|
PR EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,308.00
|
|
|
Service Code
|
HCPCS 55520
|
| Min. Negotiated Rate |
$286.70 |
| Max. Negotiated Rate |
$981.00 |
| Rate for Payer: Aetna Commercial |
$591.14
|
| Rate for Payer: Aetna Medicare |
$458.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$591.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.26
|
| Rate for Payer: BCBS Complete |
$301.04
|
| Rate for Payer: BCBS MAPPO |
$441.15
|
| Rate for Payer: BCN Commercial |
$697.17
|
| Rate for Payer: BCN Medicare Advantage |
$441.15
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cofinity Commercial |
$591.14
|
| Rate for Payer: Cofinity Commercial |
$635.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$441.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$463.21
|
| Rate for Payer: Meridian Medicaid |
$301.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$485.26
|
| Rate for Payer: Nomi Health Commercial |
$529.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$981.00
|
| Rate for Payer: PACE SWMI |
$441.15
|
| Rate for Payer: PHP Commercial |
$617.61
|
| Rate for Payer: PHP Medicare Advantage |
$441.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$759.45
|
| Rate for Payer: Priority Health Medicare |
$441.15
|
| Rate for Payer: Priority Health SBD |
$759.45
|
| Rate for Payer: Priority Health Tiered Network |
$759.45
|
| Rate for Payer: Railroad Medicare Medicare |
$441.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$801.97
|
| Rate for Payer: UHC Core |
$801.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$441.15
|
| Rate for Payer: UHC Exchange |
$801.97
|
| Rate for Payer: UHC Medicaid |
$286.70
|
| Rate for Payer: UHCCP Medicaid |
$286.70
|
| Rate for Payer: UMR Bronson Commercial |
$601.68
|
|
|
PR EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,308.00
|
|
|
Service Code
|
HCPCS 55520
|
| Hospital Charge Code |
55520
|
| Min. Negotiated Rate |
$286.70 |
| Max. Negotiated Rate |
$981.00 |
| Rate for Payer: Aetna Commercial |
$591.14
|
| Rate for Payer: Aetna Medicare |
$458.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$591.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.26
|
| Rate for Payer: BCBS Complete |
$301.04
|
| Rate for Payer: BCBS MAPPO |
$441.15
|
| Rate for Payer: BCN Commercial |
$697.17
|
| Rate for Payer: BCN Medicare Advantage |
$441.15
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cofinity Commercial |
$591.14
|
| Rate for Payer: Cofinity Commercial |
$635.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$441.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$463.21
|
| Rate for Payer: Meridian Medicaid |
$301.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$485.26
|
| Rate for Payer: Nomi Health Commercial |
$529.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$981.00
|
| Rate for Payer: PACE SWMI |
$441.15
|
| Rate for Payer: PHP Commercial |
$617.61
|
| Rate for Payer: PHP Medicare Advantage |
$441.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$759.45
|
| Rate for Payer: Priority Health Medicare |
$441.15
|
| Rate for Payer: Priority Health SBD |
$759.45
|
| Rate for Payer: Priority Health Tiered Network |
$759.45
|
| Rate for Payer: Railroad Medicare Medicare |
$441.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$801.97
|
| Rate for Payer: UHC Core |
$801.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$441.15
|
| Rate for Payer: UHC Exchange |
$801.97
|
| Rate for Payer: UHC Medicaid |
$286.70
|
| Rate for Payer: UHCCP Medicaid |
$286.70
|
| Rate for Payer: UMR Bronson Commercial |
$601.68
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
HCPCS 26160
|
| Hospital Charge Code |
26160
|
| Min. Negotiated Rate |
$196.81 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$397.51
|
| Rate for Payer: Aetna Medicare |
$308.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.18
|
| Rate for Payer: BCBS Complete |
$206.65
|
| Rate for Payer: BCBS MAPPO |
$296.65
|
| Rate for Payer: BCN Commercial |
$490.01
|
| Rate for Payer: BCN Medicare Advantage |
$296.65
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cofinity Commercial |
$397.51
|
| Rate for Payer: Cofinity Commercial |
$427.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.48
|
| Rate for Payer: Meridian Medicaid |
$206.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$326.31
|
| Rate for Payer: Nomi Health Commercial |
$355.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$816.00
|
| Rate for Payer: PACE SWMI |
$296.65
|
| Rate for Payer: PHP Commercial |
$415.31
|
| Rate for Payer: PHP Medicare Advantage |
$296.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$523.81
|
| Rate for Payer: Priority Health Medicare |
$296.65
|
| Rate for Payer: Priority Health SBD |
$523.81
|
| Rate for Payer: Priority Health Tiered Network |
$523.81
|
| Rate for Payer: Railroad Medicare Medicare |
$296.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$541.80
|
| Rate for Payer: UHC Core |
$541.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$296.65
|
| Rate for Payer: UHC Exchange |
$541.80
|
| Rate for Payer: UHC Medicaid |
$196.81
|
