|
PR DISP FEE CONTRALATERAL MONAU
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS V5200
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: UMR Bronson Commercial |
$129.26
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
HCPCS 38542
|
| Min. Negotiated Rate |
$375.20 |
| Max. Negotiated Rate |
$722.66 |
| Rate for Payer: Aetna Commercial |
$672.48
|
| Rate for Payer: Aetna Medicare |
$521.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$672.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$722.66
|
| Rate for Payer: BCBS Complete |
$375.20
|
| Rate for Payer: BCBS MAPPO |
$501.85
|
| Rate for Payer: BCN Medicare Advantage |
$501.85
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cofinity Commercial |
$722.66
|
| Rate for Payer: Cofinity Commercial |
$672.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$501.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$526.94
|
| Rate for Payer: Nomi Health Commercial |
$602.22
|
| Rate for Payer: PACE SWMI |
$501.85
|
| Rate for Payer: PHP Commercial |
$702.59
|
| Rate for Payer: PHP Medicare Advantage |
$501.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health Medicare |
$501.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$501.85
|
| Rate for Payer: UHC Medicare Advantage |
$501.85
|
| Rate for Payer: UMR Bronson Commercial |
$431.48
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Facility
|
IP
|
$938.00
|
|
|
Service Code
|
CPT 38542
|
| Hospital Charge Code |
38542
|
| Min. Negotiated Rate |
$412.72 |
| Max. Negotiated Rate |
$844.20 |
| Rate for Payer: Aetna American Axle |
$609.70
|
| Rate for Payer: Aetna Commercial |
$797.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.70
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cofinity Commercial |
$656.60
|
| Rate for Payer: Cofinity Commercial |
$806.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$656.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.40
|
| Rate for Payer: Healthscope Commercial |
$844.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$656.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$703.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.30
|
| Rate for Payer: PHP Commercial |
$797.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health SBD |
$590.94
|
| Rate for Payer: UMR Bronson Commercial |
$412.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$703.50
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Facility
|
OP
|
$938.00
|
|
|
Service Code
|
CPT 38542
|
| Hospital Charge Code |
38542
|
| Min. Negotiated Rate |
$347.06 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna American Axle |
$609.70
|
| Rate for Payer: Aetna Commercial |
$797.30
|
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cofinity Commercial |
$656.60
|
| Rate for Payer: Cofinity Commercial |
$806.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$656.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Healthscope Commercial |
$844.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$656.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$703.50
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.30
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Commercial |
$797.30
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Priority Health SBD |
$590.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: UMR Bronson Commercial |
$347.06
|
| Rate for Payer: VA VA |
$5,690.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$703.50
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
HCPCS 38542
|
| Hospital Charge Code |
38542
|
| Min. Negotiated Rate |
$375.20 |
| Max. Negotiated Rate |
$722.66 |
| Rate for Payer: Aetna Commercial |
$672.48
|
| Rate for Payer: Aetna Medicare |
$521.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$722.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$672.48
|
| Rate for Payer: BCBS Complete |
$375.20
|
| Rate for Payer: BCBS MAPPO |
$501.85
|
| Rate for Payer: BCN Medicare Advantage |
$501.85
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cofinity Commercial |
$722.66
|
| Rate for Payer: Cofinity Commercial |
$672.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$501.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$526.94
|
| Rate for Payer: Nomi Health Commercial |
$602.22
|
| Rate for Payer: PACE SWMI |
$501.85
|
| Rate for Payer: PHP Commercial |
$702.59
|
| Rate for Payer: PHP Medicare Advantage |
$501.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health Medicare |
$501.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$501.85
|
| Rate for Payer: UHC Medicare Advantage |
$501.85
|
| Rate for Payer: UMR Bronson Commercial |
