|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 43450
|
| Min. Negotiated Rate |
$75.17 |
| Max. Negotiated Rate |
$213.20 |
| Rate for Payer: Aetna Commercial |
$100.73
|
| Rate for Payer: Aetna Medicare |
$78.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.73
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$75.17
|
| Rate for Payer: BCN Medicare Advantage |
$75.17
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$108.24
|
| Rate for Payer: Cofinity Commercial |
$100.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.93
|
| Rate for Payer: Nomi Health Commercial |
$90.20
|
| Rate for Payer: PACE SWMI |
$75.17
|
| Rate for Payer: PHP Commercial |
$105.24
|
| Rate for Payer: PHP Medicare Advantage |
$75.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$75.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.17
|
| Rate for Payer: UHC Medicare Advantage |
$75.17
|
| Rate for Payer: UMR Bronson Commercial |
$150.88
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 43450
|
| Hospital Charge Code |
43450
|
| Min. Negotiated Rate |
$75.17 |
| Max. Negotiated Rate |
$213.20 |
| Rate for Payer: Aetna Commercial |
$100.73
|
| Rate for Payer: Aetna Medicare |
$78.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.73
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$75.17
|
| Rate for Payer: BCN Medicare Advantage |
$75.17
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$100.73
|
| Rate for Payer: Cofinity Commercial |
$108.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.93
|
| Rate for Payer: Nomi Health Commercial |
$90.20
|
| Rate for Payer: PACE SWMI |
$75.17
|
| Rate for Payer: PHP Commercial |
$105.24
|
| Rate for Payer: PHP Medicare Advantage |
$75.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$75.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.17
|
| Rate for Payer: UHC Medicare Advantage |
$75.17
|
| Rate for Payer: UMR Bronson Commercial |
$150.88
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
43450
|
| Min. Negotiated Rate |
$121.36 |
| Max. Negotiated Rate |
$2,573.89 |
| Rate for Payer: Aetna American Axle |
$213.20
|
| Rate for Payer: Aetna Commercial |
$278.80
|
| Rate for Payer: Aetna Medicare |
$950.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$282.08
|
| Rate for Payer: Cofinity Commercial |
$229.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$295.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.00
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$278.80
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health SBD |
$206.64
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,573.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Exchange |
$1,747.47
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
| Rate for Payer: UMR Bronson Commercial |
$121.36
|
| Rate for Payer: VA VA |
$914.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.00
|
|
|
PR DILATION LACRIMAL PUNCTUM W/WO IRRGATION
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 68801
|
| Min. Negotiated Rate |
$72.54 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Aetna Medicare |
$75.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.46
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS MAPPO |
$72.54
|
| Rate for Payer: BCN Medicare Advantage |
$72.54
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$97.20
|
| Rate for Payer: Cofinity Commercial |
$104.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.17
|
| Rate for Payer: Nomi Health Commercial |
$87.05
|
| Rate for Payer: PACE SWMI |
$72.54
|
| Rate for Payer: PHP Commercial |
$101.56
|
| Rate for Payer: PHP Medicare Advantage |
$72.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health Medicare |
$72.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.54
|
| Rate for Payer: UHC Medicare Advantage |
$72.54
|
| Rate for Payer: UMR Bronson Commercial |
$99.36
|
|
|
PR DILATION SALIVARY DUCT
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 42650
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$81.46 |
| Rate for Payer: Aetna Commercial |
$75.80
|
| Rate for Payer: Aetna Medicare |
$58.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.80
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$56.57
|
| Rate for Payer: BCN Medicare Advantage |
$56.57
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$81.46
|
| Rate for Payer: Cofinity Commercial |
$75.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.40
|
| Rate for Payer: Nomi Health Commercial |
$67.88
|
| Rate for Payer: PACE SWMI |
$56.57
|
| Rate for Payer: PHP Commercial |
$79.20
|
| Rate for Payer: PHP Medicare Advantage |