| Rate for Payer: UHCCP Medicaid |
$196.81
|
| Rate for Payer: UMR Bronson Commercial |
$500.48
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
OP
|
$1,088.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
26160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$402.56 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna American Axle |
$707.20
|
| Rate for Payer: Aetna Commercial |
$924.80
|
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$707.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,099.34
|
| Rate for Payer: BCN Commercial |
$2,099.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cofinity Advantage |
$761.60
|
| Rate for Payer: Cofinity Commercial |
$935.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$870.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Healthscope Commercial |
$979.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$761.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$816.00
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$924.80
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$816.00
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Commercial |
$924.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health SBD |
$685.44
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: UMR Bronson Commercial |
$402.56
|
| Rate for Payer: VA VA |
$1,602.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$816.00
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
IP
|
$1,088.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
26160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$478.72 |
| Max. Negotiated Rate |
$979.20 |
| Rate for Payer: Aetna American Axle |
$707.20
|
| Rate for Payer: Aetna Commercial |
$924.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$707.20
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cofinity Advantage |
$761.60
|
| Rate for Payer: Cofinity Commercial |
$935.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$870.40
|
| Rate for Payer: Healthscope Commercial |
$979.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$761.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$816.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$924.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$816.00
|
| Rate for Payer: PHP Commercial |
$924.80
|
| Rate for Payer: Priority Health SBD |
$685.44
|
| Rate for Payer: UMR Bronson Commercial |
$478.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$816.00
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
HCPCS 26160
|
| Min. Negotiated Rate |
$196.81 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$397.51
|
| Rate for Payer: Aetna Medicare |
$308.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.18
|
| Rate for Payer: BCBS Complete |
$206.65
|
| Rate for Payer: BCBS MAPPO |
$296.65
|
| Rate for Payer: BCN Commercial |
$490.01
|
| Rate for Payer: BCN Medicare Advantage |
$296.65
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cofinity Commercial |
$397.51
|
| Rate for Payer: Cofinity Commercial |
$427.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.48
|
| Rate for Payer: Meridian Medicaid |
$206.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$326.31
|
| Rate for Payer: Nomi Health Commercial |
$355.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$816.00
|
| Rate for Payer: PACE SWMI |
$296.65
|
| Rate for Payer: PHP Commercial |
$415.31
|
| Rate for Payer: PHP Medicare Advantage |
$296.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$523.81
|
| Rate for Payer: Priority Health Medicare |
$296.65
|
| Rate for Payer: Priority Health SBD |
$523.81
|
| Rate for Payer: Priority Health Tiered Network |
$523.81
|
| Rate for Payer: Railroad Medicare Medicare |
$296.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$541.80
|
| Rate for Payer: UHC Core |
$541.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$296.65
|
| Rate for Payer: UHC Exchange |
$541.80
|
| Rate for Payer: UHC Medicaid |
$196.81
|
| Rate for Payer: UHCCP Medicaid |
$196.81
|
| Rate for Payer: UMR Bronson Commercial |
$500.48
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
28090
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$401.72 |
| Max. Negotiated Rate |
$821.70 |
| Rate for Payer: Aetna American Axle |
$593.45
|
| Rate for Payer: Aetna Commercial |
$776.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.45
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cofinity Advantage |
$639.10
|
| Rate for Payer: Cofinity Commercial |
$785.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.40
|
| Rate for Payer: Healthscope Commercial |
$821.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$639.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$684.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$684.75
|
| Rate for Payer: PHP Commercial |
$776.05
|
| Rate for Payer: Priority Health SBD |
$575.19
|
| Rate for Payer: UMR Bronson Commercial |
$401.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$684.75
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$913.00
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
28090
|
| Min. Negotiated Rate |
