|
PR COMPLEX CHRONIC CARE MGMT SVC 1ST 60 MIN CAL MO
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 99487
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$123.24 |
| Rate for Payer: Aetna Commercial |
$114.68
|
| Rate for Payer: Aetna Medicare |
$89.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.68
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: BCBS MAPPO |
$85.58
|
| Rate for Payer: BCN Medicare Advantage |
$85.58
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$123.24
|
| Rate for Payer: Cofinity Commercial |
$114.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.86
|
| Rate for Payer: Nomi Health Commercial |
$102.70
|
| Rate for Payer: PACE SWMI |
$85.58
|
| Rate for Payer: PHP Commercial |
$119.81
|
| Rate for Payer: PHP Medicare Advantage |
$85.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
| Rate for Payer: Priority Health Medicare |
$85.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.58
|
| Rate for Payer: UHC Medicare Advantage |
$85.58
|
| Rate for Payer: UMR Bronson Commercial |
$50.60
|
|
|
PR COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Professional
|
Both
|
$685.00
|
|
|
Service Code
|
HCPCS 51727
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$445.25 |
| Rate for Payer: Aetna Commercial |
$414.02
|
| Rate for Payer: Aetna Medicare |
$321.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.02
|
| Rate for Payer: BCBS Complete |
$274.00
|
| Rate for Payer: BCBS MAPPO |
$308.97
|
| Rate for Payer: BCN Medicare Advantage |
$308.97
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cofinity Commercial |
$444.92
|
| Rate for Payer: Cofinity Commercial |
$414.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.42
|
| Rate for Payer: Nomi Health Commercial |
$370.76
|
| Rate for Payer: PACE SWMI |
$308.97
|
| Rate for Payer: PHP Commercial |
$432.56
|
| Rate for Payer: PHP Medicare Advantage |
$308.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.25
|
| Rate for Payer: Priority Health Medicare |
$308.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$308.97
|
| Rate for Payer: UHC Medicare Advantage |
$308.97
|
| Rate for Payer: UMR Bronson Commercial |
$315.10
|
|
|
PR COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 51728
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$442.31 |
| Rate for Payer: Aetna Commercial |
$411.59
|
| Rate for Payer: Aetna Medicare |
$319.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$442.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$411.59
|
| Rate for Payer: BCBS Complete |
$264.00
|
| Rate for Payer: BCBS MAPPO |
$307.16
|
| Rate for Payer: BCN Medicare Advantage |
$307.16
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$442.31
|
| Rate for Payer: Cofinity Commercial |
$411.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$307.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$322.52
|
| Rate for Payer: Nomi Health Commercial |
$368.59
|
| Rate for Payer: PACE SWMI |
$307.16
|
| Rate for Payer: PHP Commercial |
$430.02
|
| Rate for Payer: PHP Medicare Advantage |
$307.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$429.00
|
| Rate for Payer: Priority Health Medicare |
$307.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$307.16
|
| Rate for Payer: UHC Medicare Advantage |
$307.16
|
| Rate for Payer: UMR Bronson Commercial |
$303.60
|
|
|
PR COMPLEX E/M VISIT ADD ON
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS G2211
|
| Min. Negotiated Rate |
$15.26 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$20.45
|
| Rate for Payer: Aetna Medicare |
$15.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.45
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS MAPPO |
$15.26
|
| Rate for Payer: BCN Medicare Advantage |
$15.26
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$21.97
|
| Rate for Payer: Cofinity Commercial |
$20.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.02
|
| Rate for Payer: Nomi Health Commercial |
$18.31
|
| Rate for Payer: PACE SWMI |
$15.26
|
| Rate for Payer: PHP Commercial |
$21.36
|
| Rate for Payer: PHP Medicare Advantage |
$15.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health Medicare |
