|
PR DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 69000
|
| Min. Negotiated Rate |
$80.94 |
| Max. Negotiated Rate |
$5,524.43 |
| Rate for Payer: Aetna Commercial |
$158.33
|
| Rate for Payer: Aetna Medicare |
$122.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.15
|
| Rate for Payer: BCBS Complete |
$84.99
|
| Rate for Payer: BCBS MAPPO |
$118.16
|
| Rate for Payer: BCBS Trust/PPO |
$5,524.43
|
| Rate for Payer: BCN Commercial |
$275.12
|
| Rate for Payer: BCN Medicare Advantage |
$118.16
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$158.33
|
| Rate for Payer: Cofinity Commercial |
$170.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.07
|
| Rate for Payer: Meridian Medicaid |
$84.99
|
| Rate for Payer: Nomi Health Commercial |
$141.79
|
| Rate for Payer: PACE SWMI |
$118.16
|
| Rate for Payer: PHP Commercial |
$165.42
|
| Rate for Payer: PHP Medicare Advantage |
$118.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.82
|
| Rate for Payer: Priority Health Medicare |
$118.16
|
| Rate for Payer: Priority Health Narrow Network |
$184.82
|
| Rate for Payer: Priority Health SBD |
$184.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.16
|
| Rate for Payer: UHC Medicare Advantage |
$118.16
|
| Rate for Payer: UHCCP Medicaid |
$80.94
|
| Rate for Payer: UMR Bronson Commercial |
$145.82
|
|
|
PR DRAINAGE FINGER ABSCESS COMPLICATED
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
HCPCS 26011
|
| Min. Negotiated Rate |
$120.98 |
| Max. Negotiated Rate |
$712.98 |
| Rate for Payer: Aetna Commercial |
$237.69
|
| Rate for Payer: Aetna Medicare |
$184.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.43
|
| Rate for Payer: BCBS Complete |
$127.03
|
| Rate for Payer: BCBS MAPPO |
$177.38
|
| Rate for Payer: BCBS Trust/PPO |
$452.09
|
| Rate for Payer: BCN Commercial |
$712.98
|
| Rate for Payer: BCN Medicare Advantage |
$177.38
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cofinity Commercial |
$237.69
|
| Rate for Payer: Cofinity Commercial |
$255.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.25
|
| Rate for Payer: Meridian Medicaid |
$127.03
|
| Rate for Payer: Nomi Health Commercial |
$212.86
|
| Rate for Payer: PACE SWMI |
$177.38
|
| Rate for Payer: PHP Commercial |
$248.33
|
| Rate for Payer: PHP Medicare Advantage |
$177.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$286.49
|
| Rate for Payer: Priority Health Medicare |
$177.38
|
| Rate for Payer: Priority Health Narrow Network |
$286.49
|
| Rate for Payer: Priority Health SBD |
$286.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.38
|
| Rate for Payer: UHC Medicare Advantage |
$177.38
|
| Rate for Payer: UHCCP Medicaid |
$120.98
|
| Rate for Payer: UMR Bronson Commercial |
$373.06
|
|
|
PR DRAINAGE FINGER ABSCESS SIMPLE
|
Professional
|
Both
|
$576.00
|
|
|
Service Code
|
HCPCS 26010
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$509.69 |
| Rate for Payer: Aetna Commercial |
$179.51
|
| Rate for Payer: Aetna Medicare |
$139.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.90
|
| Rate for Payer: BCBS Complete |
$96.39
|
| Rate for Payer: BCBS MAPPO |
$133.96
|
| Rate for Payer: BCBS Trust/PPO |
$348.51
|
| Rate for Payer: BCN Commercial |
$509.69
|
| Rate for Payer: BCN Medicare Advantage |
$133.96
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cofinity Commercial |
$179.51
|
| Rate for Payer: Cofinity Commercial |
$192.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.66
|
| Rate for Payer: Meridian Medicaid |
$96.39
|
| Rate for Payer: Nomi Health Commercial |
$160.75
|
| Rate for Payer: PACE SWMI |
$133.96
|
| Rate for Payer: PHP Commercial |
$187.54
|
| Rate for Payer: PHP Medicare Advantage |
$133.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.82
|
| Rate for Payer: Priority Health Medicare |
$133.96
|
| Rate for Payer: Priority Health Narrow Network |
$218.82
|
| Rate for Payer: Priority Health SBD |
$218.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.96
|
| Rate for Payer: UHC Medicare Advantage |
$133.96
|
| Rate for Payer: UHCCP Medicaid |
$91.80
|
| Rate for Payer: UMR Bronson Commercial |
$264.96
|
|
|
PR DRAINAGE OF PALMAR BURSA MULTIPLE BURSA
|
Professional
|
Both
|
$3,178.00
|
|
|
Service Code
