
|
$835.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
43760
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$308.95 |
| Max. Negotiated Rate |
$751.50 |
| Rate for Payer: Aetna American Axle |
$542.75
|
| Rate for Payer: Aetna Commercial |
$709.75
|
| Rate for Payer: Aetna Medicare |
$417.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$542.75
|
| Rate for Payer: BCBS Complete |
$334.00
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Cofinity Commercial |
$584.50
|
| Rate for Payer: Cofinity Commercial |
$718.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$584.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$668.00
|
| Rate for Payer: Healthscope Commercial |
$751.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$584.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$626.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$709.75
|
| Rate for Payer: PHP Commercial |
$709.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.75
|
| Rate for Payer: Priority Health SBD |
$526.05
|
| Rate for Payer: UMR Bronson Commercial |
$308.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$626.25
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Professional
|
Both
|
$835.00
|
|
|
Service Code
|
HCPCS 43760
|
| Hospital Charge Code |
43760
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$542.75 |
| Rate for Payer: Aetna Medicare |
$417.50
|
| Rate for Payer: BCBS Complete |
$334.00
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.75
|
| Rate for Payer: UMR Bronson Commercial |
$384.10
|
|
