|
PR DRAINAGE OVARIAN CYST UNI/BI SPX VAGINAL APPR
|
Professional
|
Both
|
$993.00
|
|
|
Service Code
|
HCPCS 58800
|
| Min. Negotiated Rate |
$301.71 |
| Max. Negotiated Rate |
$645.45 |
| Rate for Payer: Aetna Commercial |
$404.29
|
| Rate for Payer: Aetna Medicare |
$313.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.29
|
| Rate for Payer: BCBS Complete |
$397.20
|
| Rate for Payer: BCBS MAPPO |
$301.71
|
| Rate for Payer: BCN Medicare Advantage |
$301.71
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cofinity Commercial |
$434.46
|
| Rate for Payer: Cofinity Commercial |
$404.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$316.80
|
| Rate for Payer: Nomi Health Commercial |
$362.05
|
| Rate for Payer: PACE SWMI |
$301.71
|
| Rate for Payer: PHP Commercial |
$422.39
|
| Rate for Payer: PHP Medicare Advantage |
$301.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$645.45
|
| Rate for Payer: Priority Health Medicare |
$301.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$301.71
|
| Rate for Payer: UHC Medicare Advantage |
$301.71
|
| Rate for Payer: UMR Bronson Commercial |
$456.78
|
|
|
PR DRAINAGE PERITON ABSCESS/LOCAL PERITONITIS OPEN
|
Professional
|
Both
|
$2,828.00
|
|
|
Service Code
|
HCPCS 49020
|
| Min. Negotiated Rate |
$1,131.20 |
| Max. Negotiated Rate |
$2,223.45 |
| Rate for Payer: Aetna Commercial |
$2,069.04
|
| Rate for Payer: Aetna Medicare |
$1,605.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,223.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,069.04
|
| Rate for Payer: BCBS Complete |
$1,131.20
|
| Rate for Payer: BCBS MAPPO |
$1,544.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,544.06
|
| Rate for Payer: Cash Price |
$2,262.40
|
| Rate for Payer: Cash Price |
$2,262.40
|
| Rate for Payer: Cofinity Commercial |
$2,223.45
|
| Rate for Payer: Cofinity Commercial |
$2,069.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,544.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,621.26
|
| Rate for Payer: Nomi Health Commercial |
$1,852.87
|
| Rate for Payer: PACE SWMI |
$1,544.06
|
| Rate for Payer: PHP Commercial |
$2,161.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,544.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,838.20
|
| Rate for Payer: Priority Health Medicare |
$1,544.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,544.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,544.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,300.88
|
|
|
PR DRAINAGE SCROTAL WALL ABSCESS
|
Professional
|
Both
|
$399.00
|
|
|
Service Code
|
HCPCS 55100
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$259.35 |
| Rate for Payer: Aetna Commercial |
$215.31
|
| Rate for Payer: Aetna Medicare |
$167.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.31
|
| Rate for Payer: BCBS Complete |
$159.60
|
| Rate for Payer: BCBS MAPPO |
$160.68
|
| Rate for Payer: BCN Medicare Advantage |
$160.68
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cofinity Commercial |
$231.38
|
| Rate for Payer: Cofinity Commercial |
$215.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.71
|
| Rate for Payer: Nomi Health Commercial |
$192.82
|
| Rate for Payer: PACE SWMI |
$160.68
|
| Rate for Payer: PHP Commercial |
$224.95
|
| Rate for Payer: PHP Medicare Advantage |
$160.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.35
|
| Rate for Payer: Priority Health Medicare |
$160.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.68
|
| Rate for Payer: UHC Medicare Advantage |
$160.68
|
| Rate for Payer: UMR Bronson Commercial |
$183.54
|
|
|
PR DRAINAGE SUBDIAPHRAGMATIC/SUBPHREN ABSCESS OPEN
|
Professional
|
Both
|
$2,224.00
|
|
|
Service Code
|
HCPCS 49040
|
| Min. Negotiated Rate |
$889.60 |
| Max. Negotiated Rate |
$1,445.60 |
| Rate for Payer: Aetna Commercial |
$1,307.34
|
| Rate for Payer: Aetna Medicare |
$1,014.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,404.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,307.34
|
| Rate for Payer: BCBS Complete |
$889.60
|
| Rate for Payer: BCBS MAPPO |
$975.63
|
| Rate for Payer: BCN Medicare Advantage |
$975.63
|
| Rate for Payer: Cash Price |
$1,779.20
|
| Rate for Payer: Cash Price |
$1,779.20
|
| Rate for Payer: Cofinity Commercial |
$1,404.91
|
| Rate for Payer: Cofinity Commercial |
