|
PR DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 53661
|
| Min. Negotiated Rate |
$25.56 |
| Max. Negotiated Rate |
$2,149.12 |
| Rate for Payer: Aetna Commercial |
$51.07
|
| Rate for Payer: Aetna Medicare |
$39.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.88
|
| Rate for Payer: BCBS Complete |
$26.84
|
| Rate for Payer: BCBS MAPPO |
$38.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,149.12
|
| Rate for Payer: BCN Commercial |
$108.48
|
| Rate for Payer: BCN Medicare Advantage |
$38.11
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cofinity Commercial |
$51.07
|
| Rate for Payer: Cofinity Commercial |
$54.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.02
|
| Rate for Payer: Meridian Medicaid |
$26.84
|
| Rate for Payer: Nomi Health Commercial |
$45.73
|
| Rate for Payer: PACE SWMI |
$38.11
|
| Rate for Payer: PHP Commercial |
$53.35
|
| Rate for Payer: PHP Medicare Advantage |
$38.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.92
|
| Rate for Payer: Priority Health Medicare |
$38.11
|
| Rate for Payer: Priority Health Narrow Network |
$63.92
|
| Rate for Payer: Priority Health SBD |
$63.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.11
|
| Rate for Payer: UHC Medicare Advantage |
$38.11
|
| Rate for Payer: UHCCP Medicaid |
$25.56
|
| Rate for Payer: UMR Bronson Commercial |
$66.70
|
|
|
PR DILATION CERVICAL CANAL INSTRUMENTAL SPX
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
HCPCS 57800
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$1,422.71 |
| Rate for Payer: Aetna Commercial |
$61.71
|
| Rate for Payer: Aetna Medicare |
$47.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.31
|
| Rate for Payer: BCBS Complete |
$32.43
|
| Rate for Payer: BCBS MAPPO |
$46.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.71
|
| Rate for Payer: BCN Commercial |
$114.35
|
| Rate for Payer: BCN Medicare Advantage |
$46.05
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cofinity Commercial |
$61.71
|
| Rate for Payer: Cofinity Commercial |
$66.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.35
|
| Rate for Payer: Meridian Medicaid |
$32.43
|
| Rate for Payer: Nomi Health Commercial |
$55.26
|
| Rate for Payer: PACE SWMI |
$46.05
|
| Rate for Payer: PHP Commercial |
$64.47
|
| Rate for Payer: PHP Medicare Advantage |
$46.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.93
|
| Rate for Payer: Priority Health Medicare |
$46.05
|
| Rate for Payer: Priority Health Narrow Network |
$71.93
|
| Rate for Payer: Priority Health SBD |
$71.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.05
|
| Rate for Payer: UHC Medicare Advantage |
$46.05
|
| Rate for Payer: UHCCP Medicaid |
$30.89
|
| Rate for Payer: UMR Bronson Commercial |
$94.30
|
|
|
PR DILATION & CURETTAGE CERVICAL STUMP
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 57558
|
| Min. Negotiated Rate |
$82.43 |
| Max. Negotiated Rate |
$1,924.60 |
| Rate for Payer: Aetna Commercial |
$162.62
|
| Rate for Payer: Aetna Medicare |
$126.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.76
|
| Rate for Payer: BCBS Complete |
$86.55
|
| Rate for Payer: BCBS MAPPO |
$121.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,924.60
|
| Rate for Payer: BCN Commercial |
$233.59
|
| Rate for Payer: BCN Medicare Advantage |
$121.36
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cofinity Commercial |
$162.62
|
| Rate for Payer: Cofinity Commercial |
$174.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.43
|
| Rate for Payer: Meridian Medicaid |
$86.55
|
| Rate for Payer: Nomi Health Commercial |
$145.63
|
| Rate for Payer: PACE SWMI |
$121.36
|
| Rate for Payer: PHP Commercial |
$169.90
|
| Rate for Payer: PHP Medicare Advantage |
$121.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.95
|
| Rate for Payer: Priority Health Medicare |
$121.36
|
| Rate for Payer: Priority Health Narrow Network |
$193.95
|
| Rate for Payer: Priority Health SBD |
$193.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.36
|
| Rate for Payer: UHC Medicare Advantage |
$121.36
|
| Rate for Payer: UHCCP Medicaid |
$82.43
|
| Rate for Payer: UMR Bronson Commercial |
$125.12
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 58120
|
| Hospital Charge Code |
58120
|
| Min. Negotiated Rate |
$150.17 |
| Max. Negotiated Rate |
$1,908.75 |
| Rate for Payer: Aetna Commercial |
$299.05
|
| Rate for Payer: Aetna Medicare |
$232.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.36
|
| Rate for Payer: BCBS Complete |
$157.68
|
| Rate for Payer: BCBS MAPPO |
$223.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,908.75
|
| Rate for Payer: BCN Commercial |
$438.83
|
| Rate for Payer: BCN Medicare Advantage |
$223.17
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cofinity Commercial |
