|
PR CORRJ HLX VLGS BNCTY SESMDC RESCJ PROX PHLX BASE
|
Professional
|
Both
|
$1,780.00
|
|
|
Service Code
|
HCPCS 28292
|
| Min. Negotiated Rate |
$316.52 |
| Max. Negotiated Rate |
$1,544.75 |
| Rate for Payer: Aetna Commercial |
$623.76
|
| Rate for Payer: Aetna Medicare |
$484.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$623.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.31
|
| Rate for Payer: BCBS Complete |
$332.35
|
| Rate for Payer: BCBS MAPPO |
$465.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,544.75
|
| Rate for Payer: BCN Commercial |
$1,011.07
|
| Rate for Payer: BCN Medicare Advantage |
$465.49
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cofinity Commercial |
$623.76
|
| Rate for Payer: Cofinity Commercial |
$670.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$488.76
|
| Rate for Payer: Meridian Medicaid |
$332.35
|
| Rate for Payer: Nomi Health Commercial |
$558.59
|
| Rate for Payer: PACE SWMI |
$465.49
|
| Rate for Payer: PHP Commercial |
$651.69
|
| Rate for Payer: PHP Medicare Advantage |
$465.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$316.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,157.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$749.04
|
| Rate for Payer: Priority Health Medicare |
$465.49
|
| Rate for Payer: Priority Health Narrow Network |
$749.04
|
| Rate for Payer: Priority Health SBD |
$749.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$465.49
|
| Rate for Payer: UHC Medicare Advantage |
$465.49
|
| Rate for Payer: UHCCP Medicaid |
$316.52
|
| Rate for Payer: UMR Bronson Commercial |
$818.80
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC W/DOUBLE OSTEOTOMY
|
Professional
|
Both
|
$2,406.00
|
|
|
Service Code
|
HCPCS 28299
|
| Min. Negotiated Rate |
$387.02 |
| Max. Negotiated Rate |
$1,563.90 |
| Rate for Payer: Aetna Commercial |
$765.23
|
| Rate for Payer: Aetna Medicare |
$593.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$765.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.34
|
| Rate for Payer: BCBS Complete |
$406.37
|
| Rate for Payer: BCBS MAPPO |
$571.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,113.66
|
| Rate for Payer: BCN Commercial |
$1,468.47
|
| Rate for Payer: BCN Medicare Advantage |
$571.07
|
| Rate for Payer: Cash Price |
$1,924.80
|
| Rate for Payer: Cash Price |
$1,924.80
|
| Rate for Payer: Cofinity Commercial |
$765.23
|
| Rate for Payer: Cofinity Commercial |
$822.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$571.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$599.62
|
| Rate for Payer: Meridian Medicaid |
$406.37
|
| Rate for Payer: Nomi Health Commercial |
$685.28
|
| Rate for Payer: PACE SWMI |
$571.07
|
| Rate for Payer: PHP Commercial |
$799.50
|
| Rate for Payer: PHP Medicare Advantage |
$571.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,563.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$916.46
|
| Rate for Payer: Priority Health Medicare |
$571.07
|
| Rate for Payer: Priority Health Narrow Network |
$916.46
|
| Rate for Payer: Priority Health SBD |
$916.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$571.07
|
| Rate for Payer: UHC Medicare Advantage |
$571.07
|
| Rate for Payer: UHCCP Medicaid |
$387.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,106.76
|
|
|
PR CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD
|
Professional
|
Both
|
$2,997.00
|
|
|
Service Code
|
HCPCS 67912
|
| Min. Negotiated Rate |
$307.79 |
| Max. Negotiated Rate |
$1,948.05 |
| Rate for Payer: Aetna Commercial |
$602.73
|
| Rate for Payer: Aetna Medicare |
$467.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$647.71
|
| Rate for Payer: BCBS Complete |
$323.18
|
| Rate for Payer: BCBS MAPPO |
$449.80
|
| Rate for Payer: BCN Commercial |
$1,323.34
|
| Rate for Payer: BCN Medicare Advantage |
$449.80
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cofinity Commercial |
$602.73
|
| Rate for Payer: Cofinity Commercial |
$647.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$472.29
|
| Rate for Payer: Meridian Medicaid |
$323.18
|
| Rate for Payer: Nomi Health Commercial |
$539.76
|
| Rate for Payer: PACE SWMI |
$449.80
|
| Rate for Payer: PHP Commercial |
$629.72
|
| Rate for Payer: PHP Medicare Advantage |
$449.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$307.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,948.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.78
|
| Rate for Payer: Priority Health Medicare |