$1,307.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$975.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,024.41
|
| Rate for Payer: Nomi Health Commercial |
$1,170.76
|
| Rate for Payer: PACE SWMI |
$975.63
|
| Rate for Payer: PHP Commercial |
$1,365.88
|
| Rate for Payer: PHP Medicare Advantage |
$975.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,445.60
|
| Rate for Payer: Priority Health Medicare |
$975.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$975.63
|
| Rate for Payer: UHC Medicare Advantage |
$975.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,023.04
|
|
|
PR DRAINAGE TENDON SHEATH DIGIT&/PALM EACH
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 26020
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$773.65 |
| Rate for Payer: Aetna Commercial |
$719.93
|
| Rate for Payer: Aetna Medicare |
$558.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$773.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.93
|
| Rate for Payer: BCBS Complete |
$306.00
|
| Rate for Payer: BCBS MAPPO |
$537.26
|
| Rate for Payer: BCN Medicare Advantage |
$537.26
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$773.65
|
| Rate for Payer: Cofinity Commercial |
$719.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.12
|
| Rate for Payer: Nomi Health Commercial |
$644.71
|
| Rate for Payer: PACE SWMI |
$537.26
|
| Rate for Payer: PHP Commercial |
$752.16
|
| Rate for Payer: PHP Medicare Advantage |
$537.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health Medicare |
$537.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.26
|
| Rate for Payer: UHC Medicare Advantage |
$537.26
|
| Rate for Payer: UMR Bronson Commercial |
$351.90
|
|
|
PR DRESSING CHANGE UNDER ANESTHESIA
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 15852
|
| Min. Negotiated Rate |
$42.77 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Aetna Commercial |
$57.31
|
| Rate for Payer: Aetna Medicare |
$44.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.31
|
| Rate for Payer: BCBS Complete |
$68.00
|
| Rate for Payer: BCBS MAPPO |
$42.77
|
| Rate for Payer: BCN Medicare Advantage |
$42.77
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$61.59
|
| Rate for Payer: Cofinity Commercial |
$57.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.91
|
| Rate for Payer: Nomi Health Commercial |
$51.32
|
| Rate for Payer: PACE SWMI |
$42.77
|
| Rate for Payer: PHP Commercial |
$59.88
|
| Rate for Payer: PHP Medicare Advantage |
$42.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health Medicare |
$42.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.77
|
| Rate for Payer: UHC Medicare Advantage |
$42.77
|
| Rate for Payer: UMR Bronson Commercial |
$78.20
|
|
|
PR DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS
|
Professional
|
Both
|
$558.00
|
|
|
Service Code
|
HCPCS 41800
|
| Min. Negotiated Rate |
$147.26 |
| Max. Negotiated Rate |
$362.70 |
| Rate for Payer: Aetna Commercial |
$197.33
|
| Rate for Payer: Aetna Medicare |
$153.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.33
|
| Rate for Payer: BCBS Complete |
$223.20
|
| Rate for Payer: BCBS MAPPO |
$147.26
|
| Rate for Payer: BCN Medicare Advantage |
$147.26
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cofinity Commercial |
$212.05
|
| Rate for Payer: Cofinity Commercial |
$197.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.62
|
| Rate for Payer: Nomi Health Commercial |
$176.71
|
| Rate for Payer: PACE SWMI |
$147.26
|
| Rate for Payer: PHP Commercial |
$206.16
|
| Rate for Payer: PHP Medicare Advantage |
$147.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.70
|
| Rate for Payer: Priority Health Medicare |
$147.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.26
|
| Rate for Payer: UHC Medicare Advantage |
$147.26
|
| Rate for Payer: UMR Bronson Commercial |
$256.68
|
|
|
PR DRG ABSC CST HMTMA VESTIBULE MOUTH COMP
|
Professional
|
Both
|
$632.00
|
|
|
Service Code
|
HCPCS 40801
|
| Min. Negotiated Rate |
$190.29 |
| Max. Negotiated Rate |
$410.80 |
| Rate for Payer: Aetna Commercial |
$254.99
|
| Rate for Payer: Aetna Medicare |
$197.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.99
|
| Rate for Payer: BCBS Complete |
$252.80
|
| Rate for Payer: BCBS MAPPO |
$190.29
|
| Rate for Payer: BCN Medicare Advantage |
$190.29
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cofinity Commercial |