$15.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.26
|
| Rate for Payer: UHC Medicare Advantage |
$15.26
|
| Rate for Payer: UMR Bronson Commercial |
$22.08
|
|
|
PR COMPLEX IMPLANT REMOVAL, BILATERAL
|
Professional
|
Both
|
$4,304.00
|
|
|
Service Code
|
HCPCS 00564
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,721.60 |
| Max. Negotiated Rate |
$2,797.60 |
| Rate for Payer: Aetna Medicare |
$2,152.00
|
| Rate for Payer: BCBS Complete |
$1,721.60
|
| Rate for Payer: Cash Price |
$3,443.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,797.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,979.84
|
|
|
PR COMPLEX UROFLOMETRY
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 51741
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: Aetna Medicare |
$13.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.31
|
| Rate for Payer: BCBS Complete |
$68.00
|
| Rate for Payer: BCBS MAPPO |
$13.41
|
| Rate for Payer: BCN Medicare Advantage |
$13.41
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$17.97
|
| Rate for Payer: Cofinity Commercial |
$19.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.08
|
| Rate for Payer: Nomi Health Commercial |
$16.09
|
| Rate for Payer: PACE SWMI |
$13.41
|
| Rate for Payer: PHP Commercial |
$18.77
|
| Rate for Payer: PHP Medicare Advantage |
$13.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health Medicare |
$13.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.41
|
| Rate for Payer: UHC Medicare Advantage |
$13.41
|
| Rate for Payer: UMR Bronson Commercial |
$78.20
|
|
|
PR COMPL OPH XM&EVAL GENERAL ANES W/WO MNPJ GLOBE
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
HCPCS 92018
|
| Min. Negotiated Rate |
$85.60 |
| Max. Negotiated Rate |
$189.20 |
| Rate for Payer: Aetna Commercial |
$176.06
|
| Rate for Payer: Aetna Medicare |
$136.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.06
|
| Rate for Payer: BCBS Complete |
$85.60
|
| Rate for Payer: BCBS MAPPO |
$131.39
|
| Rate for Payer: BCN Medicare Advantage |
$131.39
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cofinity Commercial |
$189.20
|
| Rate for Payer: Cofinity Commercial |
$176.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.96
|
| Rate for Payer: Nomi Health Commercial |
$157.67
|
| Rate for Payer: PACE SWMI |
$131.39
|
| Rate for Payer: PHP Commercial |
$183.95
|
| Rate for Payer: PHP Medicare Advantage |
$131.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.10
|
| Rate for Payer: Priority Health Medicare |
$131.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.39
|
| Rate for Payer: UHC Medicare Advantage |
$131.39
|
| Rate for Payer: UMR Bronson Commercial |
$98.44
|
|
|
PR COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 51729
|
| Min. Negotiated Rate |
$286.40 |
| Max. Negotiated Rate |
$470.78 |
| Rate for Payer: Aetna Commercial |
$438.09
|
| Rate for Payer: Aetna Medicare |
$340.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$470.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.09
|
| Rate for Payer: BCBS Complete |
$286.40
|
| Rate for Payer: BCBS MAPPO |
$326.93
|
| Rate for Payer: BCN Medicare Advantage |
$326.93
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$470.78
|
| Rate for Payer: Cofinity Commercial |
$438.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.28
|
| Rate for Payer: Nomi Health Commercial |
$392.32
|
| Rate for Payer: PACE SWMI |
$326.93
|
| Rate for Payer: PHP Commercial |
$457.70
|
| Rate for Payer: PHP Medicare Advantage |
$326.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health Medicare |
$326.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$326.93
|
| Rate for Payer: UHC Medicare Advantage |
$326.93
|
| Rate for Payer: UMR Bronson Commercial |
$329.36
|
|
|
PR COMPLX INTRACRANIAL ARYSM CAROTID CIRCULATION
|
Professional
|
Both
|
$10,302.00
|
|
|
Service Code
|
HCPCS 61697
|
| Min. Negotiated Rate |
$4,120.80 |
| Max. Negotiated Rate |
$6,696.30 |
| Rate for Payer: Aetna Commercial |
$5,598.91
|
| Rate for Payer: Aetna Medicare |
$4,345.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,016.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,598.91
|
| Rate for Payer: BCBS Complete |
$4,120.80