$187.87 |
| Max. Negotiated Rate |
$684.75 |
| Rate for Payer: Aetna Commercial |
$382.34
|
| Rate for Payer: Aetna Medicare |
$296.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.88
|
| Rate for Payer: BCBS Complete |
$197.26
|
| Rate for Payer: BCBS MAPPO |
$285.33
|
| Rate for Payer: BCN Commercial |
$470.59
|
| Rate for Payer: BCN Medicare Advantage |
$285.33
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cofinity Commercial |
$382.34
|
| Rate for Payer: Cofinity Commercial |
$410.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$299.60
|
| Rate for Payer: Meridian Medicaid |
$197.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$313.86
|
| Rate for Payer: Nomi Health Commercial |
$342.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$684.75
|
| Rate for Payer: PACE SWMI |
$285.33
|
| Rate for Payer: PHP Commercial |
$399.46
|
| Rate for Payer: PHP Medicare Advantage |
$285.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$503.04
|
| Rate for Payer: Priority Health Medicare |
$285.33
|
| Rate for Payer: Priority Health SBD |
$503.04
|
| Rate for Payer: Priority Health Tiered Network |
$503.04
|
| Rate for Payer: Railroad Medicare Medicare |
$285.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$534.13
|
| Rate for Payer: UHC Core |
$534.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$285.33
|
| Rate for Payer: UHC Exchange |
$534.13
|
| Rate for Payer: UHC Medicaid |
$187.87
|
| Rate for Payer: UHCCP Medicaid |
$187.87
|
| Rate for Payer: UMR Bronson Commercial |
$419.98
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
28090
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$337.81 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna American Axle |
$593.45
|
| Rate for Payer: Aetna Commercial |
$776.05
|
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,293.43
|
| Rate for Payer: BCN Commercial |
$2,293.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cofinity Advantage |
$639.10
|
| Rate for Payer: Cofinity Commercial |
$785.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Healthscope Commercial |
$821.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$639.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$684.75
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.05
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$684.75
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Commercial |
$776.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health SBD |
$575.19
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: UMR Bronson Commercial |
$337.81
|
| Rate for Payer: VA VA |
$1,602.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$684.75
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$913.00
|
|
|
Service Code
|
HCPCS 28090
|
| Min. Negotiated Rate |
$187.87 |
| Max. Negotiated Rate |
$684.75 |
| Rate for Payer: Aetna Commercial |
$382.34
|
| Rate for Payer: Aetna Medicare |
$296.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.88
|
| Rate for Payer: BCBS Complete |
$197.26
|
| Rate for Payer: BCBS MAPPO |
$285.33
|
| Rate for Payer: BCN Commercial |
$470.59
|
| Rate for Payer: BCN Medicare Advantage |
$285.33
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cofinity Commercial |
$382.34
|
| Rate for Payer: Cofinity Commercial |
$410.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$299.60
|
| Rate for Payer: Meridian Medicaid |
$197.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$313.86
|
| Rate for Payer: Nomi Health Commercial |
$342.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$684.75
|
| Rate for Payer: PACE SWMI |
$285.33
|
| Rate for Payer: PHP Commercial |
$399.46
|
| Rate for Payer: PHP Medicare Advantage |
$285.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$503.04
|
| Rate for Payer: Priority Health Medicare |
$285.33
|
| Rate for Payer: Priority Health SBD |
$503.04
|
| Rate for Payer: Priority Health Tiered Network |
$503.04
|
| Rate for Payer: Railroad Medicare Medicare |
$285.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$534.13
|
| Rate for Payer: UHC Core |
$534.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$285.33
|
| Rate for Payer: UHC Exchange |
$534.13
|
| Rate for Payer: UHC Medicaid |
$187.87
|
| Rate for Payer: UHCCP Medicaid |
$187.87
|
| Rate for Payer: UMR Bronson Commercial |
$419.98
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA
|
Professional
|
Both
|
$854.00
|
|
|
Service Code
|
HCPCS 28092
|
| Min. Negotiated Rate |
$166.35 |
| Max. Negotiated Rate |
$640.50 |
| Rate for Payer: Aetna Commercial |
$337.28
|
| Rate for Payer: Aetna Medicare |
$261.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.45
|
| Rate for Payer: BCBS Complete |
$174.67
|
| Rate for Payer: BCBS MAPPO |
$251.70
|
| Rate for Payer: BCN Commercial |
$415.81
|
| Rate for Payer: BCN Medicare Advantage |
$251.70
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Cofinity Commercial |
$337.28
|
| Rate for Payer: Cofinity Commercial |
$362.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$264.29
|
| Rate for Payer: Meridian Medicaid |
$174.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$276.87