$56.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$56.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.57
|
| Rate for Payer: UHC Medicare Advantage |
$56.57
|
| Rate for Payer: UMR Bronson Commercial |
$57.50
|
|
|
PR DILATION VAGINA W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 57400
|
| Min. Negotiated Rate |
$125.35 |
| Max. Negotiated Rate |
$240.50 |
| Rate for Payer: Aetna Commercial |
$167.97
|
| Rate for Payer: Aetna Medicare |
$130.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.97
|
| Rate for Payer: BCBS Complete |
$148.00
|
| Rate for Payer: BCBS MAPPO |
$125.35
|
| Rate for Payer: BCN Medicare Advantage |
$125.35
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cofinity Commercial |
$180.50
|
| Rate for Payer: Cofinity Commercial |
$167.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.62
|
| Rate for Payer: Nomi Health Commercial |
$150.42
|
| Rate for Payer: PACE SWMI |
$125.35
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: PHP Medicare Advantage |
$125.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.50
|
| Rate for Payer: Priority Health Medicare |
$125.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.35
|
| Rate for Payer: UHC Medicare Advantage |
$125.35
|
| Rate for Payer: UMR Bronson Commercial |
$170.20
|
|
|
PR DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 45910
|
| Min. Negotiated Rate |
$185.42 |
| Max. Negotiated Rate |
$858.00 |
| Rate for Payer: Aetna Commercial |
$248.46
|
| Rate for Payer: Aetna Medicare |
$192.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.46
|
| Rate for Payer: BCBS Complete |
$528.00
|
| Rate for Payer: BCBS MAPPO |
$185.42
|
| Rate for Payer: BCN Medicare Advantage |
$185.42
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cofinity Commercial |
$267.00
|
| Rate for Payer: Cofinity Commercial |
$248.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.69
|
| Rate for Payer: Nomi Health Commercial |
$222.50
|
| Rate for Payer: PACE SWMI |
$185.42
|
| Rate for Payer: PHP Commercial |
$259.59
|
| Rate for Payer: PHP Medicare Advantage |
$185.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$858.00
|
| Rate for Payer: Priority Health Medicare |
$185.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.42
|
| Rate for Payer: UHC Medicare Advantage |
$185.42
|
| Rate for Payer: UMR Bronson Commercial |
$607.20
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE 1ST
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 53600
|
| Min. Negotiated Rate |
$61.12 |
| Max. Negotiated Rate |
$111.80 |
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna Medicare |
$63.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.90
|
| Rate for Payer: BCBS Complete |
$68.80
|
| Rate for Payer: BCBS MAPPO |
$61.12
|
| Rate for Payer: BCN Medicare Advantage |
$61.12
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$88.01
|
| Rate for Payer: Cofinity Commercial |
$81.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.18
|
| Rate for Payer: Nomi Health Commercial |
$73.34
|
| Rate for Payer: PACE SWMI |
$61.12
|
| Rate for Payer: PHP Commercial |
$85.57
|
| Rate for Payer: PHP Medicare Advantage |
$61.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.80
|
| Rate for Payer: Priority Health Medicare |
$61.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.12
|
| Rate for Payer: UHC Medicare Advantage |
$61.12
|
| Rate for Payer: UMR Bronson Commercial |
$79.12
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE SBSQ
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 53601
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$105.95 |
| Rate for Payer: Aetna Commercial |
$68.43
|
| Rate for Payer: Aetna Medicare |
$53.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.43
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: BCBS MAPPO |
$51.07
|
| Rate for Payer: BCN Medicare Advantage |
$51.07
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$73.54
|
| Rate for Payer: Cofinity Commercial |
$68.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.62
|
| Rate for Payer: Nomi Health Commercial |
$61.28
|
| Rate for Payer: PACE SWMI |
$51.07
|
| Rate for Payer: PHP Commercial |
$71.50
|
| Rate for Payer: PHP Medicare Advantage |
$51.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health Medicare |
$51.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.07
|
| Rate for Payer: UHC Medicare Advantage |
$51.07
|
| Rate for Payer: UMR Bronson Commercial |
$74.98
|
|
|
PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 53620
|
| Min. Negotiated Rate |
$82.97 |
| Max. Negotiated Rate |
$169.65 |
| Rate for Payer: Aetna Commercial |
$111.18
|
| Rate for Payer: Aetna Medicare |