$321.36
|
| Rate for Payer: Cofinity Commercial |
$299.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.33
|
| Rate for Payer: Meridian Medicaid |
$157.68
|
| Rate for Payer: Nomi Health Commercial |
$267.80
|
| Rate for Payer: PACE SWMI |
$223.17
|
| Rate for Payer: PHP Commercial |
$312.44
|
| Rate for Payer: PHP Medicare Advantage |
$223.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$350.21
|
| Rate for Payer: Priority Health Medicare |
$223.17
|
| Rate for Payer: Priority Health Narrow Network |
$350.21
|
| Rate for Payer: Priority Health SBD |
$350.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.17
|
| Rate for Payer: UHC Medicare Advantage |
$223.17
|
| Rate for Payer: UHCCP Medicaid |
$150.17
|
| Rate for Payer: UMR Bronson Commercial |
$396.52
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
58120
|
| Min. Negotiated Rate |
$226.21 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna American Axle |
$560.30
|
| Rate for Payer: Aetna Commercial |
$732.70
|
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,446.86
|
| Rate for Payer: BCN Commercial |
$2,446.86
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cofinity Commercial |
$741.32
|
| Rate for Payer: Cofinity Commercial |
$603.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$603.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Healthscope Commercial |
$775.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$603.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$646.50
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$732.70
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Commercial |
$732.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Priority Health SBD |
$543.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.83
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$226.21
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: UMR Bronson Commercial |
$318.94
|
| Rate for Payer: VA VA |
$3,115.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$646.50
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 58120
|
| Min. Negotiated Rate |
$150.17 |
| Max. Negotiated Rate |
$1,908.75 |
| Rate for Payer: Aetna Commercial |
$299.05
|
| Rate for Payer: Aetna Medicare |
$232.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.36
|
| Rate for Payer: BCBS Complete |
$157.68
|
| Rate for Payer: BCBS MAPPO |
$223.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,908.75
|
| Rate for Payer: BCN Commercial |
$438.83
|
| Rate for Payer: BCN Medicare Advantage |
$223.17
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cofinity Commercial |
$299.05
|
| Rate for Payer: Cofinity Commercial |
$321.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.33
|
| Rate for Payer: Meridian Medicaid |
$157.68
|
| Rate for Payer: Nomi Health Commercial |
$267.80
|
| Rate for Payer: PACE SWMI |
$223.17
|
| Rate for Payer: PHP Commercial |
$312.44
|
| Rate for Payer: PHP Medicare Advantage |
$223.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$350.21
|
| Rate for Payer: Priority Health Medicare |
$223.17
|
| Rate for Payer: Priority Health Narrow Network |
$350.21
|
| Rate for Payer: Priority Health SBD |
$350.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.17
|
| Rate for Payer: UHC Medicare Advantage |
$223.17
|
| Rate for Payer: UHCCP Medicaid |
$150.17
|
| Rate for Payer: UMR Bronson Commercial |
$396.52
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
58120
|
| Min. Negotiated Rate |
$379.28 |
| Max. Negotiated Rate |
$775.80 |
| Rate for Payer: Aetna American Axle |
$560.30
|
| Rate for Payer: Aetna Commercial |
$732.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.30
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cofinity Commercial |
$603.40
|
| Rate for Payer: Cofinity Commercial |
$741.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$603.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.60
|
| Rate for Payer: Healthscope Commercial |
$775.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$603.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$646.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$732.70
|
| Rate for Payer: PHP Commercial |
$732.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.30
|
| Rate for Payer: Priority Health SBD |
$543.06
|
| Rate for Payer: UMR Bronson Commercial |
$379.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$646.50
|
|
|
PR DILATION ESOPHAGUS GUIDE WIRE
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 43453
|
| Min. Negotiated Rate |
$55.17 |
| Max. Negotiated Rate |
$1,187.00 |
| Rate for Payer: Aetna Commercial |
$109.76
|
| Rate for Payer: Aetna Medicare |
$85.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.95
|
| Rate for Payer: BCBS Complete |
$57.93
|
| Rate for Payer: BCBS MAPPO |