|
| Rate for Payer: BCBS MAPPO |
$4,178.29
|
| Rate for Payer: BCN Medicare Advantage |
$4,178.29
|
| Rate for Payer: Cash Price |
$8,241.60
|
| Rate for Payer: Cash Price |
$8,241.60
|
| Rate for Payer: Cofinity Commercial |
$6,016.74
|
| Rate for Payer: Cofinity Commercial |
$5,598.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,178.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,387.20
|
| Rate for Payer: Nomi Health Commercial |
$5,013.95
|
| Rate for Payer: PACE SWMI |
$4,178.29
|
| Rate for Payer: PHP Commercial |
$5,849.61
|
| Rate for Payer: PHP Medicare Advantage |
$4,178.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,696.30
|
| Rate for Payer: Priority Health Medicare |
$4,178.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,178.29
|
| Rate for Payer: UHC Medicare Advantage |
$4,178.29
|
| Rate for Payer: UMR Bronson Commercial |
$4,738.92
|
|
|
PR COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 92557
|
| Min. Negotiated Rate |
$29.89 |
| Max. Negotiated Rate |
$51.35 |
| Rate for Payer: Aetna Commercial |
$40.05
|
| Rate for Payer: Aetna Medicare |
$31.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.05
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCBS MAPPO |
$29.89
|
| Rate for Payer: BCN Medicare Advantage |
$29.89
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$43.04
|
| Rate for Payer: Cofinity Commercial |
$40.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.38
|
| Rate for Payer: Nomi Health Commercial |
$35.87
|
| Rate for Payer: PACE SWMI |
$29.89
|
| Rate for Payer: PHP Commercial |
$41.85
|
| Rate for Payer: PHP Medicare Advantage |
$29.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
| Rate for Payer: Priority Health Medicare |
$29.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.89
|
| Rate for Payer: UHC Medicare Advantage |
$29.89
|
| Rate for Payer: UMR Bronson Commercial |
$36.34
|
|
|
PR COMPRE EP EVAL ABLTJ 3D MAPG TX SVT
|
Professional
|
Both
|
$1,754.00
|
|
|
Service Code
|
HCPCS 93653
|
| Min. Negotiated Rate |
$701.60 |
| Max. Negotiated Rate |
$1,141.36 |
| Rate for Payer: Aetna Commercial |
$1,062.10
|
| Rate for Payer: Aetna Medicare |
$824.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,141.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,062.10
|
| Rate for Payer: BCBS Complete |
$701.60
|
| Rate for Payer: BCBS MAPPO |
$792.61
|
| Rate for Payer: BCN Medicare Advantage |
$792.61
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Cofinity Commercial |
$1,141.36
|
| Rate for Payer: Cofinity Commercial |
$1,062.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$792.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$832.24
|
| Rate for Payer: Nomi Health Commercial |
$951.13
|
| Rate for Payer: PACE SWMI |
$792.61
|
| Rate for Payer: PHP Commercial |
$1,109.65
|
| Rate for Payer: PHP Medicare Advantage |
$792.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,140.10
|
| Rate for Payer: Priority Health Medicare |
$792.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$792.61
|
| Rate for Payer: UHC Medicare Advantage |
$792.61
|
| Rate for Payer: UMR Bronson Commercial |
$806.84
|
|
|
PR COMPRE EP EVAL ABLTJ 3D MAPG TX VT
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 93654
|
| Min. Negotiated Rate |
$940.00 |
| Max. Negotiated Rate |
$1,527.50 |
| Rate for Payer: Aetna Commercial |
$1,280.34
|
| Rate for Payer: Aetna Medicare |
$993.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,375.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,280.34
|
| Rate for Payer: BCBS Complete |
$940.00
|
| Rate for Payer: BCBS MAPPO |
$955.48
|
| Rate for Payer: BCN Medicare Advantage |
$955.48
|
| Rate for Payer: Cash Price |
$1,880.00
|
| Rate for Payer: Cash Price |
$1,880.00
|
| Rate for Payer: Cofinity Commercial |
$1,375.89
|
| Rate for Payer: Cofinity Commercial |
$1,280.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$955.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,003.25
|
| Rate for Payer: Nomi Health Commercial |
$1,146.58
|
| Rate for Payer: PACE SWMI |
$955.48
|
| Rate for Payer: PHP Commercial |
$1,337.67
|
| Rate for Payer: PHP Medicare Advantage |