$431.48
|
|
|
PR DIS SITE TELE SVCS RHC/FQHC
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS G2025
|
| Min. Negotiated Rate |
$75.20 |
| Max. Negotiated Rate |
$122.20 |
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: UMR Bronson Commercial |
$86.48
|
|
|
PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS 92587
|
| Min. Negotiated Rate |
$20.33 |
| Max. Negotiated Rate |
$55.90 |
| Rate for Payer: Aetna Commercial |
$27.24
|
| Rate for Payer: Aetna Medicare |
$21.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.28
|
| Rate for Payer: BCBS Complete |
$34.40
|
| Rate for Payer: BCBS MAPPO |
$20.33
|
| Rate for Payer: BCN Medicare Advantage |
$20.33
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cofinity Commercial |
$27.24
|
| Rate for Payer: Cofinity Commercial |
$29.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.35
|
| Rate for Payer: Nomi Health Commercial |
$24.40
|
| Rate for Payer: PACE SWMI |
$20.33
|
| Rate for Payer: PHP Commercial |
$28.46
|
| Rate for Payer: PHP Medicare Advantage |
$20.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.90
|
| Rate for Payer: Priority Health Medicare |
$20.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.33
|
| Rate for Payer: UHC Medicare Advantage |
$20.33
|
| Rate for Payer: UMR Bronson Commercial |
$39.56
|
|
|
PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 92588
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$44.96 |
| Rate for Payer: Aetna Commercial |
$41.83
|
| Rate for Payer: Aetna Medicare |
$32.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.83
|
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCBS MAPPO |
$31.22
|
| Rate for Payer: BCN Medicare Advantage |
$31.22
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$44.96
|
| Rate for Payer: Cofinity Commercial |
$41.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.78
|
| Rate for Payer: Nomi Health Commercial |
$37.46
|
| Rate for Payer: PACE SWMI |
$31.22
|
| Rate for Payer: PHP Commercial |
$43.71
|
| Rate for Payer: PHP Medicare Advantage |
$31.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
| Rate for Payer: Priority Health Medicare |
$31.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.22
|
| Rate for Payer: UHC Medicare Advantage |
$31.22
|
| Rate for Payer: UMR Bronson Commercial |
$31.74
|
|
|
PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH CRV APPR
|
Professional
|
Both
|
$2,437.00
|
|
|
Service Code
|
HCPCS 43130
|
| Min. Negotiated Rate |
$760.89 |
| Max. Negotiated Rate |
$1,584.05 |
| Rate for Payer: Aetna Commercial |
$1,019.59
|
| Rate for Payer: Aetna Medicare |
$791.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,095.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,019.59
|
| Rate for Payer: BCBS Complete |
$974.80
|
| Rate for Payer: BCBS MAPPO |
$760.89
|
| Rate for Payer: BCN Medicare Advantage |
$760.89
|
| Rate for Payer: Cash Price |
$1,949.60
|
| Rate for Payer: Cash Price |
$1,949.60
|
| Rate for Payer: Cofinity Commercial |
$1,095.68
|
| Rate for Payer: Cofinity Commercial |
$1,019.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$760.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$798.93
|
| Rate for Payer: Nomi Health Commercial |
$913.07
|
| Rate for Payer: PACE SWMI |
$760.89
|
| Rate for Payer: PHP Commercial |
$1,065.25
|
| Rate for Payer: PHP Medicare Advantage |
$760.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,584.05
|
| Rate for Payer: Priority Health Medicare |
$760.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$760.89
|
| Rate for Payer: UHC Medicare Advantage |
$760.89
|
| Rate for Payer: UMR Bronson Commercial |
$1,121.02
|
|
|
PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH THRC APPR
|
Professional
|
Both
|
$3,167.00
|
|
|
Service Code
|
HCPCS 43135
|
| Min. Negotiated Rate |
$1,266.80 |
| Max. Negotiated Rate |
$2,058.55 |
| Rate for Payer: Aetna Commercial |
$1,896.94
|
| Rate for Payer: Aetna Medicare |
$1,472.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,038.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,896.94
|
| Rate for Payer: BCBS Complete |
$1,266.80
|
| Rate for Payer: BCBS MAPPO |
$1,415.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,415.63
|
| Rate for Payer: Cash Price |
$2,533.60
|
| Rate for Payer: Cash Price |
$2,533.60
|
| Rate for Payer: Cofinity Commercial |
$2,038.51
|
| Rate for Payer: Cofinity Commercial |
$1,896.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,415.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,486.41
|
| Rate for Payer: Nomi Health Commercial |
$1,698.76
|
| Rate for Payer: PACE SWMI |
$1,415.63
|