$274.02
|
| Rate for Payer: Cofinity Commercial |
$254.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.80
|
| Rate for Payer: Nomi Health Commercial |
$228.35
|
| Rate for Payer: PACE SWMI |
$190.29
|
| Rate for Payer: PHP Commercial |
$266.41
|
| Rate for Payer: PHP Medicare Advantage |
$190.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$410.80
|
| Rate for Payer: Priority Health Medicare |
$190.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.29
|
| Rate for Payer: UHC Medicare Advantage |
$190.29
|
| Rate for Payer: UMR Bronson Commercial |
$290.72
|
|
|
PR DRG LYMPH NODE ABSC/LYMPHADENITIS EXTNSV
|
Professional
|
Both
|
$1,058.00
|
|
|
Service Code
|
HCPCS 38305
|
| Min. Negotiated Rate |
$423.20 |
| Max. Negotiated Rate |
$690.15 |
| Rate for Payer: Aetna Commercial |
$642.22
|
| Rate for Payer: Aetna Medicare |
$498.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$690.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$642.22
|
| Rate for Payer: BCBS Complete |
$423.20
|
| Rate for Payer: BCBS MAPPO |
$479.27
|
| Rate for Payer: BCN Medicare Advantage |
$479.27
|
| Rate for Payer: Cash Price |
$846.40
|
| Rate for Payer: Cash Price |
$846.40
|
| Rate for Payer: Cofinity Commercial |
$690.15
|
| Rate for Payer: Cofinity Commercial |
$642.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$479.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$503.23
|
| Rate for Payer: Nomi Health Commercial |
$575.12
|
| Rate for Payer: PACE SWMI |
$479.27
|
| Rate for Payer: PHP Commercial |
$670.98
|
| Rate for Payer: PHP Medicare Advantage |
$479.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$687.70
|
| Rate for Payer: Priority Health Medicare |
$479.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$479.27
|
| Rate for Payer: UHC Medicare Advantage |
$479.27
|
| Rate for Payer: UMR Bronson Commercial |
$486.68
|
|
|
PR DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL
|
Professional
|
Both
|
$455.00
|
|
|
Service Code
|
HCPCS 38300
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$295.75 |
| Rate for Payer: Aetna Commercial |
$269.42
|
| Rate for Payer: Aetna Medicare |
$209.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.42
|
| Rate for Payer: BCBS Complete |
$182.00
|
| Rate for Payer: BCBS MAPPO |
$201.06
|
| Rate for Payer: BCN Medicare Advantage |
$201.06
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cofinity Commercial |
$289.53
|
| Rate for Payer: Cofinity Commercial |
$269.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.11
|
| Rate for Payer: Nomi Health Commercial |
$241.27
|
| Rate for Payer: PACE SWMI |
$201.06
|
| Rate for Payer: PHP Commercial |
$281.48
|
| Rate for Payer: PHP Medicare Advantage |
$201.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.75
|
| Rate for Payer: Priority Health Medicare |
$201.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$201.06
|
| Rate for Payer: UHC Medicare Advantage |
$201.06
|
| Rate for Payer: UMR Bronson Commercial |
$209.30
|
|
|
PR DRG OF SKENE'S GLAND ABSCESS OR CYST
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 53060
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Aetna Commercial |
$214.80
|
| Rate for Payer: Aetna Medicare |
$166.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.80
|
| Rate for Payer: BCBS Complete |
$246.00
|
| Rate for Payer: BCBS MAPPO |
$160.30
|
| Rate for Payer: BCN Medicare Advantage |
$160.30
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$230.83
|
| Rate for Payer: Cofinity Commercial |
$214.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.31
|
| Rate for Payer: Nomi Health Commercial |
$192.36
|
| Rate for Payer: PACE SWMI |
$160.30
|
| Rate for Payer: PHP Commercial |
$224.42
|
| Rate for Payer: PHP Medicare Advantage |
$160.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health Medicare |
$160.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.30
|
| Rate for Payer: UHC Medicare Advantage |
$160.30
|
| Rate for Payer: UMR Bronson Commercial |
$282.90
|
|
|
PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
HCPCS 16030
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$200.85 |
| Rate for Payer: Aetna Commercial |
$171.31
|
| Rate for Payer: Aetna Medicare |
$132.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.31
|