$955.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,527.50
|
| Rate for Payer: Priority Health Medicare |
$955.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$955.48
|
| Rate for Payer: UHC Medicare Advantage |
$955.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,081.00
|
|
|
PR COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION
|
Professional
|
Both
|
$1,842.00
|
|
|
Service Code
|
HCPCS 93656
|
| Min. Negotiated Rate |
$736.80 |
| Max. Negotiated Rate |
$1,293.22 |
| Rate for Payer: Aetna Commercial |
$1,203.41
|
| Rate for Payer: Aetna Medicare |
$933.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,293.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,203.41
|
| Rate for Payer: BCBS Complete |
$736.80
|
| Rate for Payer: BCBS MAPPO |
$898.07
|
| Rate for Payer: BCN Medicare Advantage |
$898.07
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cofinity Commercial |
$1,293.22
|
| Rate for Payer: Cofinity Commercial |
$1,203.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$898.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$942.97
|
| Rate for Payer: Nomi Health Commercial |
$1,077.68
|
| Rate for Payer: PACE SWMI |
$898.07
|
| Rate for Payer: PHP Commercial |
$1,257.30
|
| Rate for Payer: PHP Medicare Advantage |
$898.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,197.30
|
| Rate for Payer: Priority Health Medicare |
$898.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$898.07
|
| Rate for Payer: UHC Medicare Advantage |
$898.07
|
| Rate for Payer: UMR Bronson Commercial |
$847.32
|
|
|
PR COMPRE EP EVAL R ATR VNTRC PACG&REC HIS BNDL REC
|
Professional
|
Both
|
$1,319.00
|
|
|
Service Code
|
HCPCS 93620
|
| Min. Negotiated Rate |
$527.60 |
| Max. Negotiated Rate |
$857.35 |
| Rate for Payer: Aetna Medicare |
$659.50
|
| Rate for Payer: BCBS Complete |
$527.60
|
| Rate for Payer: Cash Price |
$1,055.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$857.35
|
| Rate for Payer: UMR Bronson Commercial |
$606.74
|
|
|
PR COMPRE EP EVAL W/L ATRIAL PACG&REC C SINS/L ATR
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 93621
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$159.25 |
| Rate for Payer: Aetna Medicare |
$122.50
|
| Rate for Payer: BCBS Complete |
$98.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.25
|
| Rate for Payer: UMR Bronson Commercial |
$112.70
|
|
|
PR CONDITIONING PLAY AUDIOMETRY
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 92582
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$113.85 |
| Rate for Payer: Aetna Commercial |
$105.94
|
| Rate for Payer: Aetna Medicare |
$82.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.94
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$79.06
|
| Rate for Payer: BCN Medicare Advantage |
$79.06
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$105.94
|
| Rate for Payer: Cofinity Commercial |
$113.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.01
|
| Rate for Payer: Nomi Health Commercial |
$94.87
|
| Rate for Payer: PACE SWMI |
$79.06
|
| Rate for Payer: PHP Commercial |
$110.68
|
| Rate for Payer: PHP Medicare Advantage |
$79.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$79.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.06
|
| Rate for Payer: UHC Medicare Advantage |
$79.06
|
| Rate for Payer: UMR Bronson Commercial |
$60.26
|
|
|
PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 57522
|
| Hospital Charge Code |
57522
|
| Min. Negotiated Rate |
$243.52 |
| Max. Negotiated Rate |
$600.60 |
| Rate for Payer: Aetna Commercial |
$326.32
|
| Rate for Payer: Aetna Medicare |
$253.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$350.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.32
|
| Rate for Payer: BCBS Complete |
$369.60
|
| Rate for Payer: BCBS MAPPO |
$243.52
|
| Rate for Payer: BCN Medicare Advantage |
$243.52
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$326.32
|
| Rate for Payer: Cofinity Commercial |
$350.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$255.70
|
| Rate for Payer: Nomi Health Commercial |
$292.22
|
| Rate for Payer: PACE SWMI |
$243.52
|
| Rate for Payer: PHP Commercial |
$340.93
|
| Rate for Payer: PHP Medicare Advantage |