|
| Rate for Payer: Nomi Health Commercial |
$302.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$640.50
|
| Rate for Payer: PACE SWMI |
$251.70
|
| Rate for Payer: PHP Commercial |
$352.38
|
| Rate for Payer: PHP Medicare Advantage |
$251.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$444.49
|
| Rate for Payer: Priority Health Medicare |
$251.70
|
| Rate for Payer: Priority Health SBD |
$444.49
|
| Rate for Payer: Priority Health Tiered Network |
$444.49
|
| Rate for Payer: Railroad Medicare Medicare |
$251.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.49
|
| Rate for Payer: UHC Core |
$467.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$251.70
|
| Rate for Payer: UHC Exchange |
$467.49
|
| Rate for Payer: UHC Medicaid |
$166.35
|
| Rate for Payer: UHCCP Medicaid |
$166.35
|
| Rate for Payer: UMR Bronson Commercial |
$392.84
|
|
|
PR EXC LESION TONGUE W/CLSR ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$611.00
|
|
|
Service Code
|
HCPCS 41112
|
| Min. Negotiated Rate |
$143.99 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$290.66
|
| Rate for Payer: Aetna Medicare |
$225.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.35
|
| Rate for Payer: BCBS Complete |
$151.19
|
| Rate for Payer: BCBS MAPPO |
$216.91
|
| Rate for Payer: BCN Commercial |
$367.51
|
| Rate for Payer: BCN Medicare Advantage |
$216.91
|
| Rate for Payer: Cash Price |
$488.80
|
| Rate for Payer: Cash Price |
$488.80
|
| Rate for Payer: Cofinity Commercial |
$290.66
|
| Rate for Payer: Cofinity Commercial |
$312.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.76
|
| Rate for Payer: Meridian Medicaid |
$151.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$238.60
|
| Rate for Payer: Nomi Health Commercial |
$260.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$458.25
|
| Rate for Payer: PACE SWMI |
$216.91
|
| Rate for Payer: PHP Commercial |
$303.67
|
| Rate for Payer: PHP Medicare Advantage |
$216.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$447.79
|
| Rate for Payer: Priority Health Medicare |
$216.91
|
| Rate for Payer: Priority Health SBD |
$447.79
|
| Rate for Payer: Priority Health Tiered Network |
$447.79
|
| Rate for Payer: Railroad Medicare Medicare |
$216.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$420.73
|
| Rate for Payer: UHC Core |
$420.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$216.91
|
| Rate for Payer: UHC Exchange |
$420.73
|
| Rate for Payer: UHC Medicaid |
$143.99
|
| Rate for Payer: UHCCP Medicaid |
$143.99
|
| Rate for Payer: UMR Bronson Commercial |
$281.06
|
|
|
PR EXC LESION TONGUE W/CLSR POSTERIOR ONE-THIRD
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 41113
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$316.19
|
| Rate for Payer: Aetna Medicare |
$245.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.78
|
| Rate for Payer: BCBS Complete |
$163.94
|
| Rate for Payer: BCBS MAPPO |
$235.96
|
| Rate for Payer: BCN Commercial |
$398.88
|
| Rate for Payer: BCN Medicare Advantage |
$235.96
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cofinity Commercial |
$316.19
|
| Rate for Payer: Cofinity Commercial |
$339.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.76
|
| Rate for Payer: Meridian Medicaid |
$163.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$259.56
|
| Rate for Payer: Nomi Health Commercial |
$283.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.00
|
| Rate for Payer: PACE SWMI |
$235.96
|
| Rate for Payer: PHP Commercial |
$330.34
|
| Rate for Payer: PHP Medicare Advantage |
$235.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$486.02
|
| Rate for Payer: Priority Health Medicare |
$235.96
|
| Rate for Payer: Priority Health SBD |
$486.02
|
| Rate for Payer: Priority Health Tiered Network |
$486.02
|
| Rate for Payer: Railroad Medicare Medicare |
$235.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$465.38
|
| Rate for Payer: UHC Core |
$465.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$235.96
|
| Rate for Payer: UHC Exchange |
$465.38
|
| Rate for Payer: UHC Medicaid |
$156.13
|
| Rate for Payer: UHCCP Medicaid |
$156.13
|
| Rate for Payer: UMR Bronson Commercial |
$358.80
|
|
|
PR EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP
|
Professional
|
Both
|
$1,190.00
|
|
|
Service Code
|
HCPCS 41114
|
| Min. Negotiated Rate |
$349.75 |
| Max. Negotiated Rate |
$1,137.68 |
| Rate for Payer: Aetna Commercial |
$716.65
|
| Rate for Payer: Aetna Medicare |
$556.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$716.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$770.13
|
| Rate for Payer: BCBS Complete |
$367.24
|
| Rate for Payer: BCBS MAPPO |
$534.81
|
| Rate for Payer: BCN Commercial |
$933.72
|
| Rate for Payer: BCN Medicare Advantage |
$534.81
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cofinity Commercial |
$716.65
|
| Rate for Payer: Cofinity Commercial |
$770.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$534.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$561.55
|
| Rate for Payer: Meridian Medicaid |
$367.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$588.29