$449.80
|
| Rate for Payer: Priority Health Narrow Network |
$845.78
|
| Rate for Payer: Priority Health SBD |
$845.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$449.80
|
| Rate for Payer: UHC Medicare Advantage |
$449.80
|
| Rate for Payer: UHCCP Medicaid |
$307.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,378.62
|
|
|
PR CORRJ MALROTATION BANDS&/RDCTJ VOLVULUS
|
Professional
|
Both
|
$3,172.00
|
|
|
Service Code
|
HCPCS 44055
|
| Min. Negotiated Rate |
$957.44 |
| Max. Negotiated Rate |
$2,659.62 |
| Rate for Payer: Aetna Commercial |
$1,945.34
|
| Rate for Payer: Aetna Medicare |
$1,509.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,945.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,090.52
|
| Rate for Payer: BCBS Complete |
$1,005.31
|
| Rate for Payer: BCBS MAPPO |
$1,451.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,321.81
|
| Rate for Payer: BCN Commercial |
$2,163.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.75
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Cofinity Commercial |
$1,945.34
|
| Rate for Payer: Cofinity Commercial |
$2,090.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,524.34
|
| Rate for Payer: Meridian Medicaid |
$1,005.31
|
| Rate for Payer: Nomi Health Commercial |
$1,742.10
|
| Rate for Payer: PACE SWMI |
$1,451.75
|
| Rate for Payer: PHP Commercial |
$2,032.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$957.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,659.62
|
| Rate for Payer: Priority Health Medicare |
$1,451.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,659.62
|
| Rate for Payer: Priority Health SBD |
$2,659.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,451.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,451.75
|
| Rate for Payer: UHCCP Medicaid |
$957.44
|
| Rate for Payer: UMR Bronson Commercial |
$1,459.12
|
|
|
PR COSMETIC CORRECTION OF INVERTED NIPPLES
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 00557
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$612.00 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Aetna Medicare |
$765.00
|
| Rate for Payer: BCBS Complete |
$612.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: UMR Bronson Commercial |
$703.80
|
|
|
PR COSMETIC SCLEROTHERAPY
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00181
|
|
Hospital Revenue Code
|
960
|
| 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 COSMETIC SCLEROTHERAPY/LASER
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: UMR Bronson Commercial |
$117.30
|
|
|
PR COSMETIC SCLEROTHERAPY/LASER/F/U TREATMENT
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 00123
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: UMR Bronson Commercial |
$35.42
|
|
|
PR COSTOVERTEBRAL DCMPRN SPINAL CORD THORACIC 1 SEG
|
Professional
|
Both
|
$6,256.00
|
|
|
Service Code
|
HCPCS 63064
|
| Min. Negotiated Rate |
$631.85 |
| Max. Negotiated Rate |
$4,066.40 |
| Rate for Payer: Aetna Commercial |
$2,323.77
|
| Rate for Payer: Aetna Medicare |
$1,803.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,323.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,497.19
|
| Rate for Payer: BCBS Complete |
$1,201.89
|
| Rate for Payer: BCBS MAPPO |
$1,734.16
|
| Rate for Payer: BCBS Trust/PPO |
$631.85
|
| Rate for Payer: BCN Commercial |
$2,887.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,734.16
|
| Rate for Payer: Cash Price |
$5,004.80
|
| Rate for Payer: Cash Price |
$5,004.80
|
| Rate for Payer: Cofinity Commercial |
$2,497.19
|
| Rate for Payer: Cofinity Commercial |
$2,323.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,734.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,820.87
|
| Rate for Payer: Meridian Medicaid |
$1,201.89
|
| Rate for Payer: Nomi Health Commercial |
$2,080.99
|
| Rate for Payer: PACE SWMI |
$1,734.16
|
| Rate for Payer: PHP Commercial |
$2,427.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,734.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,144.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,066.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,065.95
|
| Rate for Payer: Priority Health Medicare |
$1,734.16
|
| Rate for Payer: Priority Health Narrow Network |
$3,065.95
|
| Rate for Payer: Priority Health SBD |
$3,065.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,734.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,734.16
|
| Rate for Payer: UHCCP Medicaid |
$1,144.66
|
| Rate for Payer: UMR Bronson Commercial |