|
HCPCS 26030
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$2,065.70 |
| Rate for Payer: Aetna Commercial |
$637.71
|
| Rate for Payer: Aetna Medicare |
$494.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$637.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$685.30
|
| Rate for Payer: BCBS Complete |
$339.95
|
| Rate for Payer: BCBS MAPPO |
$475.90
|
| Rate for Payer: BCBS Trust/PPO |
$104.00
|
| Rate for Payer: BCN Commercial |
$727.15
|
| Rate for Payer: BCN Medicare Advantage |
$475.90
|
| Rate for Payer: Cash Price |
$2,542.40
|
| Rate for Payer: Cash Price |
$2,542.40
|
| Rate for Payer: Cofinity Commercial |
$637.71
|
| Rate for Payer: Cofinity Commercial |
$685.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$475.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$499.70
|
| Rate for Payer: Meridian Medicaid |
$339.95
|
| Rate for Payer: Nomi Health Commercial |
$571.08
|
| Rate for Payer: PACE SWMI |
$475.90
|
| Rate for Payer: PHP Commercial |
$666.26
|
| Rate for Payer: PHP Medicare Advantage |
$475.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$323.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,065.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$765.32
|
| Rate for Payer: Priority Health Medicare |
$475.90
|
| Rate for Payer: Priority Health Narrow Network |
$765.32
|
| Rate for Payer: Priority Health SBD |
$765.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$475.90
|
| Rate for Payer: UHC Medicare Advantage |
$475.90
|
| Rate for Payer: UHCCP Medicaid |
$323.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,461.88
|
|
|
PR DRAINAGE OF PALMAR BURSA SINGLE BURSA
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS 26025
|
| Min. Negotiated Rate |
$84.90 |
| Max. Negotiated Rate |
$885.95 |
| Rate for Payer: Aetna Commercial |
$541.29
|
| Rate for Payer: Aetna Medicare |
$420.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$541.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.69
|
| Rate for Payer: BCBS Complete |
$289.18
|
| Rate for Payer: BCBS MAPPO |
$403.95
|
| Rate for Payer: BCBS Trust/PPO |
$84.90
|
| Rate for Payer: BCN Commercial |
$621.60
|
| Rate for Payer: BCN Medicare Advantage |
$403.95
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cofinity Commercial |
$541.29
|
| Rate for Payer: Cofinity Commercial |
$581.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$424.15
|
| Rate for Payer: Meridian Medicaid |
$289.18
|
| Rate for Payer: Nomi Health Commercial |
$484.74
|
| Rate for Payer: PACE SWMI |
$403.95
|
| Rate for Payer: PHP Commercial |
$565.53
|
| Rate for Payer: PHP Medicare Advantage |
$403.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$653.37
|
| Rate for Payer: Priority Health Medicare |
$403.95
|
| Rate for Payer: Priority Health Narrow Network |
$653.37
|
| Rate for Payer: Priority Health SBD |
$653.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.95
|
| Rate for Payer: UHC Medicare Advantage |
$403.95
|
| Rate for Payer: UHCCP Medicaid |
$275.41
|
| Rate for Payer: UMR Bronson Commercial |
$626.98
|
|
|
PR DRAINAGE OF RETROPERITONEAL ABSCESS OPEN
|
Professional
|
Both
|
$2,249.00
|
|
|
Service Code
|
HCPCS 49060
|
| Min. Negotiated Rate |
$709.29 |
| Max. Negotiated Rate |
$1,957.42 |
| Rate for Payer: Aetna Commercial |
$1,433.85
|
| Rate for Payer: Aetna Medicare |
$1,112.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,433.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,540.86
|
| Rate for Payer: BCBS Complete |
$744.75
|
| Rate for Payer: BCBS MAPPO |
$1,070.04
|
| Rate for Payer: BCBS Trust/PPO |
$798.26
|
| Rate for Payer: BCN Commercial |
$1,595.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,070.04
|
| Rate for Payer: Cash Price |
$1,799.20
|
| Rate for Payer: Cash Price |
$1,799.20
|
| Rate for Payer: Cofinity Commercial |
$1,433.85
|
| Rate for Payer: Cofinity Commercial |
$1,540.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,070.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,123.54
|
| Rate for Payer: Meridian Medicaid |
$744.75
|
| Rate for Payer: Nomi Health Commercial |
$1,284.05
|
| Rate for Payer: PACE SWMI |
$1,070.04
|
| Rate for Payer: PHP Commercial |