| Rate for Payer: PHP Commercial |
$1,981.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,415.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,058.55
|
| Rate for Payer: Priority Health Medicare |
$1,415.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,415.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,415.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,456.82
|
|
|
PR DIVISION ABERRANT VESSEL VASCULAR RING
|
Professional
|
Both
|
$4,233.00
|
|
|
Service Code
|
HCPCS 33802
|
| Min. Negotiated Rate |
$1,045.18 |
| Max. Negotiated Rate |
$2,751.45 |
| Rate for Payer: Aetna Commercial |
$1,400.54
|
| Rate for Payer: Aetna Medicare |
$1,086.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,505.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,400.54
|
| Rate for Payer: BCBS Complete |
$1,693.20
|
| Rate for Payer: BCBS MAPPO |
$1,045.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,045.18
|
| Rate for Payer: Cash Price |
$3,386.40
|
| Rate for Payer: Cash Price |
$3,386.40
|
| Rate for Payer: Cofinity Commercial |
$1,505.06
|
| Rate for Payer: Cofinity Commercial |
$1,400.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,045.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,097.44
|
| Rate for Payer: Nomi Health Commercial |
$1,254.22
|
| Rate for Payer: PACE SWMI |
$1,045.18
|
| Rate for Payer: PHP Commercial |
$1,463.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,045.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,751.45
|
| Rate for Payer: Priority Health Medicare |
$1,045.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,045.18
|
| Rate for Payer: UHC Medicare Advantage |
$1,045.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,947.18
|
|
|
PR DIVISION PLANTAR FASCIA & MUSCLE SPX
|
Professional
|
Both
|
$1,311.00
|
|
|
Service Code
|
HCPCS 28250
|
| Min. Negotiated Rate |
$397.33 |
| Max. Negotiated Rate |
$852.15 |
| Rate for Payer: Aetna Commercial |
$532.42
|
| Rate for Payer: Aetna Medicare |
$413.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$572.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.42
|
| Rate for Payer: BCBS Complete |
$524.40
|
| Rate for Payer: BCBS MAPPO |
$397.33
|
| Rate for Payer: BCN Medicare Advantage |
$397.33
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cofinity Commercial |
$572.16
|
| Rate for Payer: Cofinity Commercial |
$532.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$397.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$417.20
|
| Rate for Payer: Nomi Health Commercial |
$476.80
|
| Rate for Payer: PACE SWMI |
$397.33
|
| Rate for Payer: PHP Commercial |
$556.26
|
| Rate for Payer: PHP Medicare Advantage |
$397.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$852.15
|
| Rate for Payer: Priority Health Medicare |
$397.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$397.33
|
| Rate for Payer: UHC Medicare Advantage |
$397.33
|
| Rate for Payer: UMR Bronson Commercial |
$603.06
|
|
|
PR DIVISION SCALENUS ANTICUS RESECTION CERVICAL RIB
|
Professional
|
Both
|
$1,119.00
|
|
|
Service Code
|
HCPCS 21705
|
| Min. Negotiated Rate |
$447.60 |
| Max. Negotiated Rate |
$746.02 |
| Rate for Payer: Aetna Commercial |
$694.21
|
| Rate for Payer: Aetna Medicare |
$538.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$746.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$694.21
|
| Rate for Payer: BCBS Complete |
$447.60
|
| Rate for Payer: BCBS MAPPO |
$518.07
|
| Rate for Payer: BCN Medicare Advantage |
$518.07
|
| Rate for Payer: Cash Price |
$895.20
|
| Rate for Payer: Cash Price |
$895.20
|
| Rate for Payer: Cofinity Commercial |
$746.02
|
| Rate for Payer: Cofinity Commercial |
$694.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$518.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.97
|
| Rate for Payer: Nomi Health Commercial |
$621.68
|
| Rate for Payer: PACE SWMI |
$518.07
|
| Rate for Payer: PHP Commercial |
$725.30
|
| Rate for Payer: PHP Medicare Advantage |
$518.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$727.35
|
| Rate for Payer: Priority Health Medicare |
$518.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$518.07
|
| Rate for Payer: UHC Medicare Advantage |
$518.07
|
| Rate for Payer: UMR Bronson Commercial |
$514.74
|
|
|
PR DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB
|
Professional
|
Both
|
$1,549.00
|
|
|
Service Code
|
HCPCS 21700
|
| Min. Negotiated Rate |
$345.81 |
| Max. Negotiated Rate |
$1,006.85 |
| Rate for Payer: Aetna Commercial |
$463.39
|
| Rate for Payer: Aetna Medicare |
$359.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.39
|
| Rate for Payer: BCBS Complete |