| Rate for Payer: BCBS Complete |
$123.60
|
| Rate for Payer: BCBS MAPPO |
$127.84
|
| Rate for Payer: BCN Medicare Advantage |
$127.84
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cofinity Commercial |
$184.09
|
| Rate for Payer: Cofinity Commercial |
$171.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.23
|
| Rate for Payer: Nomi Health Commercial |
$153.41
|
| Rate for Payer: PACE SWMI |
$127.84
|
| Rate for Payer: PHP Commercial |
$178.98
|
| Rate for Payer: PHP Medicare Advantage |
$127.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.85
|
| Rate for Payer: Priority Health Medicare |
$127.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.84
|
| Rate for Payer: UHC Medicare Advantage |
$127.84
|
| Rate for Payer: UMR Bronson Commercial |
$142.14
|
|
|
PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 16025
|
| Min. Negotiated Rate |
$100.40 |
| Max. Negotiated Rate |
$163.15 |
| Rate for Payer: Aetna Commercial |
$141.89
|
| Rate for Payer: Aetna Medicare |
$110.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.89
|
| Rate for Payer: BCBS Complete |
$100.40
|
| Rate for Payer: BCBS MAPPO |
$105.89
|
| Rate for Payer: BCN Medicare Advantage |
$105.89
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cofinity Commercial |
$152.48
|
| Rate for Payer: Cofinity Commercial |
$141.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.18
|
| Rate for Payer: Nomi Health Commercial |
$127.07
|
| Rate for Payer: PACE SWMI |
$105.89
|
| Rate for Payer: PHP Commercial |
$148.25
|
| Rate for Payer: PHP Medicare Advantage |
$105.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health Medicare |
$105.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.89
|
| Rate for Payer: UHC Medicare Advantage |
$105.89
|
| Rate for Payer: UMR Bronson Commercial |
$115.46
|
|
|
PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 16020
|
| Min. Negotiated Rate |
$52.95 |
| Max. Negotiated Rate |
$89.70 |
| Rate for Payer: Aetna Commercial |
$70.95
|
| Rate for Payer: Aetna Medicare |
$55.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.95
|
| Rate for Payer: BCBS Complete |
$55.20
|
| Rate for Payer: BCBS MAPPO |
$52.95
|
| Rate for Payer: BCN Medicare Advantage |
$52.95
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cofinity Commercial |
$76.25
|
| Rate for Payer: Cofinity Commercial |
$70.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.60
|
| Rate for Payer: Nomi Health Commercial |
$63.54
|
| Rate for Payer: PACE SWMI |
$52.95
|
| Rate for Payer: PHP Commercial |
$74.13
|
| Rate for Payer: PHP Medicare Advantage |
$52.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
| Rate for Payer: Priority Health Medicare |
$52.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.95
|
| Rate for Payer: UHC Medicare Advantage |
$52.95
|
| Rate for Payer: UMR Bronson Commercial |
$63.48
|
|
|
PR DRUG-ELUTING STENTS, SINGLE
|
Professional
|
Both
|
$2,525.00
|
|
|
Service Code
|
HCPCS G0290
|
| Min. Negotiated Rate |
$1,010.00 |
| Max. Negotiated Rate |
$1,641.25 |
| Rate for Payer: Aetna Medicare |
$1,262.50
|
| Rate for Payer: BCBS Complete |
$1,010.00
|
| Rate for Payer: Cash Price |
$2,020.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,641.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,161.50
|
|
|
PR DRUG SCREEN MULTI DRUG CLASS
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS G0434
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: UMR Bronson Commercial |
$17.94
|
|
|
PR DRUG SCREEN MULTIP CLASS
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS G0431
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$40.30 |
| Rate for Payer: Aetna Medicare |
$31.00
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.30
|
| Rate for Payer: UMR Bronson Commercial |
$28.52
|
|
|
PR DRUG SCREEN PANEL 10 WITH BATH SALTS
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 00124
|
|
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 DSTL REVSC&INTERVAL LIG UXTR HEMO ACCESS
|
Professional
|
Both
|
$2,434.00
|
|
|
Service Code
|
HCPCS 36838
|
| Min. Negotiated Rate |
$973.60 |
| Max. Negotiated Rate |
$1,582.10 |
| Rate for Payer: Aetna Commercial |
$1,466.88
|
| Rate for Payer: Aetna Medicare |
$1,138.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,466.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,576.35
|