$86.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.18
|
| Rate for Payer: BCBS Complete |
$104.40
|
| Rate for Payer: BCBS MAPPO |
$82.97
|
| Rate for Payer: BCN Medicare Advantage |
$82.97
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$119.48
|
| Rate for Payer: Cofinity Commercial |
$111.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.12
|
| Rate for Payer: Nomi Health Commercial |
$99.56
|
| Rate for Payer: PACE SWMI |
$82.97
|
| Rate for Payer: PHP Commercial |
$116.16
|
| Rate for Payer: PHP Medicare Advantage |
$82.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: Priority Health Medicare |
$82.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.97
|
| Rate for Payer: UHC Medicare Advantage |
$82.97
|
| Rate for Payer: UMR Bronson Commercial |
$120.06
|
|
|
PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE SBSQ
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 53621
|
| Min. Negotiated Rate |
$68.30 |
| Max. Negotiated Rate |
$159.90 |
| Rate for Payer: Aetna Commercial |
$91.52
|
| Rate for Payer: Aetna Medicare |
$71.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.52
|
| Rate for Payer: BCBS Complete |
$98.40
|
| Rate for Payer: BCBS MAPPO |
$68.30
|
| Rate for Payer: BCN Medicare Advantage |
$68.30
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$98.35
|
| Rate for Payer: Cofinity Commercial |
$91.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.72
|
| Rate for Payer: Nomi Health Commercial |
$81.96
|
| Rate for Payer: PACE SWMI |
$68.30
|
| Rate for Payer: PHP Commercial |
$95.62
|
| Rate for Payer: PHP Medicare Advantage |
$68.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.90
|
| Rate for Payer: Priority Health Medicare |
$68.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.30
|
| Rate for Payer: UHC Medicare Advantage |
$68.30
|
| Rate for Payer: UMR Bronson Commercial |
$113.16
|
|
|
PR DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 53605
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$87.88 |
| Rate for Payer: Aetna Commercial |
$81.78
|
| Rate for Payer: Aetna Medicare |
$63.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.78
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$61.03
|
| Rate for Payer: BCN Medicare Advantage |
$61.03
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$87.88
|
| Rate for Payer: Cofinity Commercial |
$81.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.08
|
| Rate for Payer: Nomi Health Commercial |
$73.24
|
| Rate for Payer: PACE SWMI |
$61.03
|
| Rate for Payer: PHP Commercial |
$85.44
|
| Rate for Payer: PHP Medicare Advantage |
$61.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$61.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.03
|
| Rate for Payer: UHC Medicare Advantage |
$61.03
|
| Rate for Payer: UMR Bronson Commercial |
$57.50
|
|
|
PR DIPHENHYDRAMINE HCL INJECTIO
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J1200
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$1.02
|
| Rate for Payer: Aetna Medicare |
$0.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.02
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$0.76
|
| Rate for Payer: BCN Medicare Advantage |
$0.76
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$1.09
|
| Rate for Payer: Cofinity Commercial |
$1.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.80
|
| Rate for Payer: Nomi Health Commercial |
$0.91
|
| Rate for Payer: PACE SWMI |
$0.76
|
| Rate for Payer: PHP Commercial |
$1.06
|
| Rate for Payer: PHP Medicare Advantage |
$0.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$0.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.76
|
| Rate for Payer: UHC Medicare Advantage |
$0.76
|
| Rate for Payer: UMR Bronson Commercial |
$9.20
|
|
|
PR DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 90700
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Medicare |
$24.00
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: UMR Bronson Commercial |
$22.08
|
|
|
PR DIR/PTCH CLS SINUS VENOSUS W/WO ANOM PUL VEN DRG
|
Professional
|
Both
|
$7,628.00
|
|
|
Service Code
|
HCPCS 33645
|
| Min. Negotiated Rate |
$1,662.30 |
| Max. Negotiated Rate |
$4,958.20 |
| Rate for Payer: Aetna Commercial |
$2,227.48
|
| Rate for Payer: Aetna Medicare |
$1,728.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,227.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,393.71
|
| Rate for Payer: BCBS Complete |
$3,051.20
|
| Rate for Payer: BCBS MAPPO |
$1,662.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,662.30
|
| Rate for Payer: Cash Price |
$6,102.40
|
| Rate for Payer: Cash Price |
$6,102.40
|