$1,498.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,070.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$709.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,461.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,957.42
|
| Rate for Payer: Priority Health Medicare |
$1,070.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,957.42
|
| Rate for Payer: Priority Health SBD |
$1,957.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,070.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,070.04
|
| Rate for Payer: UHCCP Medicaid |
$709.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,034.54
|
|
|
PR DRAINAGE OVARIAN ABSCESS ABDOMINAL APPROACH
|
Professional
|
Both
|
$1,725.00
|
|
|
Service Code
|
HCPCS 58822
|
| Min. Negotiated Rate |
$280.53 |
| Max. Negotiated Rate |
$1,121.25 |
| Rate for Payer: Aetna Commercial |
$917.79
|
| Rate for Payer: Aetna Medicare |
$712.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.28
|
| Rate for Payer: BCBS Complete |
$481.30
|
| Rate for Payer: BCBS MAPPO |
$684.92
|
| Rate for Payer: BCBS Trust/PPO |
$280.53
|
| Rate for Payer: BCN Commercial |
$1,050.17
|
| Rate for Payer: BCN Medicare Advantage |
$684.92
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cofinity Commercial |
$917.79
|
| Rate for Payer: Cofinity Commercial |
$986.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$684.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.17
|
| Rate for Payer: Meridian Medicaid |
$481.30
|
| Rate for Payer: Nomi Health Commercial |
$821.90
|
| Rate for Payer: PACE SWMI |
$684.92
|
| Rate for Payer: PHP Commercial |
$958.89
|
| Rate for Payer: PHP Medicare Advantage |
$684.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$458.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,121.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,070.46
|
| Rate for Payer: Priority Health Medicare |
$684.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,070.46
|
| Rate for Payer: Priority Health SBD |
$1,070.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$684.92
|
| Rate for Payer: UHC Medicare Advantage |
$684.92
|
| Rate for Payer: UHCCP Medicaid |
$458.38
|
| Rate for Payer: UMR Bronson Commercial |
$793.50
|
|
|
PR DRAINAGE OVARIAN ABSCESS VAGINAL APPR OPEN
|
Professional
|
Both
|
$897.00
|
|
|
Service Code
|
HCPCS 58820
|
| Min. Negotiated Rate |
$136.83 |
| Max. Negotiated Rate |
$583.05 |
| Rate for Payer: Aetna Commercial |
$431.95
|
| Rate for Payer: Aetna Medicare |
$335.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$431.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.18
|
| Rate for Payer: BCBS Complete |
$229.25
|
| Rate for Payer: BCBS MAPPO |
$322.35
|
| Rate for Payer: BCBS Trust/PPO |
$136.83
|
| Rate for Payer: BCN Commercial |
$500.41
|
| Rate for Payer: BCN Medicare Advantage |
$322.35
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cofinity Commercial |
$431.95
|
| Rate for Payer: Cofinity Commercial |
$464.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.47
|
| Rate for Payer: Meridian Medicaid |
$229.25
|
| Rate for Payer: Nomi Health Commercial |
$386.82
|
| Rate for Payer: PACE SWMI |
$322.35
|
| Rate for Payer: PHP Commercial |
$451.29
|
| Rate for Payer: PHP Medicare Advantage |
$322.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$218.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$510.43
|
| Rate for Payer: Priority Health Medicare |
$322.35
|
| Rate for Payer: Priority Health Narrow Network |
$510.43
|
| Rate for Payer: Priority Health SBD |
$510.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.35
|
| Rate for Payer: UHC Medicare Advantage |
$322.35
|
| Rate for Payer: UHCCP Medicaid |
$218.33
|
| Rate for Payer: UMR Bronson Commercial |
$412.62
|
|
|
PR DRAINAGE OVARIAN CYST UNI/BI SPX ABDOMINAL
|
Professional
|
Both
|
$1,612.00
|
|
|
Service Code
|
HCPCS 58805
|
| Min. Negotiated Rate |
$274.77 |
| Max. Negotiated Rate |
$1,047.80 |
| Rate for Payer: Aetna Commercial |
$546.29
|
| Rate for Payer: Aetna Medicare |
$423.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.06
|
| Rate for Payer: BCBS Complete |
$288.51
|
| Rate for Payer: BCBS MAPPO |
$407.68
|
| Rate for Payer: BCBS Trust/PPO |
$275.77
|
| Rate for Payer: BCN Commercial |
$630.89