$619.60
|
| Rate for Payer: BCBS MAPPO |
$345.81
|
| Rate for Payer: BCN Medicare Advantage |
$345.81
|
| Rate for Payer: Cash Price |
$1,239.20
|
| Rate for Payer: Cash Price |
$1,239.20
|
| Rate for Payer: Cofinity Commercial |
$497.97
|
| Rate for Payer: Cofinity Commercial |
$463.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$363.10
|
| Rate for Payer: Nomi Health Commercial |
$414.97
|
| Rate for Payer: PACE SWMI |
$345.81
|
| Rate for Payer: PHP Commercial |
$484.13
|
| Rate for Payer: PHP Medicare Advantage |
$345.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.85
|
| Rate for Payer: Priority Health Medicare |
$345.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$345.81
|
| Rate for Payer: UHC Medicare Advantage |
$345.81
|
| Rate for Payer: UMR Bronson Commercial |
$712.54
|
|
|
PR DIVISION STRICTURE RECTUM
|
Professional
|
Both
|
$1,380.00
|
|
|
Service Code
|
HCPCS 45150
|
| Min. Negotiated Rate |
$410.86 |
| Max. Negotiated Rate |
$897.00 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Aetna Medicare |
$427.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$591.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$550.55
|
| Rate for Payer: BCBS Complete |
$552.00
|
| Rate for Payer: BCBS MAPPO |
$410.86
|
| Rate for Payer: BCN Medicare Advantage |
$410.86
|
| Rate for Payer: Cash Price |
$1,104.00
|
| Rate for Payer: Cash Price |
$1,104.00
|
| Rate for Payer: Cofinity Commercial |
$591.64
|
| Rate for Payer: Cofinity Commercial |
$550.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$410.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$431.40
|
| Rate for Payer: Nomi Health Commercial |
$493.03
|
| Rate for Payer: PACE SWMI |
$410.86
|
| Rate for Payer: PHP Commercial |
$575.20
|
| Rate for Payer: PHP Medicare Advantage |
$410.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.00
|
| Rate for Payer: Priority Health Medicare |
$410.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$410.86
|
| Rate for Payer: UHC Medicare Advantage |
$410.86
|
| Rate for Payer: UMR Bronson Commercial |
$634.80
|
|
|
PR DLYD PLACEMENT XTN PROSTH FOR EVASC RPR 1ST VSL
|
Professional
|
Both
|
$1,681.00
|
|
|
Service Code
|
HCPCS 34710
|
| Min. Negotiated Rate |
$672.40 |
| Max. Negotiated Rate |
$1,096.52 |
| Rate for Payer: Aetna Commercial |
$1,020.37
|
| Rate for Payer: Aetna Medicare |
$791.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,096.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,020.37
|
| Rate for Payer: BCBS Complete |
$672.40
|
| Rate for Payer: BCBS MAPPO |
$761.47
|
| Rate for Payer: BCN Medicare Advantage |
$761.47
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Cofinity Commercial |
$1,096.52
|
| Rate for Payer: Cofinity Commercial |
$1,020.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$761.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$799.54
|
| Rate for Payer: Nomi Health Commercial |
$913.76
|
| Rate for Payer: PACE SWMI |
$761.47
|
| Rate for Payer: PHP Commercial |
$1,066.06
|
| Rate for Payer: PHP Medicare Advantage |
$761.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,092.65
|
| Rate for Payer: Priority Health Medicare |
$761.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$761.47
|
| Rate for Payer: UHC Medicare Advantage |
$761.47
|
| Rate for Payer: UMR Bronson Commercial |
$773.26
|
|
|
PR DLYD PLACEMENT XTN PROSTH FOR EVASC RPR EA ADDL
|
Professional
|
Both
|
$629.00
|
|
|
Service Code
|
HCPCS 34711
|
| Min. Negotiated Rate |
$251.60 |
| Max. Negotiated Rate |
$408.85 |
| Rate for Payer: Aetna Commercial |
$379.70
|
| Rate for Payer: Aetna Medicare |
$294.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.70
|
| Rate for Payer: BCBS Complete |
$251.60
|
| Rate for Payer: BCBS MAPPO |
$283.36
|
| Rate for Payer: BCN Medicare Advantage |
$283.36
|
| Rate for Payer: Cash Price |
$503.20
|
| Rate for Payer: Cash Price |
$503.20
|
| Rate for Payer: Cofinity Commercial |
$408.04
|
| Rate for Payer: Cofinity Commercial |
$379.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$283.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$297.53
|
| Rate for Payer: Nomi Health Commercial |
$340.03
|
| Rate for Payer: PACE SWMI |
$283.36
|
| Rate for Payer: PHP Commercial |
$396.70
|
| Rate for Payer: PHP Medicare Advantage |
$283.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.85
|
| Rate for Payer: Priority Health Medicare |
$283.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$283.36
|
| Rate for Payer: UHC Medicare Advantage |
$283.36
|
| Rate for Payer: UMR Bronson Commercial |
$289.34
|
|
|
PR DOG EAR REVISION
|
Professional
|
Both
|
$1,845.00
|
|
|
Service Code