$243.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health Medicare |
$243.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$243.52
|
| Rate for Payer: UHC Medicare Advantage |
$243.52
|
| Rate for Payer: UMR Bronson Commercial |
$425.04
|
|
|
PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 57522
|
| Min. Negotiated Rate |
$243.52 |
| Max. Negotiated Rate |
$600.60 |
| Rate for Payer: Aetna Commercial |
$326.32
|
| Rate for Payer: Aetna Medicare |
$253.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$350.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.32
|
| Rate for Payer: BCBS Complete |
$369.60
|
| Rate for Payer: BCBS MAPPO |
$243.52
|
| Rate for Payer: BCN Medicare Advantage |
$243.52
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$350.67
|
| Rate for Payer: Cofinity Commercial |
$326.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$255.70
|
| Rate for Payer: Nomi Health Commercial |
$292.22
|
| Rate for Payer: PACE SWMI |
$243.52
|
| Rate for Payer: PHP Commercial |
$340.93
|
| Rate for Payer: PHP Medicare Advantage |
$243.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health Medicare |
$243.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$243.52
|
| Rate for Payer: UHC Medicare Advantage |
$243.52
|
| Rate for Payer: UMR Bronson Commercial |
$425.04
|
|
|
PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
57522
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$406.56 |
| Max. Negotiated Rate |
$831.60 |
| Rate for Payer: Aetna American Axle |
$600.60
|
| Rate for Payer: Aetna Commercial |
$785.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$600.60
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$646.80
|
| Rate for Payer: Cofinity Commercial |
$794.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$646.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$739.20
|
| Rate for Payer: Healthscope Commercial |
$831.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$646.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$693.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.40
|
| Rate for Payer: PHP Commercial |
$785.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health SBD |
$582.12
|
| Rate for Payer: UMR Bronson Commercial |
$406.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$693.00
|
|
|
PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
57522
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$341.88 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna American Axle |
$600.60
|
| Rate for Payer: Aetna Commercial |
$785.40
|
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$600.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$646.80
|
| Rate for Payer: Cofinity Commercial |
$794.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$646.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$739.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$831.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$646.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$693.00
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.40
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Commercial |
$785.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Priority Health SBD |
$582.12
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Exchange |
$5,926.19
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,662.10
|
| Rate for Payer: UMR Bronson Commercial |
$341.88
|
| Rate for Payer: VA VA |
$3,100.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$693.00
|
|
|
PR CONIZATION CERVIX W/WO D&C RPR KNIFE/LASER
|
Professional
|
Both
|
$1,039.00
|
|
|
Service Code
|
HCPCS 57520
|
| Min. Negotiated Rate |
$282.59 |
| Max. Negotiated Rate |
$675.35 |
| Rate for Payer: Aetna Commercial |
$378.67
|
| Rate for Payer: Aetna Medicare |
$293.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$406.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.67
|
| Rate for Payer: BCBS Complete |
$415.60
|
| Rate for Payer: BCBS MAPPO |
$282.59
|
| Rate for Payer: BCN Medicare Advantage |
$282.59
|
| Rate for Payer: Cash Price |
$831.20
|
| Rate for Payer: Cash Price |
$831.20
|
| Rate for Payer: Cofinity Commercial |
$406.93
|