| Rate for Payer: Cofinity Commercial |
$2,227.48
|
| Rate for Payer: Cofinity Commercial |
$2,393.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,662.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,745.41
|
| Rate for Payer: Nomi Health Commercial |
$1,994.76
|
| Rate for Payer: PACE SWMI |
$1,662.30
|
| Rate for Payer: PHP Commercial |
$2,327.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,662.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,958.20
|
| Rate for Payer: Priority Health Medicare |
$1,662.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,662.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,662.30
|
| Rate for Payer: UMR Bronson Commercial |
$3,508.88
|
|
|
PR DIR RPR ANEURYSM ABDOM AORTA W/ILIAC VESSELS
|
Professional
|
Both
|
$3,721.00
|
|
|
Service Code
|
HCPCS 35102
|
| Min. Negotiated Rate |
$1,488.40 |
| Max. Negotiated Rate |
$2,596.98 |
| Rate for Payer: Aetna Commercial |
$2,416.64
|
| Rate for Payer: Aetna Medicare |
$1,875.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,596.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,416.64
|
| Rate for Payer: BCBS Complete |
$1,488.40
|
| Rate for Payer: BCBS MAPPO |
$1,803.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,803.46
|
| Rate for Payer: Cash Price |
$2,976.80
|
| Rate for Payer: Cash Price |
$2,976.80
|
| Rate for Payer: Cofinity Commercial |
$2,596.98
|
| Rate for Payer: Cofinity Commercial |
$2,416.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,803.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,893.63
|
| Rate for Payer: Nomi Health Commercial |
$2,164.15
|
| Rate for Payer: PACE SWMI |
$1,803.46
|
| Rate for Payer: PHP Commercial |
$2,524.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,803.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,418.65
|
| Rate for Payer: Priority Health Medicare |
$1,803.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,803.46
|
| Rate for Payer: UHC Medicare Advantage |
$1,803.46
|
| Rate for Payer: UMR Bronson Commercial |
$1,711.66
|
|
|
PR DIR RPR ANEURYSM ABDOM AORTA W/VISCERAL VESSELS
|
Professional
|
Both
|
$3,573.00
|
|
|
Service Code
|
HCPCS 35091
|
| Min. Negotiated Rate |
$1,429.20 |
| Max. Negotiated Rate |
$2,466.10 |
| Rate for Payer: Aetna Commercial |
$2,294.84
|
| Rate for Payer: Aetna Medicare |
$1,781.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,466.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,294.84
|
| Rate for Payer: BCBS Complete |
$1,429.20
|
| Rate for Payer: BCBS MAPPO |
$1,712.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,712.57
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cofinity Commercial |
$2,466.10
|
| Rate for Payer: Cofinity Commercial |
$2,294.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,712.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,798.20
|
| Rate for Payer: Nomi Health Commercial |
$2,055.08
|
| Rate for Payer: PACE SWMI |
$1,712.57
|
| Rate for Payer: PHP Commercial |
$2,397.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,712.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,322.45
|
| Rate for Payer: Priority Health Medicare |
$1,712.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,712.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,712.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,643.58
|
|
|
PR DIR RPR ANEURYSM ABDOMINAL AORTA
|
Professional
|
Both
|
$5,682.00
|
|
|
Service Code
|
HCPCS 35081
|
| Min. Negotiated Rate |
$1,659.06 |
| Max. Negotiated Rate |
$3,693.30 |
| Rate for Payer: Aetna Commercial |
$2,223.14
|
| Rate for Payer: Aetna Medicare |
$1,725.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,389.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,223.14
|
| Rate for Payer: BCBS Complete |
$2,272.80
|
| Rate for Payer: BCBS MAPPO |
$1,659.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,659.06
|
| Rate for Payer: Cash Price |
$4,545.60
|
| Rate for Payer: Cash Price |
$4,545.60
|
| Rate for Payer: Cofinity Commercial |
$2,389.05
|
| Rate for Payer: Cofinity Commercial |
$2,223.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,659.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,742.01
|
| Rate for Payer: Nomi Health Commercial |
$1,990.87
|
| Rate for Payer: PACE SWMI |
$1,659.06
|
| Rate for Payer: PHP Commercial |
$2,322.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,659.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,693.30
|
| Rate for Payer: Priority Health Medicare |
$1,659.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,659.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,659.06
|
| Rate for Payer: UMR Bronson Commercial |