|
| Rate for Payer: Nomi Health Commercial |
$641.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$892.50
|
| Rate for Payer: PACE SWMI |
$534.81
|
| Rate for Payer: PHP Commercial |
$748.73
|
| Rate for Payer: PHP Medicare Advantage |
$534.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$349.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,137.68
|
| Rate for Payer: Priority Health Medicare |
$534.81
|
| Rate for Payer: Priority Health SBD |
$1,137.68
|
| Rate for Payer: Priority Health Tiered Network |
$1,137.68
|
| Rate for Payer: Railroad Medicare Medicare |
$534.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,072.24
|
| Rate for Payer: UHC Core |
$1,072.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$534.81
|
| Rate for Payer: UHC Exchange |
$1,072.24
|
| Rate for Payer: UHC Medicaid |
$349.75
|
| Rate for Payer: UHCCP Medicaid |
$349.75
|
| Rate for Payer: UMR Bronson Commercial |
$547.40
|
|
|
PR EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR
|
Professional
|
Both
|
$732.00
|
|
|
Service Code
|
HCPCS 41827
|
| Min. Negotiated Rate |
$168.48 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Aetna Commercial |
$342.30
|
| Rate for Payer: Aetna Medicare |
$265.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.85
|
| Rate for Payer: BCBS Complete |
$176.90
|
| Rate for Payer: BCBS MAPPO |
$255.45
|
| Rate for Payer: BCN Commercial |
$440.71
|
| Rate for Payer: BCN Medicare Advantage |
$255.45
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cofinity Commercial |
$342.30
|
| Rate for Payer: Cofinity Commercial |
$367.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$268.22
|
| Rate for Payer: Meridian Medicaid |
$176.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$281.00
|
| Rate for Payer: Nomi Health Commercial |
$306.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$549.00
|
| Rate for Payer: PACE SWMI |
$255.45
|
| Rate for Payer: PHP Commercial |
$357.63
|
| Rate for Payer: PHP Medicare Advantage |
$255.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$168.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$536.99
|
| Rate for Payer: Priority Health Medicare |
$255.45
|
| Rate for Payer: Priority Health SBD |
$536.99
|
| Rate for Payer: Priority Health Tiered Network |
$536.99
|
| Rate for Payer: Railroad Medicare Medicare |
$255.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$516.17
|
| Rate for Payer: UHC Core |
$516.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$255.45
|
| Rate for Payer: UHC Exchange |
$516.17
|
| Rate for Payer: UHC Medicaid |
$168.48
|
| Rate for Payer: UHCCP Medicaid |
$168.48
|
| Rate for Payer: UMR Bronson Commercial |
$336.72
|
|
|
PR EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR
|
Professional
|
Both
|
$433.00
|
|
|
Service Code
|
HCPCS 41825
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$324.75 |
| Rate for Payer: Aetna Commercial |
$142.74
|
| Rate for Payer: Aetna Medicare |
$110.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.39
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS MAPPO |
$106.52
|
| Rate for Payer: BCN Commercial |
$184.25
|
| Rate for Payer: BCN Medicare Advantage |
$106.52
|
| Rate for Payer: Cash Price |
$346.40
|
| Rate for Payer: Cash Price |
$346.40
|
| Rate for Payer: Cofinity Commercial |
$142.74
|
| Rate for Payer: Cofinity Commercial |
$153.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.85
|
| Rate for Payer: Meridian Medicaid |
$74.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$117.17
|
| Rate for Payer: Nomi Health Commercial |
$127.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.75
|
| Rate for Payer: PACE SWMI |
$106.52
|
| Rate for Payer: PHP Commercial |
$149.13
|
| Rate for Payer: PHP Medicare Advantage |
$106.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$224.50
|
| Rate for Payer: Priority Health Medicare |
$106.52
|
| Rate for Payer: Priority Health SBD |
$224.50
|
| Rate for Payer: Priority Health Tiered Network |
$224.50
|
| Rate for Payer: Railroad Medicare Medicare |
$106.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.29
|
| Rate for Payer: UHC Core |
$205.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$106.52
|
| Rate for Payer: UHC Exchange |
$205.29
|
| Rate for Payer: UHC Medicaid |
$70.72
|
| Rate for Payer: UHCCP Medicaid |
$70.72
|
| Rate for Payer: UMR Bronson Commercial |
$199.18
|
|
|
PR EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR
|
Professional
|
Both
|
$380.00
|
|
|
Service Code
|
HCPCS 40810
|
| Min. Negotiated Rate |
$73.27 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$147.49
|
| Rate for Payer: Aetna Medicare |
$114.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.50
|
| Rate for Payer: BCBS Complete |
$76.93
|
| Rate for Payer: BCBS MAPPO |
$110.07
|
| Rate for Payer: BCN Commercial |
$184.75
|
| Rate for Payer: BCN Medicare Advantage |
$110.07
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cofinity Commercial |
$147.49
|
| Rate for Payer: Cofinity Commercial |
$158.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.57
|
| Rate for Payer: Meridian Medicaid |