|
HCPCS 00565
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$738.00 |
| Max. Negotiated Rate |
$1,199.25 |
| Rate for Payer: Aetna Medicare |
$922.50
|
| Rate for Payer: BCBS Complete |
$738.00
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,199.25
|
| Rate for Payer: UMR Bronson Commercial |
$848.70
|
|
|
PR DOMICIL/REST HOME NEW PT VISIT LOW SEVER 20 MIN
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 99324
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: Aetna Medicare |
$46.00
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: UMR Bronson Commercial |
$42.32
|
|
|
PR DOM/R-HOME E/M EST PT LW MOD SEVERITY 25 MINUTES
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 99335
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$92.95 |
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: UMR Bronson Commercial |
$65.78
|
|
|
PR DOM/R-HOME E/M EST PT MOD HI SEVERITY 40 MINUTES
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 99336
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$131.30 |
| Rate for Payer: Aetna Medicare |
$101.00
|
| Rate for Payer: BCBS Complete |
$80.80
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.30
|
| Rate for Payer: UMR Bronson Commercial |
$92.92
|
|
|
PR DOM/R-HOME E/M EST PT SELF-LMTD/MINOR 15 MINUTES
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 99334
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$59.15 |
| Rate for Payer: Aetna Medicare |
$45.50
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: UMR Bronson Commercial |
$41.86
|
|
|
PR DOM/R-HOME E/M EST PT SIGNIF NEW PROB 60 MINUTES
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 99337
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$187.85 |
| Rate for Payer: Aetna Medicare |
$144.50
|
| Rate for Payer: BCBS Complete |
$115.60
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.85
|
| Rate for Payer: UMR Bronson Commercial |
$132.94
|
|
|
PR DOPPLER ECHO COLOR FLOW VELOCITY MAPPING
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
93325
|
| Min. Negotiated Rate |
$88.44 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Aetna American Axle |
$130.65
|
| Rate for Payer: Aetna American Axle |
$214.50
|
| Rate for Payer: Aetna Commercial |
$170.85
|
| Rate for Payer: Aetna Commercial |
$280.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.50
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cofinity Commercial |
$283.80
|
| Rate for Payer: Cofinity Commercial |
$231.00
|
| Rate for Payer: Cofinity Commercial |
$140.70
|
| Rate for Payer: Cofinity Commercial |
$172.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.00
|
| Rate for Payer: Healthscope Commercial |
$180.90
|
| Rate for Payer: Healthscope Commercial |
$297.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.85
|
| Rate for Payer: PHP Commercial |
$280.50
|
| Rate for Payer: PHP Commercial |
$170.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.50
|
| Rate for Payer: Priority Health SBD |
$126.63
|
| Rate for Payer: Priority Health SBD |
$207.90
|
| Rate for Payer: UMR Bronson Commercial |
$88.44
|
| Rate for Payer: UMR Bronson Commercial |
$145.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.50
|
|
|
PR DOPPLER ECHO COLOR FLOW VELOCITY MAPPING
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
93325
|
| Min. Negotiated Rate |
$74.37 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Aetna American Axle |
$130.65
|
| Rate for Payer: Aetna American Axle |
$214.50
|
| Rate for Payer: Aetna Commercial |
$170.85
|
| Rate for Payer: Aetna Commercial |
$280.50
|
| Rate for Payer: Aetna Medicare |
$100.50
|
| Rate for Payer: Aetna Medicare |
$165.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.50
|
| Rate for Payer: BCBS Complete |
$132.00
|
| Rate for Payer: BCBS Complete |
$80.40
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cofinity Commercial |
$172.86
|
| Rate for Payer: Cofinity Commercial |
$140.70
|
| Rate for Payer: Cofinity Commercial |
$231.00
|
| Rate for Payer: Cofinity Commercial |
$283.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.00
|
| Rate for Payer: Healthscope Commercial |
$297.00
|
| Rate for Payer: Healthscope Commercial |
$180.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.50
|
| Rate for Payer: PHP Commercial |
$280.50
|
| Rate for Payer: PHP Commercial |
$170.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.50
|
| Rate for Payer: Priority Health SBD |
$207.90
|
| Rate for Payer: Priority Health SBD |
$126.63
|
| Rate for Payer: UMR Bronson Commercial |
$74.37
|
| Rate for Payer: UMR Bronson Commercial |
$122.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.75
|
|