$81.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,014.34
|
| Rate for Payer: BCN Commercial |
$1,187.00
|
| Rate for Payer: BCN Medicare Advantage |
$81.91
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$109.76
|
| Rate for Payer: Cofinity Commercial |
$117.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.01
|
| Rate for Payer: Meridian Medicaid |
$57.93
|
| Rate for Payer: Nomi Health Commercial |
$98.29
|
| Rate for Payer: PACE SWMI |
$81.91
|
| Rate for Payer: PHP Commercial |
$114.67
|
| Rate for Payer: PHP Medicare Advantage |
$81.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.92
|
| Rate for Payer: Priority Health Medicare |
$81.91
|
| Rate for Payer: Priority Health Narrow Network |
$153.92
|
| Rate for Payer: Priority Health SBD |
$153.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.91
|
| Rate for Payer: UHC Medicare Advantage |
$81.91
|
| Rate for Payer: UHCCP Medicaid |
$55.17
|
| Rate for Payer: UMR Bronson Commercial |
$237.82
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 43450
|
| Hospital Charge Code |
43450
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$1,202.94 |
| Rate for Payer: Aetna Commercial |
$100.73
|
| Rate for Payer: Aetna Medicare |
$78.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.24
|
| Rate for Payer: BCBS Complete |
$53.22
|
| Rate for Payer: BCBS MAPPO |
$75.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.94
|
| Rate for Payer: BCN Commercial |
$275.61
|
| 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: Meridian Medicaid |
$53.22
|
| 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 Choice Medicaid |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.39
|
| Rate for Payer: Priority Health Medicare |
$75.17
|
| Rate for Payer: Priority Health Narrow Network |
$141.39
|
| Rate for Payer: Priority Health SBD |
$141.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.17
|
| Rate for Payer: UHC Medicare Advantage |
$75.17
|
| Rate for Payer: UHCCP Medicaid |
$50.69
|
| Rate for Payer: UMR Bronson Commercial |
$150.88
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
43450
|
| Min. Negotiated Rate |
$144.32 |
| Max. Negotiated Rate |
$295.20 |
| Rate for Payer: Aetna American Axle |
$213.20
|
| Rate for Payer: Aetna Commercial |
$278.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.20
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$229.60
|
| Rate for Payer: Cofinity Commercial |
$282.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| 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: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: PHP Commercial |
$278.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health SBD |
$206.64
|
| Rate for Payer: UMR Bronson Commercial |
$144.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.00
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 43450
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$1,202.94 |
| Rate for Payer: Aetna Commercial |
$100.73
|
| Rate for Payer: Aetna Medicare |
$78.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.24
|
| Rate for Payer: BCBS Complete |
$53.22
|
| Rate for Payer: BCBS MAPPO |
$75.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.94
|
| Rate for Payer: BCN Commercial |
$275.61
|
| 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: Meridian Medicaid |
$53.22
|
| 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 Choice Medicaid |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.39
|
| Rate for Payer: Priority Health Medicare |
$75.17
|
| Rate for Payer: Priority Health Narrow Network |
$141.39
|
| Rate for Payer: Priority Health SBD |
$141.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.17
|
| Rate for Payer: UHC Medicare Advantage |
$75.17
|
| Rate for Payer: UHCCP Medicaid |
$50.69
|
| 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 |
$75.80 |
| Max. Negotiated Rate |
$2,887.15 |
| Rate for Payer: Aetna American Axle |
$213.20
|
| Rate for Payer: Aetna Commercial |
$278.80
|
| Rate for Payer: Aetna Medicare |
$955.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,148.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,148.25
|
| Rate for Payer: BCBS Complete |
$516.99
|
| Rate for Payer: BCBS MAPPO |
$918.60
|
| Rate for Payer: BCBS Trust/PPO |
$687.15
|
| Rate for Payer: BCN Commercial |
$687.15
|
| Rate for Payer: BCN Medicare Advantage |
$918.60
|
| Rate for Payer: Cash Price |
$262.40
|
| 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 |
$918.60
|
| 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 |
$492.37
|
| Rate for Payer: Mclaren Medicare |
$918.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.53
|
| Rate for Payer: Meridian Medicaid |
$516.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,056.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: Nomi Health Commercial |