| Rate for Payer: BCBS Complete |
$973.60
|
| Rate for Payer: BCBS MAPPO |
$1,094.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,094.69
|
| Rate for Payer: Cash Price |
$1,947.20
|
| Rate for Payer: Cash Price |
$1,947.20
|
| Rate for Payer: Cofinity Commercial |
$1,576.35
|
| Rate for Payer: Cofinity Commercial |
$1,466.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,094.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,149.42
|
| Rate for Payer: Nomi Health Commercial |
$1,313.63
|
| Rate for Payer: PACE SWMI |
$1,094.69
|
| Rate for Payer: PHP Commercial |
$1,532.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,094.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,582.10
|
| Rate for Payer: Priority Health Medicare |
$1,094.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,094.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,094.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,119.64
|
|
|
PR DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM
|
Professional
|
Both
|
$818.00
|
|
|
Service Code
|
HCPCS 17107
|
| Min. Negotiated Rate |
$327.20 |
| Max. Negotiated Rate |
$531.70 |
| Rate for Payer: Aetna Commercial |
$456.48
|
| Rate for Payer: Aetna Medicare |
$354.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$490.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.48
|
| Rate for Payer: BCBS Complete |
$327.20
|
| Rate for Payer: BCBS MAPPO |
$340.66
|
| Rate for Payer: BCN Medicare Advantage |
$340.66
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cofinity Commercial |
$490.55
|
| Rate for Payer: Cofinity Commercial |
$456.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$340.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$357.69
|
| Rate for Payer: Nomi Health Commercial |
$408.79
|
| Rate for Payer: PACE SWMI |
$340.66
|
| Rate for Payer: PHP Commercial |
$476.92
|
| Rate for Payer: PHP Medicare Advantage |
$340.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.70
|
| Rate for Payer: Priority Health Medicare |
$340.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$340.66
|
| Rate for Payer: UHC Medicare Advantage |
$340.66
|
| Rate for Payer: UMR Bronson Commercial |
$376.28
|
|
|
PR DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 17108
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna Commercial |
$671.65
|
| Rate for Payer: Aetna Medicare |
$521.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$721.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.65
|
| Rate for Payer: BCBS Complete |
$468.00
|
| Rate for Payer: BCBS MAPPO |
$501.23
|
| Rate for Payer: BCN Medicare Advantage |
$501.23
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$721.77
|
| Rate for Payer: Cofinity Commercial |
$671.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$501.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$526.29
|
| Rate for Payer: Nomi Health Commercial |
$601.48
|
| Rate for Payer: PACE SWMI |
$501.23
|
| Rate for Payer: PHP Commercial |
$701.72
|
| Rate for Payer: PHP Medicare Advantage |
$501.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.50
|
| Rate for Payer: Priority Health Medicare |
$501.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$501.23
|
| Rate for Payer: UHC Medicare Advantage |
$501.23
|
| Rate for Payer: UMR Bronson Commercial |
$538.20
|
|
|
PR DSTRJ LESION ANUS EXTENSIVE
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
CPT 46924
|
| Hospital Charge Code |
46924
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$320.05 |
| Max. Negotiated Rate |
$7,528.73 |
| Rate for Payer: Aetna American Axle |
$562.25
|
| Rate for Payer: Aetna Commercial |
$735.25
|
| Rate for Payer: Aetna Medicare |
$2,781.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,343.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,343.25
|
| Rate for Payer: BCBS Complete |
$1,505.26
|
| Rate for Payer: BCBS MAPPO |
$2,674.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,674.60
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$605.50
|
| Rate for Payer: Cofinity Commercial |
$743.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$605.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$692.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,674.60
|
| Rate for Payer: Healthscope Commercial |