|
| Rate for Payer: BCN Medicare Advantage |
$407.68
|
| Rate for Payer: Cash Price |
$1,289.60
|
| Rate for Payer: Cash Price |
$1,289.60
|
| Rate for Payer: Cofinity Commercial |
$546.29
|
| Rate for Payer: Cofinity Commercial |
$587.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$428.06
|
| Rate for Payer: Meridian Medicaid |
$288.51
|
| Rate for Payer: Nomi Health Commercial |
$489.22
|
| Rate for Payer: PACE SWMI |
$407.68
|
| Rate for Payer: PHP Commercial |
$570.75
|
| Rate for Payer: PHP Medicare Advantage |
$407.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,047.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$643.87
|
| Rate for Payer: Priority Health Medicare |
$407.68
|
| Rate for Payer: Priority Health Narrow Network |
$643.87
|
| Rate for Payer: Priority Health SBD |
$643.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$407.68
|
| Rate for Payer: UHC Medicare Advantage |
$407.68
|
| Rate for Payer: UHCCP Medicaid |
$274.77
|
| Rate for Payer: UMR Bronson Commercial |
$741.52
|
|
|
PR DRAINAGE OVARIAN CYST UNI/BI SPX VAGINAL APPR
|
Professional
|
Both
|
$993.00
|
|
|
Service Code
|
HCPCS 58800
|
| Min. Negotiated Rate |
$203.63 |
| 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) |
$404.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.46
|
| Rate for Payer: BCBS Complete |
$213.81
|
| Rate for Payer: BCBS MAPPO |
$301.71
|
| Rate for Payer: BCBS Trust/PPO |
$503.47
|
| Rate for Payer: BCN Commercial |
$535.10
|
| 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 |
$404.29
|
| Rate for Payer: Cofinity Commercial |
$434.46
|
| 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: Meridian Medicaid |
$213.81
|
| 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 Choice Medicaid |
$203.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$645.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$474.71
|
| Rate for Payer: Priority Health Medicare |
$301.71
|
| Rate for Payer: Priority Health Narrow Network |
$474.71
|
| Rate for Payer: Priority Health SBD |
$474.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$301.71
|
| Rate for Payer: UHC Medicare Advantage |
$301.71
|
| Rate for Payer: UHCCP Medicaid |
$203.63
|
| 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 |
$537.81 |
| Max. Negotiated Rate |
$2,851.12 |
| Rate for Payer: Aetna Commercial |
$2,069.04
|
| Rate for Payer: Aetna Medicare |
$1,605.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,069.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,223.45
|
| Rate for Payer: BCBS Complete |
$1,073.74
|
| Rate for Payer: BCBS MAPPO |
$1,544.06
|
| Rate for Payer: BCBS Trust/PPO |
$537.81
|
| Rate for Payer: BCN Commercial |
$2,320.24
|
| 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 |
$2,069.04
|
| Rate for Payer: Cofinity Commercial |
$2,223.45
|
| 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: Meridian Medicaid |
$1,073.74
|
| 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 Choice Medicaid |
$1,022.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,838.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,851.12
|
| Rate for Payer: Priority Health Medicare |
$1,544.06
|
| Rate for Payer: Priority Health Narrow Network |
$2,851.12
|
| Rate for Payer: Priority Health SBD |
$2,851.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,544.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,544.06
|
| Rate for Payer: UHCCP Medicaid |
$1,022.61
|
| 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 |
$108.84 |
| Max. Negotiated Rate |
$1,199.77 |
| Rate for Payer: Aetna Commercial |
$215.31
|
| Rate for Payer: Aetna Medicare |
$167.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.38
|
| Rate for Payer: BCBS Complete |
$114.28
|
| Rate for Payer: BCBS MAPPO |
$160.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,199.77
|
| Rate for Payer: BCN Commercial |
$336.70
|
| 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 |
$215.31
|
| Rate for Payer: Cofinity Commercial |
$231.38
|
| 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: Meridian Medicaid |
$114.28
|
| 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 Choice Medicaid |
$108.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.03