$1,929.06
|
| Rate for Payer: PACE Medicare |
$872.67
|
| Rate for Payer: PACE SWMI |
$918.60
|
| Rate for Payer: PHP Commercial |
$278.80
|
| Rate for Payer: PHP Medicare Advantage |
$918.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,887.15
|
| Rate for Payer: Priority Health Medicare |
$918.60
|
| Rate for Payer: Priority Health Narrow Network |
$2,309.72
|
| Rate for Payer: Priority Health SBD |
$206.64
|
| Rate for Payer: Railroad Medicare Medicare |
$918.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.38
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.60
|
| Rate for Payer: UHC Exchange |
$75.80
|
| Rate for Payer: UHC Medicare Advantage |
$918.60
|
| Rate for Payer: UHCCP Medicaid |
$492.37
|
| Rate for Payer: UMR Bronson Commercial |
$121.36
|
| Rate for Payer: VA VA |
$918.60
|
| 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 |
$50.48 |
| Max. Negotiated Rate |
$1,061.88 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Aetna Medicare |
$75.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.20
|
| Rate for Payer: BCBS Complete |
$53.00
|
| Rate for Payer: BCBS MAPPO |
$72.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.88
|
| Rate for Payer: BCN Commercial |
$112.30
|
| 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 |
$104.46
|
| Rate for Payer: Cofinity Commercial |
$97.20
|
| 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: Meridian Medicaid |
$53.00
|
| 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 Choice Medicaid |
$50.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.20
|
| Rate for Payer: Priority Health Medicare |
$72.54
|
| Rate for Payer: Priority Health Narrow Network |
$139.20
|
| Rate for Payer: Priority Health SBD |
$139.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.54
|
| Rate for Payer: UHC Medicare Advantage |
$72.54
|
| Rate for Payer: UHCCP Medicaid |
$50.48
|
| Rate for Payer: UMR Bronson Commercial |
$99.36
|
|
|
PR DILATION SALIVARY DUCT
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 42650
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$619.17 |
| Rate for Payer: Aetna Commercial |
$75.80
|
| Rate for Payer: Aetna Medicare |
$58.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.46
|
| Rate for Payer: BCBS Complete |
$40.48
|
| Rate for Payer: BCBS MAPPO |
$56.57
|
| Rate for Payer: BCBS Trust/PPO |
$619.17
|
| Rate for Payer: BCN Commercial |
$109.95
|
| 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 |
$75.80
|
| Rate for Payer: Cofinity Commercial |
$81.46
|
| 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: Meridian Medicaid |
$40.48
|
| 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 Choice Medicaid |
$38.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.19
|
| Rate for Payer: Priority Health Medicare |
$56.57
|
| Rate for Payer: Priority Health Narrow Network |
$106.19
|
| Rate for Payer: Priority Health SBD |
$106.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.57
|
| Rate for Payer: UHC Medicare Advantage |
$56.57
|
| Rate for Payer: UHCCP Medicaid |
$38.55
|
| 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 |
$83.50 |
| Max. Negotiated Rate |
$1,877.58 |
| Rate for Payer: Aetna Commercial |
$167.97
|
| Rate for Payer: Aetna Medicare |
$130.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.50
|
| Rate for Payer: BCBS Complete |
$87.68
|
| Rate for Payer: BCBS MAPPO |
$125.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,877.58
|
| Rate for Payer: BCN Commercial |
$188.63
|
| 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 |
$167.97
|
| Rate for Payer: Cofinity Commercial |
$180.50
|
| 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: Meridian Medicaid |
$87.68
|
| 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 Choice Medicaid |
$83.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.95
|
| Rate for Payer: Priority Health Medicare |
$125.35
|
| Rate for Payer: Priority Health Narrow Network |
$193.95
|
| Rate for Payer: Priority Health SBD |
$193.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.35
|
| Rate for Payer: UHC Medicare Advantage |
$125.35
|
| Rate for Payer: UHCCP Medicaid |
$83.50
|
| 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 |
$125.03 |
| Max. Negotiated Rate |
$1,149.58 |
| Rate for Payer: Aetna Commercial |
$248.46
|
| Rate for Payer: Aetna Medicare |
$192.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.00
|
| Rate for Payer: BCBS Complete |
$131.28
|
| Rate for Payer: BCBS MAPPO |
$185.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,149.58
|
| Rate for Payer: BCN Commercial |
$281.97
|
| 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 |
$248.46
|
| Rate for Payer: Cofinity Commercial |
$267.00
|