$778.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$605.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.75
|
| Rate for Payer: Mclaren Medicaid |
$1,433.59
|
| Rate for Payer: Mclaren Medicare |
$2,674.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,808.33
|
| Rate for Payer: Meridian Medicaid |
$1,505.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,075.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.25
|
| Rate for Payer: PACE Medicare |
$2,540.87
|
| Rate for Payer: PACE SWMI |
$2,674.60
|
| Rate for Payer: PHP Commercial |
$735.25
|
| Rate for Payer: PHP Medicare Advantage |
$2,674.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,433.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health Medicare |
$2,674.60
|
| Rate for Payer: Priority Health SBD |
$544.95
|
| Rate for Payer: Railroad Medicare Medicare |
$2,674.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,528.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,674.60
|
| Rate for Payer: UHC Exchange |
$5,111.43
|
| Rate for Payer: UHC Medicare Advantage |
$2,674.60
|
| Rate for Payer: UHCCP Medicaid |
$1,433.59
|
| Rate for Payer: UMR Bronson Commercial |
$320.05
|
| Rate for Payer: VA VA |
$2,674.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.75
|
|
|
PR DSTRJ LESION ANUS EXTENSIVE
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
CPT 46924
|
| Hospital Charge Code |
46924
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$380.60 |
| Max. Negotiated Rate |
$778.50 |
| Rate for Payer: Aetna American Axle |
$562.25
|
| Rate for Payer: Aetna Commercial |
$735.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.25
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$605.50
|
| Rate for Payer: Cofinity Commercial |
$743.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$605.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$692.00
|
| Rate for Payer: Healthscope Commercial |
$778.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$605.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.25
|
| Rate for Payer: PHP Commercial |
$735.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health SBD |
$544.95
|
| Rate for Payer: UMR Bronson Commercial |
$380.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.75
|
|
|
PR DSTRJ LESION ANUS EXTENSIVE
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 46924
|
| Hospital Charge Code |
46924
|
| Min. Negotiated Rate |
$174.98 |
| Max. Negotiated Rate |
$562.25 |
| Rate for Payer: Aetna Commercial |
$234.47
|
| Rate for Payer: Aetna Medicare |
$181.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.47
|
| Rate for Payer: BCBS Complete |
$346.00
|
| Rate for Payer: BCBS MAPPO |
$174.98
|
| Rate for Payer: BCN Medicare Advantage |
$174.98
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$234.47
|
| Rate for Payer: Cofinity Commercial |
$251.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.73
|
| Rate for Payer: Nomi Health Commercial |
$209.98
|
| Rate for Payer: PACE SWMI |
$174.98
|
| Rate for Payer: PHP Commercial |
$244.97
|
| Rate for Payer: PHP Medicare Advantage |
$174.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health Medicare |
$174.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.98
|
| Rate for Payer: UHC Medicare Advantage |
$174.98
|
| Rate for Payer: UMR Bronson Commercial |
$397.90
|
|
|
PR DSTRJ LESION ANUS EXTENSIVE
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 46924
|
| Min. Negotiated Rate |
$174.98 |
| Max. Negotiated Rate |
$562.25 |
| Rate for Payer: Aetna Commercial |
$234.47
|
| Rate for Payer: Aetna Medicare |
$181.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.47
|
| Rate for Payer: BCBS Complete |
$346.00
|
| Rate for Payer: BCBS MAPPO |
$174.98
|
| Rate for Payer: BCN Medicare Advantage |
$174.98
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$251.97
|
| Rate for Payer: Cofinity Commercial |
$234.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.73
|
| Rate for Payer: Nomi Health Commercial |
$209.98
|
| Rate for Payer: PACE SWMI |
$174.98
|
| Rate for Payer: PHP Commercial |
$244.97
|
| Rate for Payer: PHP Medicare Advantage |
$174.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health Medicare |
$174.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.98
|
| Rate for Payer: UHC Medicare Advantage |
$174.98
|
| Rate for Payer: UMR Bronson Commercial |
$397.90
|
|