$2,613.72
|
|
|
PR DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION
|
Professional
|
Both
|
$3,720.00
|
|
|
Service Code
|
HCPCS 35011
|
| Min. Negotiated Rate |
$966.02 |
| Max. Negotiated Rate |
$2,418.00 |
| Rate for Payer: Aetna Commercial |
$1,294.47
|
| Rate for Payer: Aetna Medicare |
$1,004.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,391.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,294.47
|
| Rate for Payer: BCBS Complete |
$1,488.00
|
| Rate for Payer: BCBS MAPPO |
$966.02
|
| Rate for Payer: BCN Medicare Advantage |
$966.02
|
| Rate for Payer: Cash Price |
$2,976.00
|
| Rate for Payer: Cash Price |
$2,976.00
|
| Rate for Payer: Cofinity Commercial |
$1,391.07
|
| Rate for Payer: Cofinity Commercial |
$1,294.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$966.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,014.32
|
| Rate for Payer: Nomi Health Commercial |
$1,159.22
|
| Rate for Payer: PACE SWMI |
$966.02
|
| Rate for Payer: PHP Commercial |
$1,352.43
|
| Rate for Payer: PHP Medicare Advantage |
$966.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,418.00
|
| Rate for Payer: Priority Health Medicare |
$966.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$966.02
|
| Rate for Payer: UHC Medicare Advantage |
$966.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,711.20
|
|
|
PR DIR RPR ANEURYSM CAROTID-SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$2,213.00
|
|
|
Service Code
|
HCPCS 35001
|
| Min. Negotiated Rate |
$885.20 |
| Max. Negotiated Rate |
$1,531.05 |
| Rate for Payer: Aetna Commercial |
$1,424.73
|
| Rate for Payer: Aetna Medicare |
$1,105.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,531.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,424.73
|
| Rate for Payer: BCBS Complete |
$885.20
|
| Rate for Payer: BCBS MAPPO |
$1,063.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,063.23
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cofinity Commercial |
$1,531.05
|
| Rate for Payer: Cofinity Commercial |
$1,424.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,063.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,116.39
|
| Rate for Payer: Nomi Health Commercial |
$1,275.88
|
| Rate for Payer: PACE SWMI |
$1,063.23
|
| Rate for Payer: PHP Commercial |
$1,488.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,063.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,438.45
|
| Rate for Payer: Priority Health Medicare |
$1,063.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,063.23
|
| Rate for Payer: UHC Medicare Advantage |
$1,063.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,017.98
|
|
|
PR DIR RPR ANEURYSM & GRAFT COMMON FEMORAL ARTERY
|
Professional
|
Both
|
$2,176.00
|
|
|
Service Code
|
HCPCS 35141
|
| Min. Negotiated Rate |
$870.40 |
| Max. Negotiated Rate |
$1,508.86 |
| Rate for Payer: Aetna Commercial |
$1,404.08
|
| Rate for Payer: Aetna Medicare |
$1,089.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,508.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,404.08
|
| Rate for Payer: BCBS Complete |
$870.40
|
| Rate for Payer: BCBS MAPPO |
$1,047.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,047.82
|
| Rate for Payer: Cash Price |
$1,740.80
|
| Rate for Payer: Cash Price |
$1,740.80
|
| Rate for Payer: Cofinity Commercial |
$1,508.86
|
| Rate for Payer: Cofinity Commercial |
$1,404.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,047.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,100.21
|
| Rate for Payer: Nomi Health Commercial |
$1,257.38
|
| Rate for Payer: PACE SWMI |
$1,047.82
|
| Rate for Payer: PHP Commercial |
$1,466.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,047.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.40
|
| Rate for Payer: Priority Health Medicare |
$1,047.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,047.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,047.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,000.96
|
|
|
PR DIR RPR ANEURYSM & GRAFT ILIAC ARTERY
|
Professional
|
Both
|
$4,955.00
|
|
|
Service Code
|
HCPCS 35131
|
| Min. Negotiated Rate |
$1,329.03 |
| Max. Negotiated Rate |
$3,220.75 |
| Rate for Payer: Aetna Commercial |
$1,780.90
|
| Rate for Payer: Aetna Medicare |
$1,382.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,913.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,780.90
|
| Rate for Payer: BCBS Complete |
$1,982.00
|
| Rate for Payer: BCBS MAPPO |
$1,329.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,329.03
|
| Rate for Payer: Cash Price |
$3,964.00
|
| Rate for Payer: Cash Price |
$3,964.00
|
| Rate for Payer: Cofinity Commercial |