$76.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$121.08
|
| Rate for Payer: Nomi Health Commercial |
$132.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.00
|
| Rate for Payer: PACE SWMI |
$110.07
|
| Rate for Payer: PHP Commercial |
$154.10
|
| Rate for Payer: PHP Medicare Advantage |
$110.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$225.12
|
| Rate for Payer: Priority Health Medicare |
$110.07
|
| Rate for Payer: Priority Health SBD |
$225.12
|
| Rate for Payer: Priority Health Tiered Network |
$225.12
|
| Rate for Payer: Railroad Medicare Medicare |
$110.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.50
|
| Rate for Payer: UHC Core |
$211.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$110.07
|
| Rate for Payer: UHC Exchange |
$211.50
|
| Rate for Payer: UHC Medicaid |
$73.27
|
| Rate for Payer: UHCCP Medicaid |
$73.27
|
| Rate for Payer: UMR Bronson Commercial |
$174.80
|
|
|
PR EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP
|
Professional
|
Both
|
$2,042.00
|
|
|
Service Code
|
HCPCS 40525
|
| Min. Negotiated Rate |
$317.58 |
| Max. Negotiated Rate |
$1,531.50 |
| Rate for Payer: Aetna Commercial |
$650.19
|
| Rate for Payer: Aetna Medicare |
$504.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$698.72
|
| Rate for Payer: BCBS Complete |
$333.46
|
| Rate for Payer: BCBS MAPPO |
$485.22
|
| Rate for Payer: BCN Commercial |
$831.63
|
| Rate for Payer: BCN Medicare Advantage |
$485.22
|
| Rate for Payer: Cash Price |
$1,633.60
|
| Rate for Payer: Cash Price |
$1,633.60
|
| Rate for Payer: Cofinity Commercial |
$650.19
|
| Rate for Payer: Cofinity Commercial |
$698.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$485.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$509.48
|
| Rate for Payer: Meridian Medicaid |
$333.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$533.74
|
| Rate for Payer: Nomi Health Commercial |
$582.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,531.50
|
| Rate for Payer: PACE SWMI |
$485.22
|
| Rate for Payer: PHP Commercial |
$679.31
|
| Rate for Payer: PHP Medicare Advantage |
$485.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$317.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,013.29
|
| Rate for Payer: Priority Health Medicare |
$485.22
|
| Rate for Payer: Priority Health SBD |
$1,013.29
|
| Rate for Payer: Priority Health Tiered Network |
$1,013.29
|
| Rate for Payer: Railroad Medicare Medicare |
$485.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$959.82
|
| Rate for Payer: UHC Core |
$959.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$485.22
|
| Rate for Payer: UHC Exchange |
$959.82
|
| Rate for Payer: UHC Medicaid |
$317.58
|
| Rate for Payer: UHCCP Medicaid |
$317.58
|
| Rate for Payer: UMR Bronson Commercial |
$939.32
|
|
|
PR EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR
|
Professional
|
Both
|
$748.00
|
|
|
Service Code
|
HCPCS 40510
|
| Min. Negotiated Rate |
$202.35 |
| Max. Negotiated Rate |
$644.98 |
| Rate for Payer: Aetna Commercial |
$413.18
|
| Rate for Payer: Aetna Medicare |
$320.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.01
|
| Rate for Payer: BCBS Complete |
$212.47
|
| Rate for Payer: BCBS MAPPO |
$308.34
|
| Rate for Payer: BCN Commercial |
$529.35
|
| Rate for Payer: BCN Medicare Advantage |
$308.34
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Cofinity Commercial |
$413.18
|
| Rate for Payer: Cofinity Commercial |
$444.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$323.76
|
| Rate for Payer: Meridian Medicaid |
$212.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$339.17
|
| Rate for Payer: Nomi Health Commercial |
$370.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$561.00
|
| Rate for Payer: PACE SWMI |
$308.34
|
| Rate for Payer: PHP Commercial |
$431.68
|
| Rate for Payer: PHP Medicare Advantage |
$308.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$644.98
|
| Rate for Payer: Priority Health Medicare |
$308.34
|
| Rate for Payer: Priority Health SBD |
$644.98
|
| Rate for Payer: Priority Health Tiered Network |
$644.98
|
| Rate for Payer: Railroad Medicare Medicare |
$308.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$606.51
|
| Rate for Payer: UHC Core |
$606.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$308.34
|
| Rate for Payer: UHC Exchange |
$606.51
|
| Rate for Payer: UHC Medicaid |
$202.35
|
| Rate for Payer: UHCCP Medicaid |
$202.35
|
| Rate for Payer: UMR Bronson Commercial |
$344.08
|
|
|
PR EXC LIP V-EXC W/PRIM DIR LINR CLSR
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 40520
|
| Min. Negotiated Rate |
$208.53 |
| Max. Negotiated Rate |
$915.00 |
| Rate for Payer: Aetna Commercial |
$425.20
|
| Rate for Payer: Aetna Medicare |
$330.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.93
|
| Rate for Payer: BCBS Complete |
$218.96
|
| Rate for Payer: BCBS MAPPO |
$317.31
|
| Rate for Payer: BCN Commercial |
$543.80
|
| Rate for Payer: BCN Medicare Advantage |
$317.31
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cofinity Commercial |
$425.20
|
| Rate for Payer: Cofinity Commercial |