$2,877.76
|
|
|
PR COSTOVERTEBRAL DCMPRN SPINE CORD THORACIC EA SEG
|
Professional
|
Both
|
$2,145.00
|
|
|
Service Code
|
HCPCS 63066
|
| Min. Negotiated Rate |
$132.06 |
| Max. Negotiated Rate |
$1,394.25 |
| Rate for Payer: Aetna Commercial |
$272.73
|
| Rate for Payer: Aetna Medicare |
$211.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.08
|
| Rate for Payer: BCBS Complete |
$138.66
|
| Rate for Payer: BCBS MAPPO |
$203.53
|
| Rate for Payer: BCBS Trust/PPO |
$766.04
|
| Rate for Payer: BCN Commercial |
$330.92
|
| Rate for Payer: BCN Medicare Advantage |
$203.53
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cofinity Commercial |
$293.08
|
| Rate for Payer: Cofinity Commercial |
$272.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.71
|
| Rate for Payer: Meridian Medicaid |
$138.66
|
| Rate for Payer: Nomi Health Commercial |
$244.24
|
| Rate for Payer: PACE SWMI |
$203.53
|
| Rate for Payer: PHP Commercial |
$284.94
|
| Rate for Payer: PHP Medicare Advantage |
$203.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$132.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$350.89
|
| Rate for Payer: Priority Health Medicare |
$203.53
|
| Rate for Payer: Priority Health Narrow Network |
$350.89
|
| Rate for Payer: Priority Health SBD |
$350.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.53
|
| Rate for Payer: UHC Medicare Advantage |
$203.53
|
| Rate for Payer: UHCCP Medicaid |
$132.06
|
| Rate for Payer: UMR Bronson Commercial |
$986.70
|
|
|
PR COUDE TIP URINARY CATHETER
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS A4352
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCN Commercial |
$6.01
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: UMR Bronson Commercial |
$3.68
|
|
|
PR COUNSEL IMMUNE <21 16-30 M
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS G0314
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$29.90 |
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: UMR Bronson Commercial |
$21.16
|
|
|
PR COUNSEL IMMUNE <21 5-15 M
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS G0315
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
|
|
PR CPAP VENTILATION CPAP INITIATION&MGMT
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 94660
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$313.28 |
| Rate for Payer: Aetna Commercial |
$46.54
|
| Rate for Payer: Aetna Medicare |
$36.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.01
|
| Rate for Payer: BCBS Complete |
$24.38
|
| Rate for Payer: BCBS MAPPO |
$34.73
|
| Rate for Payer: BCBS Trust/PPO |
$313.28
|
| Rate for Payer: BCN Commercial |
$91.87
|
| Rate for Payer: BCN Medicare Advantage |
$34.73
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cofinity Commercial |
$46.54
|
| Rate for Payer: Cofinity Commercial |
$50.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.47
|
| Rate for Payer: Meridian Medicaid |
$24.38
|
| Rate for Payer: Nomi Health Commercial |
$41.68
|
| Rate for Payer: PACE SWMI |
$34.73
|
| Rate for Payer: PHP Commercial |
$48.62
|
| Rate for Payer: PHP Medicare Advantage |
$34.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.76
|
| Rate for Payer: Priority Health Medicare |
$34.73
|
| Rate for Payer: Priority Health Narrow Network |
$49.76
|
| Rate for Payer: Priority Health SBD |
$49.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.73
|
| Rate for Payer: UHC Medicare Advantage |
$34.73
|
| Rate for Payer: UHCCP Medicaid |
$23.22
|
| Rate for Payer: UMR Bronson Commercial |
$107.18
|
|
|
PR CPLX CHRONIC CARE MGMT SVC EA ADDL 30 MIN CAL MO
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 99489
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$1,256.83 |
| Rate for Payer: Aetna Commercial |
$62.19
|
| Rate for Payer: Aetna Medicare |
$48.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.83
|
| Rate for Payer: BCBS Complete |
$32.66
|
| Rate for Payer: BCBS MAPPO |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,256.83
|
| Rate for Payer: BCN Commercial |
$74.52
|
| Rate for Payer: BCN Medicare Advantage |
$46.41
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$62.19
|
| Rate for Payer: Cofinity Commercial |
$66.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.73
|
| Rate for Payer: Meridian Medicaid |
$32.66
|
| Rate for Payer: Nomi Health Commercial |
$55.69
|
| Rate for Payer: PACE SWMI |
$46.41
|
| Rate for Payer: PHP Commercial |
$64.97
|
| Rate for Payer: PHP Medicare Advantage |