$1,913.80
|
| Rate for Payer: Cofinity Commercial |
$1,780.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,329.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,395.48
|
| Rate for Payer: Nomi Health Commercial |
$1,594.84
|
| Rate for Payer: PACE SWMI |
$1,329.03
|
| Rate for Payer: PHP Commercial |
$1,860.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,329.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,220.75
|
| Rate for Payer: Priority Health Medicare |
$1,329.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,329.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,329.03
|
| Rate for Payer: UMR Bronson Commercial |
$2,279.30
|
|
|
PR DIR RPR ANEURYSM & GRAFT POPLITEAL ARTERY
|
Professional
|
Both
|
$2,457.00
|
|
|
Service Code
|
HCPCS 35151
|
| Min. Negotiated Rate |
$982.80 |
| Max. Negotiated Rate |
$1,710.23 |
| Rate for Payer: Aetna Commercial |
$1,591.46
|
| Rate for Payer: Aetna Medicare |
$1,235.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,710.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,591.46
|
| Rate for Payer: BCBS Complete |
$982.80
|
| Rate for Payer: BCBS MAPPO |
$1,187.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,187.66
|
| Rate for Payer: Cash Price |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,965.60
|
| Rate for Payer: Cofinity Commercial |
$1,710.23
|
| Rate for Payer: Cofinity Commercial |
$1,591.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,187.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,247.04
|
| Rate for Payer: Nomi Health Commercial |
$1,425.19
|
| Rate for Payer: PACE SWMI |
$1,187.66
|
| Rate for Payer: PHP Commercial |
$1,662.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,187.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,597.05
|
| Rate for Payer: Priority Health Medicare |
$1,187.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,187.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,187.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,130.22
|
|
|
PR DIR RPR ANEURYSM HEPATIC/CELIAC/RENAL/MESENTERIC
|
Professional
|
Both
|
$3,196.00
|
|
|
Service Code
|
HCPCS 35121
|
| Min. Negotiated Rate |
$1,278.40 |
| Max. Negotiated Rate |
$2,194.40 |
| Rate for Payer: Aetna Commercial |
$2,042.01
|
| Rate for Payer: Aetna Medicare |
$1,584.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,194.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,042.01
|
| Rate for Payer: BCBS Complete |
$1,278.40
|
| Rate for Payer: BCBS MAPPO |
$1,523.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,523.89
|
| Rate for Payer: Cash Price |
$2,556.80
|
| Rate for Payer: Cash Price |
$2,556.80
|
| Rate for Payer: Cofinity Commercial |
$2,194.40
|
| Rate for Payer: Cofinity Commercial |
$2,042.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,523.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,600.08
|
| Rate for Payer: Nomi Health Commercial |
$1,828.67
|
| Rate for Payer: PACE SWMI |
$1,523.89
|
| Rate for Payer: PHP Commercial |
$2,133.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,523.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,077.40
|
| Rate for Payer: Priority Health Medicare |
$1,523.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,523.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,523.89
|
| Rate for Payer: UMR Bronson Commercial |
$1,470.16
|
|
|
PR DIR RPR ANEURYSM SPLENIC ARTERY
|
Professional
|
Both
|
$2,774.00
|
|
|
Service Code
|
HCPCS 35111
|
| Min. Negotiated Rate |
$1,109.60 |
| Max. Negotiated Rate |
$1,844.74 |
| Rate for Payer: Aetna Commercial |
$1,716.63
|
| Rate for Payer: Aetna Medicare |
$1,332.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,844.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,716.63
|
| Rate for Payer: BCBS Complete |
$1,109.60
|
| Rate for Payer: BCBS MAPPO |
$1,281.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,281.07
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Cofinity Commercial |
$1,844.74
|
| Rate for Payer: Cofinity Commercial |
$1,716.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,281.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,345.12
|
| Rate for Payer: Nomi Health Commercial |
$1,537.28
|
| Rate for Payer: PACE SWMI |
$1,281.07
|
| Rate for Payer: PHP Commercial |
$1,793.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,281.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.10
|
| Rate for Payer: Priority Health Medicare |
$1,281.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,281.07
|
| Rate for Payer: UHC Medicare Advantage |
$1,281.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,276.04
|
|