| 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: Meridian Medicaid |
$131.28
|
| 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 Choice Medicaid |
$125.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$858.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$347.21
|
| Rate for Payer: Priority Health Medicare |
$185.42
|
| Rate for Payer: Priority Health Narrow Network |
$347.21
|
| Rate for Payer: Priority Health SBD |
$347.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.42
|
| Rate for Payer: UHC Medicare Advantage |
$185.42
|
| Rate for Payer: UHCCP Medicaid |
$125.03
|
| 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 |
$40.68 |
| Max. Negotiated Rate |
$549.43 |
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna Medicare |
$63.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.01
|
| Rate for Payer: BCBS Complete |
$42.71
|
| Rate for Payer: BCBS MAPPO |
$61.12
|
| Rate for Payer: BCBS Trust/PPO |
$549.43
|
| Rate for Payer: BCN Commercial |
$129.50
|
| 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 |
$81.90
|
| Rate for Payer: Cofinity Commercial |
$88.01
|
| 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: Meridian Medicaid |
$42.71
|
| 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 Choice Medicaid |
$40.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.13
|
| Rate for Payer: Priority Health Medicare |
$61.12
|
| Rate for Payer: Priority Health Narrow Network |
$100.13
|
| Rate for Payer: Priority Health SBD |
$100.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.12
|
| Rate for Payer: UHC Medicare Advantage |
$61.12
|
| Rate for Payer: UHCCP Medicaid |
$40.68
|
| 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 |
$34.08 |
| Max. Negotiated Rate |
$244.07 |
| Rate for Payer: Aetna Commercial |
$68.43
|
| Rate for Payer: Aetna Medicare |
$53.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.54
|
| Rate for Payer: BCBS Complete |
$35.78
|
| Rate for Payer: BCBS MAPPO |
$51.07
|
| Rate for Payer: BCBS Trust/PPO |
$244.07
|
| Rate for Payer: BCN Commercial |
$124.13
|
| 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 |
$68.43
|
| Rate for Payer: Cofinity Commercial |
$73.54
|
| 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: Meridian Medicaid |
$35.78
|
| 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 Choice Medicaid |
$34.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.14
|
| Rate for Payer: Priority Health Medicare |
$51.07
|
| Rate for Payer: Priority Health Narrow Network |
$84.14
|
| Rate for Payer: Priority Health SBD |
$84.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.07
|
| Rate for Payer: UHC Medicare Advantage |
$51.07
|
| Rate for Payer: UHCCP Medicaid |
$34.08
|
| 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 |
$55.38 |
| Max. Negotiated Rate |
$1,543.16 |
| Rate for Payer: Aetna Commercial |
$111.18
|
| Rate for Payer: Aetna Medicare |
$86.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.48
|
| Rate for Payer: BCBS Complete |
$58.15
|
| Rate for Payer: BCBS MAPPO |
$82.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.16
|
| Rate for Payer: BCN Commercial |
$248.73
|
| 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 |
$111.18
|
| Rate for Payer: Cofinity Commercial |
$119.48
|
| 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: Meridian Medicaid |
$58.15
|
| 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 Choice Medicaid |
$55.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.41
|
| Rate for Payer: Priority Health Medicare |
$82.97
|
| Rate for Payer: Priority Health Narrow Network |
$137.41
|
| Rate for Payer: Priority Health SBD |
$137.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.97
|
| Rate for Payer: UHC Medicare Advantage |
$82.97
|
| Rate for Payer: UHCCP Medicaid |
$55.38
|
| 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 |
$45.58 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna Commercial |
$91.52
|
| Rate for Payer: Aetna Medicare |
$71.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.35
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS MAPPO |
$68.30
|
| Rate for Payer: BCBS Trust/PPO |
$924.00
|
| Rate for Payer: BCN Commercial |
$237.98
|
| 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 |
$91.52
|
| Rate for Payer: Cofinity Commercial |
$98.35
|
| 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: Meridian Medicaid |
$47.86
|
| 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 Choice Medicaid |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.44
|
| Rate for Payer: Priority Health Medicare |
$68.30
|
| Rate for Payer: Priority Health Narrow Network |
$113.44
|
| Rate for Payer: Priority Health SBD |
$113.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.30
|