$46.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.86
|
| Rate for Payer: Priority Health Medicare |
$46.41
|
| Rate for Payer: Priority Health Narrow Network |
$66.86
|
| Rate for Payer: Priority Health SBD |
$66.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.41
|
| Rate for Payer: UHC Medicare Advantage |
$46.41
|
| Rate for Payer: UHCCP Medicaid |
$31.10
|
| Rate for Payer: UMR Bronson Commercial |
$26.22
|
|
|
PR CPLX INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ
|
Professional
|
Both
|
$10,302.00
|
|
|
Service Code
|
HCPCS 61698
|
| Min. Negotiated Rate |
$905.51 |
| Max. Negotiated Rate |
$9,419.88 |
| Rate for Payer: Aetna Commercial |
$6,138.85
|
| Rate for Payer: Aetna Medicare |
$4,764.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,138.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,596.97
|
| Rate for Payer: BCBS Complete |
$3,140.72
|
| Rate for Payer: BCBS MAPPO |
$4,581.23
|
| Rate for Payer: BCBS Trust/PPO |
$905.51
|
| Rate for Payer: BCN Commercial |
$9,419.88
|
| Rate for Payer: BCN Medicare Advantage |
$4,581.23
|
| Rate for Payer: Cash Price |
$8,241.60
|
| Rate for Payer: Cash Price |
$8,241.60
|
| Rate for Payer: Cofinity Commercial |
$6,138.85
|
| Rate for Payer: Cofinity Commercial |
$6,596.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,581.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,810.29
|
| Rate for Payer: Meridian Medicaid |
$3,140.72
|
| Rate for Payer: Nomi Health Commercial |
$5,497.48
|
| Rate for Payer: PACE SWMI |
$4,581.23
|
| Rate for Payer: PHP Commercial |
$6,413.72
|
| Rate for Payer: PHP Medicare Advantage |
$4,581.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,991.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,696.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,956.89
|
| Rate for Payer: Priority Health Medicare |
$4,581.23
|
| Rate for Payer: Priority Health Narrow Network |
$7,956.89
|
| Rate for Payer: Priority Health SBD |
$7,956.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,581.23
|
| Rate for Payer: UHC Medicare Advantage |
$4,581.23
|
| Rate for Payer: UHCCP Medicaid |
$2,991.16
|
| Rate for Payer: UMR Bronson Commercial |
$4,738.92
|
|
|
PR CPTR-ASST MUSCSKEL NAVIGJ ORTHO CT/MRI
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 0055T
|
| Min. Negotiated Rate |
$146.69 |
| Max. Negotiated Rate |
$448.43 |
| Rate for Payer: Aetna Commercial |
$210.14
|
| Rate for Payer: Aetna Medicare |
$255.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.14
|
| Rate for Payer: BCBS Complete |
$154.02
|
| Rate for Payer: BCBS Trust/PPO |
$448.43
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Meridian Medicaid |
$154.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: UHCCP Medicaid |
$146.69
|
| Rate for Payer: UMR Bronson Commercial |
$234.60
|
|
|
PR CPTR-ASST MUSCSKEL NAVIGJ ORTHO FLUOR IMAGES
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 0054T
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$179.20 |
| Rate for Payer: Aetna Commercial |
$179.20
|
| Rate for Payer: Aetna Medicare |
$133.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.20
|
| Rate for Payer: BCBS Complete |
$96.34
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Meridian Medicaid |
$96.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.55
|
| Rate for Payer: UHCCP Medicaid |
$91.75
|
| Rate for Payer: UMR Bronson Commercial |
$122.82
|
|
|
PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 20985
|
| Hospital Charge Code |
20985
|
| Min. Negotiated Rate |
$124.52 |
| Max. Negotiated Rate |
$254.70 |
| Rate for Payer: Aetna American Axle |
$183.95
|
| Rate for Payer: Aetna Commercial |
$240.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.95
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cofinity Commercial |
$198.10
|
| Rate for Payer: Cofinity Commercial |
$243.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$198.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.40
|
| Rate for Payer: Healthscope Commercial |
$254.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.55
|
| Rate for Payer: PHP Commercial |
$240.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.95
|
| Rate for Payer: Priority Health SBD |
$178.29
|
| Rate for Payer: UMR Bronson Commercial |
$124.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.25
|
|
|
PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
HCPCS 20985
|
| Hospital Charge Code |
20985
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$218.82 |