|
| Rate for Payer: Priority Health Medicare |
$160.68
|
| Rate for Payer: Priority Health Narrow Network |
$270.03
|
| Rate for Payer: Priority Health SBD |
$270.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.68
|
| Rate for Payer: UHC Medicare Advantage |
$160.68
|
| Rate for Payer: UHCCP Medicaid |
$108.84
|
| 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 |
$640.83 |
| Max. Negotiated Rate |
$1,796.35 |
| Rate for Payer: Aetna Commercial |
$1,307.34
|
| Rate for Payer: Aetna Medicare |
$1,014.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,307.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,404.91
|
| Rate for Payer: BCBS Complete |
$679.22
|
| Rate for Payer: BCBS MAPPO |
$975.63
|
| Rate for Payer: BCBS Trust/PPO |
$640.83
|
| Rate for Payer: BCN Commercial |
$1,465.54
|
| 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 |
$1,307.34
|
| Rate for Payer: Cofinity Commercial |
$1,404.91
|
| 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: Meridian Medicaid |
$679.22
|
| 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 Choice Medicaid |
$646.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,445.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,796.35
|
| Rate for Payer: Priority Health Medicare |
$975.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,796.35
|
| Rate for Payer: Priority Health SBD |
$1,796.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$975.63
|
| Rate for Payer: UHC Medicare Advantage |
$975.63
|
| Rate for Payer: UHCCP Medicaid |
$646.88
|
| 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 |
$351.90 |
| Max. Negotiated Rate |
$865.57 |
| Rate for Payer: Aetna Commercial |
$719.93
|
| Rate for Payer: Aetna Medicare |
$558.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$773.65
|
| Rate for Payer: BCBS Complete |
$384.46
|
| Rate for Payer: BCBS MAPPO |
$537.26
|
| Rate for Payer: BCBS Trust/PPO |
$663.49
|
| Rate for Payer: BCN Commercial |
$823.43
|
| 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 |
$719.93
|
| Rate for Payer: Cofinity Commercial |
$773.65
|
| 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: Meridian Medicaid |
$384.46
|
| 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 Choice Medicaid |
$366.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$865.57
|
| Rate for Payer: Priority Health Medicare |
$537.26
|
| Rate for Payer: Priority Health Narrow Network |
$865.57
|
| Rate for Payer: Priority Health SBD |
$865.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.26
|
| Rate for Payer: UHC Medicare Advantage |
$537.26
|
| Rate for Payer: UHCCP Medicaid |
$366.15
|
| Rate for Payer: UMR Bronson Commercial |
$351.90
|
|
|
PR DRESSING CHANGE UNDER ANESTHESIA
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 15852
|
| Min. Negotiated Rate |
$28.33 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$57.31
|
| Rate for Payer: Aetna Medicare |
$44.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.59
|
| Rate for Payer: BCBS Complete |
$29.75
|
| Rate for Payer: BCBS MAPPO |
$42.77
|
| Rate for Payer: BCBS Trust/PPO |
$450.00
|
| Rate for Payer: BCN Commercial |
$66.95
|
| 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 |
$57.31
|
| Rate for Payer: Cofinity Commercial |
$61.59
|
| 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: Meridian Medicaid |
$29.75
|
| 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 Choice Medicaid |
$28.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.05
|
| Rate for Payer: Priority Health Medicare |
$42.77
|
| Rate for Payer: Priority Health Narrow Network |
$60.05
|
| Rate for Payer: Priority Health SBD |
$60.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.77
|
| Rate for Payer: UHC Medicare Advantage |
$42.77
|
| Rate for Payer: UHCCP Medicaid |
$28.33
|
| 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 |
$102.45 |
| Max. Negotiated Rate |
$2,059.31 |
| Rate for Payer: Aetna Commercial |
$197.33
|
| Rate for Payer: Aetna Medicare |
$153.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.05
|
| Rate for Payer: BCBS Complete |
$107.57
|
| Rate for Payer: BCBS MAPPO |
$147.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,059.31
|
| Rate for Payer: BCN Commercial |