| Rate for Payer: UHC Medicare Advantage |
$68.30
|
| Rate for Payer: UHCCP Medicaid |
$45.58
|
| 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 |
$40.47 |
| Max. Negotiated Rate |
$1,411.09 |
| Rate for Payer: Aetna Commercial |
$81.78
|
| Rate for Payer: Aetna Medicare |
$63.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.88
|
| Rate for Payer: BCBS Complete |
$42.49
|
| Rate for Payer: BCBS MAPPO |
$61.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,411.09
|
| Rate for Payer: BCN Commercial |
$92.36
|
| 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 |
$81.78
|
| Rate for Payer: Cofinity Commercial |
$87.88
|
| 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: Meridian Medicaid |
$42.49
|
| 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 Choice Medicaid |
$40.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.66
|
| Rate for Payer: Priority Health Medicare |
$61.03
|
| Rate for Payer: Priority Health Narrow Network |
$100.66
|
| Rate for Payer: Priority Health SBD |
$100.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.03
|
| Rate for Payer: UHC Medicare Advantage |
$61.03
|
| Rate for Payer: UHCCP Medicaid |
$40.47
|
| Rate for Payer: UMR Bronson Commercial |
$57.50
|
|
|
PR DIPHENHYDRAMINE HCL INJECTIO
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J1200
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$1.21
|
| Rate for Payer: Aetna Medicare |
$0.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.30
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$0.90
|
| Rate for Payer: BCBS Trust/PPO |
$0.39
|
| Rate for Payer: BCN Commercial |
$0.58
|
| Rate for Payer: BCN Medicare Advantage |
$0.90
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$1.30
|
| Rate for Payer: Cofinity Commercial |
$1.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.95
|
| Rate for Payer: Nomi Health Commercial |
$1.08
|
| Rate for Payer: PACE SWMI |
$0.90
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: PHP Medicare Advantage |
$0.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$0.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.90
|
| Rate for Payer: UHC Medicare Advantage |
$0.90
|
| 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 |
$34.91 |
| Rate for Payer: Aetna Commercial |
$29.53
|
| Rate for Payer: Aetna Medicare |
$24.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.53
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS Trust/PPO |
$34.91
|
| Rate for Payer: BCN Commercial |
$34.91
|
| Rate for Payer: Cash Price |
$38.40
|
| 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 |
$1,089.50 |
| 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 |
$1,143.98
|
| Rate for Payer: BCBS MAPPO |
$1,662.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,139.01
|
| Rate for Payer: BCN Commercial |
$2,482.48
|
| 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 |
$1,745.42
|
| Rate for Payer: Meridian Medicaid |
$1,143.98
|
| 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 Choice Medicaid |
$1,089.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,958.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,712.30
|
| Rate for Payer: Priority Health Medicare |
$1,662.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,712.30
|
| Rate for Payer: Priority Health SBD |
$2,712.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,662.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,662.30
|
| Rate for Payer: UHCCP Medicaid |
$1,089.50
|
| 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 |
$1,172.57 |
| Max. Negotiated Rate |
$2,929.82 |
| Rate for Payer: Aetna Commercial |
$2,416.64
|
| Rate for Payer: Aetna Medicare |
$1,875.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,416.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,596.98
|
| Rate for Payer: BCBS Complete |
$1,231.20
|
| Rate for Payer: BCBS MAPPO |
$1,803.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,938.33
|
| Rate for Payer: BCN Commercial |
$2,674.05
|
| 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 |
$2,416.64
|
| Rate for Payer: Cofinity Commercial |
$2,596.98
|
| 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: Meridian Medicaid |
$1,231.20
|
| 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 Choice Medicaid |
$1,172.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,418.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,929.82
|
| Rate for Payer: Priority Health Medicare |
$1,803.46
|
| Rate for Payer: Priority Health Narrow Network |
$2,929.82
|
| Rate for Payer: Priority Health SBD |
$2,929.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,803.46
|
| Rate for Payer: UHC Medicare Advantage |
$1,803.46
|
| Rate for Payer: UHCCP Medicaid |
$1,172.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,711.66
|
|