| Rate for Payer: Aetna Commercial |
$186.41
|
| Rate for Payer: Aetna Medicare |
$144.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.32
|
| Rate for Payer: BCBS Complete |
$96.84
|
| Rate for Payer: BCBS MAPPO |
$139.11
|
| Rate for Payer: BCBS Trust/PPO |
$99.81
|
| Rate for Payer: BCN Commercial |
$210.13
|
| Rate for Payer: BCN Medicare Advantage |
$139.11
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cofinity Commercial |
$200.32
|
| Rate for Payer: Cofinity Commercial |
$186.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.07
|
| Rate for Payer: Meridian Medicaid |
$96.84
|
| Rate for Payer: Nomi Health Commercial |
$166.93
|
| Rate for Payer: PACE SWMI |
$139.11
|
| Rate for Payer: PHP Commercial |
$194.75
|
| Rate for Payer: PHP Medicare Advantage |
$139.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.82
|
| Rate for Payer: Priority Health Medicare |
$139.11
|
| Rate for Payer: Priority Health Narrow Network |
$218.82
|
| Rate for Payer: Priority Health SBD |
$218.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.11
|
| Rate for Payer: UHC Medicare Advantage |
$139.11
|
| Rate for Payer: UHCCP Medicaid |
$92.23
|
| Rate for Payer: UMR Bronson Commercial |
$130.18
|
|
|
PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
HCPCS 20985
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$218.82 |
| Rate for Payer: Aetna Commercial |
$186.41
|
| Rate for Payer: Aetna Medicare |
$144.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.41
|
| Rate for Payer: BCBS Complete |
$96.84
|
| Rate for Payer: BCBS MAPPO |
$139.11
|
| Rate for Payer: BCBS Trust/PPO |
$99.81
|
| Rate for Payer: BCN Commercial |
$210.13
|
| Rate for Payer: BCN Medicare Advantage |
$139.11
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cofinity Commercial |
$186.41
|
| Rate for Payer: Cofinity Commercial |
$200.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.07
|
| Rate for Payer: Meridian Medicaid |
$96.84
|
| Rate for Payer: Nomi Health Commercial |
$166.93
|
| Rate for Payer: PACE SWMI |
$139.11
|
| Rate for Payer: PHP Commercial |
$194.75
|
| Rate for Payer: PHP Medicare Advantage |
$139.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.82
|
| Rate for Payer: Priority Health Medicare |
$139.11
|
| Rate for Payer: Priority Health Narrow Network |
$218.82
|
| Rate for Payer: Priority Health SBD |
$218.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.11
|
| Rate for Payer: UHC Medicare Advantage |
$139.11
|
| Rate for Payer: UHCCP Medicaid |
$92.23
|
| Rate for Payer: UMR Bronson Commercial |
$130.18
|
|
|
PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT 20985
|
| Hospital Charge Code |
20985
|
| Min. Negotiated Rate |
$104.71 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$183.95
|
| Rate for Payer: Aetna Commercial |
$240.55
|
| Rate for Payer: Aetna Medicare |
$141.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.95
|
| Rate for Payer: BCBS Complete |
$113.20
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cofinity Commercial |
$243.38
|
| Rate for Payer: Cofinity Commercial |
$198.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$198.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.40
|
| Rate for Payer: Healthscope Commercial |
$254.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.55
|
| Rate for Payer: PHP Commercial |
$240.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.95
|
| Rate for Payer: Priority Health SBD |
$178.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.92
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$139.93
|
| Rate for Payer: UMR Bronson Commercial |
$104.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.25
|
|
|
PR CRANFCL ANT CRANIAL FOSSA UNI/BI CRANIOT/OSTEOT
|
Professional
|
Both
|
$7,294.00
|
|
|
Service Code
|
HCPCS 61582
|
| Min. Negotiated Rate |
$893.36 |
| Max. Negotiated Rate |
$6,455.95 |
| Rate for Payer: Aetna Commercial |
$3,925.76
|
| Rate for Payer: Aetna Medicare |
$3,046.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,925.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,218.72
|
| Rate for Payer: BCBS Complete |
$2,059.60
|
| Rate for Payer: BCBS MAPPO |
$2,929.67
|
| Rate for Payer: BCBS Trust/PPO |
$893.36
|
| Rate for Payer: BCN Commercial |
$6,455.95
|
| Rate for Payer: BCN Medicare Advantage |
$2,929.67
|
| Rate for Payer: Cash Price |
$5,835.20
|
| Rate for Payer: Cash Price |
$5,835.20
|
| Rate for Payer: Cofinity Commercial |
$3,925.76
|
| Rate for Payer: Cofinity Commercial |