$429.55
|
| 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 |
$197.33
|
| Rate for Payer: Cofinity Commercial |
$212.05
|
| 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: Meridian Medicaid |
$107.57
|
| 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 Choice Medicaid |
$102.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$278.01
|
| Rate for Payer: Priority Health Medicare |
$147.26
|
| Rate for Payer: Priority Health Narrow Network |
$278.01
|
| Rate for Payer: Priority Health SBD |
$278.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.26
|
| Rate for Payer: UHC Medicare Advantage |
$147.26
|
| Rate for Payer: UHCCP Medicaid |
$102.45
|
| 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 |
$130.36 |
| Max. Negotiated Rate |
$1,779.31 |
| Rate for Payer: Aetna Commercial |
$254.99
|
| Rate for Payer: Aetna Medicare |
$197.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.02
|
| Rate for Payer: BCBS Complete |
$136.88
|
| Rate for Payer: BCBS MAPPO |
$190.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,779.31
|
| Rate for Payer: BCN Commercial |
$425.15
|
| 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 |
$254.99
|
| Rate for Payer: Cofinity Commercial |
$274.02
|
| 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: Meridian Medicaid |
$136.88
|
| 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 Choice Medicaid |
$130.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$410.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$356.76
|
| Rate for Payer: Priority Health Medicare |
$190.29
|
| Rate for Payer: Priority Health Narrow Network |
$356.76
|
| Rate for Payer: Priority Health SBD |
$356.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.29
|
| Rate for Payer: UHC Medicare Advantage |
$190.29
|
| Rate for Payer: UHCCP Medicaid |
$130.36
|
| 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 |
$322.06 |
| Max. Negotiated Rate |
$998.62 |
| Rate for Payer: Aetna Commercial |
$642.22
|
| Rate for Payer: Aetna Medicare |
$498.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$642.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$690.15
|
| Rate for Payer: BCBS Complete |
$338.16
|
| Rate for Payer: BCBS MAPPO |
$479.27
|
| Rate for Payer: BCBS Trust/PPO |
$565.81
|
| Rate for Payer: BCN Commercial |
$725.20
|
| 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 |
$642.22
|
| Rate for Payer: Cofinity Commercial |
$690.15
|
| 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: Meridian Medicaid |
$338.16
|
| 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 Choice Medicaid |
$322.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$687.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$998.62
|
| Rate for Payer: Priority Health Medicare |
$479.27
|
| Rate for Payer: Priority Health Narrow Network |
$998.62
|
| Rate for Payer: Priority Health SBD |
$998.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$479.27
|
| Rate for Payer: UHC Medicare Advantage |
$479.27
|
| Rate for Payer: UHCCP Medicaid |
$322.06
|
| 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 |
$136.75 |
| Max. Negotiated Rate |
$604.38 |
| Rate for Payer: Aetna Commercial |
$269.42
|
| Rate for Payer: Aetna Medicare |
$209.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.53
|
| Rate for Payer: BCBS Complete |
$143.59
|
| Rate for Payer: BCBS MAPPO |
$201.06
|
| Rate for Payer: BCBS Trust/PPO |
$604.38
|
| Rate for Payer: BCN Commercial |
$498.94
|
| 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 |
$269.42
|
| Rate for Payer: Cofinity Commercial |
$289.53
|
| 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: Meridian Medicaid |
$143.59
|
| 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 Choice Medicaid |
$136.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$423.42
|
| Rate for Payer: Priority Health Medicare |
$201.06
|
| Rate for Payer: Priority Health Narrow Network |
$423.42
|
| Rate for Payer: Priority Health SBD |
$423.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$201.06
|
| Rate for Payer: UHC Medicare Advantage |
$201.06
|
| Rate for Payer: UHCCP Medicaid |
$136.75
|
| 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 |
$107.35 |