$456.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$317.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$333.18
|
| Rate for Payer: Meridian Medicaid |
$218.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$349.04
|
| Rate for Payer: Nomi Health Commercial |
$380.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$915.00
|
| Rate for Payer: PACE SWMI |
$317.31
|
| Rate for Payer: PHP Commercial |
$444.23
|
| Rate for Payer: PHP Medicare Advantage |
$317.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$662.57
|
| Rate for Payer: Priority Health Medicare |
$317.31
|
| Rate for Payer: Priority Health SBD |
$662.57
|
| Rate for Payer: Priority Health Tiered Network |
$662.57
|
| Rate for Payer: Railroad Medicare Medicare |
$317.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$615.18
|
| Rate for Payer: UHC Core |
$615.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$317.31
|
| Rate for Payer: UHC Exchange |
$615.18
|
| Rate for Payer: UHC Medicaid |
$208.53
|
| Rate for Payer: UHCCP Medicaid |
$208.53
|
| Rate for Payer: UMR Bronson Commercial |
$561.20
|
|
|
PR EXC LOCAL MALIGNANT TUMOR STOMACH
|
Professional
|
Both
|
$1,898.00
|
|
|
Service Code
|
HCPCS 43611
|
| Min. Negotiated Rate |
$732.72 |
| Max. Negotiated Rate |
$2,248.64 |
| Rate for Payer: Aetna Commercial |
$1,531.02
|
| Rate for Payer: Aetna Medicare |
$1,188.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,531.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,645.27
|
| Rate for Payer: BCBS Complete |
$769.36
|
| Rate for Payer: BCBS MAPPO |
$1,142.55
|
| Rate for Payer: BCN Commercial |
$1,845.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.55
|
| Rate for Payer: Cash Price |
$1,518.40
|
| Rate for Payer: Cash Price |
$1,518.40
|
| Rate for Payer: Cofinity Commercial |
$1,531.02
|
| Rate for Payer: Cofinity Commercial |
$1,645.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.68
|
| Rate for Payer: Meridian Medicaid |
$769.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,256.81
|
| Rate for Payer: Nomi Health Commercial |
$1,371.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,423.50
|
| Rate for Payer: PACE SWMI |
$1,142.55
|
| Rate for Payer: PHP Commercial |
$1,599.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$732.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,248.64
|
| Rate for Payer: Priority Health Medicare |
$1,142.55
|
| Rate for Payer: Priority Health SBD |
$2,248.64
|
| Rate for Payer: Priority Health Tiered Network |
$2,248.64
|
| Rate for Payer: Railroad Medicare Medicare |
$1,142.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,181.02
|
| Rate for Payer: UHC Core |
$2,181.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,142.55
|
| Rate for Payer: UHC Exchange |
$2,181.02
|
| Rate for Payer: UHC Medicaid |
$732.72
|
| Rate for Payer: UHCCP Medicaid |
$732.72
|
| Rate for Payer: UMR Bronson Commercial |
$873.08
|
|
|
PR EXC LOCAL ULCER/BENIGN TUMOR STOMACH
|
Professional
|
Both
|
$3,254.00
|
|
|
Service Code
|
HCPCS 43610
|
| Min. Negotiated Rate |
$586.60 |
| Max. Negotiated Rate |
$2,440.50 |
| Rate for Payer: Aetna Commercial |
$1,226.76
|
| Rate for Payer: Aetna Medicare |
$952.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,226.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,318.31
|
| Rate for Payer: BCBS Complete |
$615.93
|
| Rate for Payer: BCBS MAPPO |
$915.49
|
| Rate for Payer: BCN Commercial |
$1,466.56
|
| Rate for Payer: BCN Medicare Advantage |
$915.49
|
| Rate for Payer: Cash Price |
$2,603.20
|
| Rate for Payer: Cash Price |
$2,603.20
|
| Rate for Payer: Cofinity Commercial |
$1,226.76
|
| Rate for Payer: Cofinity Commercial |
$1,318.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$915.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$961.26
|
| Rate for Payer: Meridian Medicaid |
$615.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,007.04
|
| Rate for Payer: Nomi Health Commercial |
$1,098.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,440.50
|
| Rate for Payer: PACE SWMI |
$915.49
|
| Rate for Payer: PHP Commercial |
$1,281.69
|
| Rate for Payer: PHP Medicare Advantage |
$915.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$586.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,786.89
|
| Rate for Payer: Priority Health Medicare |
$915.49
|
| Rate for Payer: Priority Health SBD |
$1,786.89
|
| Rate for Payer: Priority Health Tiered Network |
$1,786.89
|
| Rate for Payer: Railroad Medicare Medicare |
$915.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,749.41
|
| Rate for Payer: UHC Core |
$1,749.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$915.49
|
| Rate for Payer: UHC Exchange |
$1,749.41
|
| Rate for Payer: UHC Medicaid |
$586.60
|
| Rate for Payer: UHCCP Medicaid |
$586.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,496.84
|
|
|
PR EXCLUSION LAA OPEN TM STRNT/THRCM ANY METHOD
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
HCPCS 33268
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$236.99 |
| Rate for Payer: Aetna Commercial |
$158.63
|
| Rate for Payer: Aetna Medicare |
$123.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.47