$4,218.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,929.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,076.15
|
| Rate for Payer: Meridian Medicaid |
$2,059.60
|
| Rate for Payer: Nomi Health Commercial |
$3,515.60
|
| Rate for Payer: PACE SWMI |
$2,929.67
|
| Rate for Payer: PHP Commercial |
$4,101.54
|
| Rate for Payer: PHP Medicare Advantage |
$2,929.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,961.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,741.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,171.32
|
| Rate for Payer: Priority Health Medicare |
$2,929.67
|
| Rate for Payer: Priority Health Narrow Network |
$5,171.32
|
| Rate for Payer: Priority Health SBD |
$5,171.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,929.67
|
| Rate for Payer: UHC Medicare Advantage |
$2,929.67
|
| Rate for Payer: UHCCP Medicaid |
$1,961.52
|
| Rate for Payer: UMR Bronson Commercial |
$3,355.24
|
|
|
PR CRANFCL ANT CRANIAL FOSSA UNI/BIFRNTL ELEV LOBE
|
Professional
|
Both
|
$7,968.00
|
|
|
Service Code
|
HCPCS 61583
|
| Min. Negotiated Rate |
$841.58 |
| Max. Negotiated Rate |
$6,001.73 |
| Rate for Payer: Aetna Commercial |
$3,833.46
|
| Rate for Payer: Aetna Medicare |
$2,975.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,833.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,119.54
|
| Rate for Payer: BCBS Complete |
$1,990.26
|
| Rate for Payer: BCBS MAPPO |
$2,860.79
|
| Rate for Payer: BCBS Trust/PPO |
$841.58
|
| Rate for Payer: BCN Commercial |
$6,001.73
|
| Rate for Payer: BCN Medicare Advantage |
$2,860.79
|
| Rate for Payer: Cash Price |
$6,374.40
|
| Rate for Payer: Cash Price |
$6,374.40
|
| Rate for Payer: Cofinity Commercial |
$3,833.46
|
| Rate for Payer: Cofinity Commercial |
$4,119.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,860.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,003.83
|
| Rate for Payer: Meridian Medicaid |
$1,990.26
|
| Rate for Payer: Nomi Health Commercial |
$3,432.95
|
| Rate for Payer: PACE SWMI |
$2,860.79
|
| Rate for Payer: PHP Commercial |
$4,005.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,860.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,895.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,179.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,031.43
|
| Rate for Payer: Priority Health Medicare |
$2,860.79
|
| Rate for Payer: Priority Health Narrow Network |
$5,031.43
|
| Rate for Payer: Priority Health SBD |
$5,031.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,860.79
|
| Rate for Payer: UHC Medicare Advantage |
$2,860.79
|
| Rate for Payer: UHCCP Medicaid |
$1,895.49
|
| Rate for Payer: UMR Bronson Commercial |
$3,665.28
|
|
|
PR CRANIECTOMY CRANIOSYNOSTOSIS BIFRONTAL BONE FLAP
|
Professional
|
Both
|
$3,387.00
|
|
|
Service Code
|
HCPCS 61557
|
| Min. Negotiated Rate |
$1,103.13 |
| Max. Negotiated Rate |
$3,460.84 |
| Rate for Payer: Aetna Commercial |
$2,243.72
|
| Rate for Payer: Aetna Medicare |
$1,741.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,243.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,411.16
|
| Rate for Payer: BCBS Complete |
$1,158.29
|
| Rate for Payer: BCBS MAPPO |
$1,674.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,068.29
|
| Rate for Payer: BCN Commercial |
$3,460.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,674.42
|
| Rate for Payer: Cash Price |
$2,709.60
|
| Rate for Payer: Cash Price |
$2,709.60
|
| Rate for Payer: Cofinity Commercial |
$2,243.72
|
| Rate for Payer: Cofinity Commercial |
$2,411.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,674.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,758.14
|
| Rate for Payer: Meridian Medicaid |
$1,158.29
|
| Rate for Payer: Nomi Health Commercial |
$2,009.30
|
| Rate for Payer: PACE SWMI |
$1,674.42
|
| Rate for Payer: PHP Commercial |
$2,344.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,674.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,103.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,201.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,931.16
|
| Rate for Payer: Priority Health Medicare |
$1,674.42
|
| Rate for Payer: Priority Health Narrow Network |
$2,931.16
|
| Rate for Payer: Priority Health SBD |
$2,931.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,674.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,674.42
|
| Rate for Payer: UHCCP Medicaid |
$1,103.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,558.02
|
|