| Rate for Payer: Cofinity Commercial |
$378.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$282.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$296.72
|
| Rate for Payer: Nomi Health Commercial |
$339.11
|
| Rate for Payer: PACE SWMI |
$282.59
|
| Rate for Payer: PHP Commercial |
$395.63
|
| Rate for Payer: PHP Medicare Advantage |
$282.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.35
|
| Rate for Payer: Priority Health Medicare |
$282.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$282.59
|
| Rate for Payer: UHC Medicare Advantage |
$282.59
|
| Rate for Payer: UMR Bronson Commercial |
$477.94
|
|
|
PR CONSTRUCTION ARTIFICIAL VAGINA W/O GRAFT
|
Professional
|
Both
|
$1,701.00
|
|
|
Service Code
|
HCPCS 57291
|
| Min. Negotiated Rate |
$526.11 |
| Max. Negotiated Rate |
$1,105.65 |
| Rate for Payer: Aetna Commercial |
$704.99
|
| Rate for Payer: Aetna Medicare |
$547.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$757.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$704.99
|
| Rate for Payer: BCBS Complete |
$680.40
|
| Rate for Payer: BCBS MAPPO |
$526.11
|
| Rate for Payer: BCN Medicare Advantage |
$526.11
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cofinity Commercial |
$757.60
|
| Rate for Payer: Cofinity Commercial |
$704.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$526.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$552.42
|
| Rate for Payer: Nomi Health Commercial |
$631.33
|
| Rate for Payer: PACE SWMI |
$526.11
|
| Rate for Payer: PHP Commercial |
$736.55
|
| Rate for Payer: PHP Medicare Advantage |
$526.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: Priority Health Medicare |
$526.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$526.11
|
| Rate for Payer: UHC Medicare Advantage |
$526.11
|
| Rate for Payer: UMR Bronson Commercial |
$782.46
|
|
|
PR CONSULTS
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 00125
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Aetna Medicare |
$255.00
|
| Rate for Payer: BCBS Complete |
$204.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: UMR Bronson Commercial |
$234.60
|
|
|
PR CONT GLUC MNTR PHYSICIAN/QHP PROVIDED EQUIPMENT
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 95250
|
| Min. Negotiated Rate |
$109.60 |
| Max. Negotiated Rate |
$183.37 |
| Rate for Payer: Aetna Commercial |
$170.64
|
| Rate for Payer: Aetna Medicare |
$132.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.37
|
| Rate for Payer: BCBS Complete |
$109.60
|
| Rate for Payer: BCBS MAPPO |
$127.34
|
| Rate for Payer: BCN Medicare Advantage |
$127.34
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$170.64
|
| Rate for Payer: Cofinity Commercial |
$183.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.71
|
| Rate for Payer: Nomi Health Commercial |
$152.81
|
| Rate for Payer: PACE SWMI |
$127.34
|
| Rate for Payer: PHP Commercial |
$178.28
|
| Rate for Payer: PHP Medicare Advantage |
$127.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health Medicare |
$127.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.34
|
| Rate for Payer: UHC Medicare Advantage |
$127.34
|
| Rate for Payer: UMR Bronson Commercial |
$126.04
|
|
|
PR CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 95249
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$84.50 |
| Rate for Payer: Aetna Commercial |
$78.63
|
| Rate for Payer: Aetna Medicare |
$61.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.63
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: BCBS MAPPO |
$58.68
|
| Rate for Payer: BCN Medicare Advantage |
$58.68
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$84.50
|
| Rate for Payer: Cofinity Commercial |
$78.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.61
|
| Rate for Payer: Nomi Health Commercial |
$70.42
|
| Rate for Payer: PACE SWMI |
$58.68
|
| Rate for Payer: PHP Commercial |
$82.15
|
| Rate for Payer: PHP Medicare Advantage |
$58.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: Priority Health Medicare |
$58.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.68
|
| Rate for Payer: UHC Medicare Advantage |
$58.68
|
| Rate for Payer: UMR Bronson Commercial |
$42.32
|
|