|
| Rate for Payer: BCBS Complete |
$78.50
|
| Rate for Payer: BCBS MAPPO |
$118.38
|
| Rate for Payer: BCN Commercial |
$189.73
|
| Rate for Payer: BCN Medicare Advantage |
$118.38
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cofinity Commercial |
$158.63
|
| Rate for Payer: Cofinity Commercial |
$170.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.30
|
| Rate for Payer: Meridian Medicaid |
$78.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$130.22
|
| Rate for Payer: Nomi Health Commercial |
$142.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.75
|
| Rate for Payer: PACE SWMI |
$118.38
|
| Rate for Payer: PHP Commercial |
$165.73
|
| Rate for Payer: PHP Medicare Advantage |
$118.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$204.03
|
| Rate for Payer: Priority Health Medicare |
$118.38
|
| Rate for Payer: Priority Health SBD |
$204.03
|
| Rate for Payer: Priority Health Tiered Network |
$204.03
|
| Rate for Payer: Railroad Medicare Medicare |
$118.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.99
|
| Rate for Payer: UHC Core |
$236.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$118.38
|
| Rate for Payer: UHC Exchange |
$236.99
|
| Rate for Payer: UHC Medicaid |
$74.76
|
| Rate for Payer: UHCCP Medicaid |
$74.76
|
| Rate for Payer: UMR Bronson Commercial |
$138.46
|
|
|
PR EXCLUSION LEFT ATRIAL APPENDAGE OPEN ANY METHOD
|
Professional
|
Both
|
$2,188.00
|
|
|
Service Code
|
HCPCS 33267
|
| Min. Negotiated Rate |
$630.48 |
| Max. Negotiated Rate |
$1,889.21 |
| Rate for Payer: Aetna Commercial |
$1,322.63
|
| Rate for Payer: Aetna Medicare |
$1,026.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,421.34
|
| Rate for Payer: BCBS Complete |
$662.00
|
| Rate for Payer: BCBS MAPPO |
$987.04
|
| Rate for Payer: BCN Commercial |
$1,542.25
|
| Rate for Payer: BCN Medicare Advantage |
$987.04
|
| Rate for Payer: Cash Price |
$1,750.40
|
| Rate for Payer: Cash Price |
$1,750.40
|
| Rate for Payer: Cofinity Commercial |
$1,322.63
|
| Rate for Payer: Cofinity Commercial |
$1,421.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$987.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,036.39
|
| Rate for Payer: Meridian Medicaid |
$662.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,085.74
|
| Rate for Payer: Nomi Health Commercial |
$1,184.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,641.00
|
| Rate for Payer: PACE SWMI |
$987.04
|
| Rate for Payer: PHP Commercial |
$1,381.86
|
| Rate for Payer: PHP Medicare Advantage |
$987.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$630.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,658.49
|
| Rate for Payer: Priority Health Medicare |
$987.04
|
| Rate for Payer: Priority Health SBD |
$1,658.49
|
| Rate for Payer: Priority Health Tiered Network |
$1,658.49
|
| Rate for Payer: Railroad Medicare Medicare |
$987.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,889.21
|
| Rate for Payer: UHC Core |
$1,889.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$987.04
|
| Rate for Payer: UHC Exchange |
$1,889.21
|
| Rate for Payer: UHC Medicaid |
$630.48
|
| Rate for Payer: UHCCP Medicaid |
$630.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,006.48
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$2,177.00
|
|
|
Service Code
|
HCPCS 44800
|
| Min. Negotiated Rate |
$471.80 |
| Max. Negotiated Rate |
$1,632.75 |
| Rate for Payer: Aetna Commercial |
$979.00
|
| Rate for Payer: Aetna Medicare |
$759.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,052.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.00
|
| Rate for Payer: BCBS Complete |
$495.39
|
| Rate for Payer: BCBS MAPPO |
$730.60
|
| Rate for Payer: BCN Commercial |
$1,169.25
|
| Rate for Payer: BCN Medicare Advantage |
$730.60
|
| Rate for Payer: Cash Price |
$1,741.60
|
| Rate for Payer: Cash Price |
$1,741.60
|
| Rate for Payer: Cofinity Commercial |
$1,052.06
|
| Rate for Payer: Cofinity Commercial |
$979.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$730.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$767.13
|
| Rate for Payer: Meridian Medicaid |
$495.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$803.66
|
| Rate for Payer: Nomi Health Commercial |
$876.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,632.75
|
| Rate for Payer: PACE SWMI |
$730.60
|
| Rate for Payer: PHP Commercial |
$1,022.84
|
| Rate for Payer: PHP Medicare Advantage |
$730.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$471.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,424.67
|
| Rate for Payer: Priority Health Medicare |
$730.60
|
| Rate for Payer: Priority Health SBD |
$1,424.67
|
| Rate for Payer: Priority Health Tiered Network |
$1,424.67
|
| Rate for Payer: Railroad Medicare Medicare |
$730.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,364.06
|
| Rate for Payer: UHC Core |
$1,364.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$730.60
|
| Rate for Payer: UHC Exchange |
$1,364.06
|
| Rate for Payer: UHC Medicaid |
$471.80
|
| Rate for Payer: UHCCP Medicaid |
$471.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,001.42
|
|