| 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) |
$214.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.83
|
| Rate for Payer: BCBS Complete |
$112.72
|
| Rate for Payer: BCBS MAPPO |
$160.30
|
| Rate for Payer: BCBS Trust/PPO |
$283.70
|
| Rate for Payer: BCN Commercial |
$277.56
|
| 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 |
$214.80
|
| Rate for Payer: Cofinity Commercial |
$230.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.32
|
| Rate for Payer: Meridian Medicaid |
$112.72
|
| 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 Choice Medicaid |
$107.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$266.30
|
| Rate for Payer: Priority Health Medicare |
$160.30
|
| Rate for Payer: Priority Health Narrow Network |
$266.30
|
| Rate for Payer: Priority Health SBD |
$266.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.30
|
| Rate for Payer: UHC Medicare Advantage |
$160.30
|
| Rate for Payer: UHCCP Medicaid |
$107.35
|
| 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 |
$85.20 |
| Max. Negotiated Rate |
$569.29 |
| Rate for Payer: Aetna Commercial |
$171.31
|
| Rate for Payer: Aetna Medicare |
$132.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.09
|
| Rate for Payer: BCBS Complete |
$89.46
|
| Rate for Payer: BCBS MAPPO |
$127.84
|
| Rate for Payer: BCBS Trust/PPO |
$569.29
|
| Rate for Payer: BCN Commercial |
$287.83
|
| 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 |
$171.31
|
| Rate for Payer: Cofinity Commercial |
$184.09
|
| 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: Meridian Medicaid |
$89.46
|
| 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 Choice Medicaid |
$85.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.36
|
| Rate for Payer: Priority Health Medicare |
$127.84
|
| Rate for Payer: Priority Health Narrow Network |
$178.36
|
| Rate for Payer: Priority Health SBD |
$178.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.84
|
| Rate for Payer: UHC Medicare Advantage |
$127.84
|
| Rate for Payer: UHCCP Medicaid |
$85.20
|
| 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 |
$71.14 |
| Max. Negotiated Rate |
$2,369.57 |
| Rate for Payer: Aetna Commercial |
$141.89
|
| Rate for Payer: Aetna Medicare |
$110.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.48
|
| Rate for Payer: BCBS Complete |
$74.70
|
| Rate for Payer: BCBS MAPPO |
$105.89
|
| Rate for Payer: BCBS Trust/PPO |
$2,369.57
|
| Rate for Payer: BCN Commercial |
$228.70
|
| 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 |
$141.89
|
| Rate for Payer: Cofinity Commercial |
$152.48
|
| 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: Meridian Medicaid |
$74.70
|
| 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 Choice Medicaid |
$71.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.81
|
| Rate for Payer: Priority Health Medicare |
$105.89
|
| Rate for Payer: Priority Health Narrow Network |
$150.81
|
| Rate for Payer: Priority Health SBD |
$150.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.89
|
| Rate for Payer: UHC Medicare Advantage |
$105.89
|
| Rate for Payer: UHCCP Medicaid |
$71.14
|
| 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 |
$36.00 |
| Max. Negotiated Rate |
$3,995.58 |
| Rate for Payer: Aetna Commercial |
$70.95
|
| Rate for Payer: Aetna Medicare |
$55.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.25
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: BCBS MAPPO |
$52.95
|
| Rate for Payer: BCBS Trust/PPO |
$3,995.58
|
| Rate for Payer: BCN Commercial |
$125.10
|
| 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 |
$70.95
|
| Rate for Payer: Cofinity Commercial |
$76.25
|
| 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: Meridian Medicaid |
$37.80
|
| 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 Choice Medicaid |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.85
|
| Rate for Payer: Priority Health Medicare |
$52.95
|
| Rate for Payer: Priority Health Narrow Network |
$75.85
|
| Rate for Payer: Priority Health SBD |
$75.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.95
|
| Rate for Payer: UHC Medicare Advantage |
$52.95
|
| Rate for Payer: UHCCP Medicaid |
$36.00
|
| 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
|
|
