|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Professional
|
Both
|
$1,122.00
|
|
|
Service Code
|
HCPCS 26115
|
| Min. Negotiated Rate |
$204.91 |
| Max. Negotiated Rate |
$841.50 |
| Rate for Payer: Aetna Commercial |
$415.39
|
| Rate for Payer: Aetna Medicare |
$322.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$415.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.39
|
| Rate for Payer: BCBS Complete |
$215.16
|
| Rate for Payer: BCBS MAPPO |
$309.99
|
| Rate for Payer: BCN Commercial |
$514.42
|
| Rate for Payer: BCN Medicare Advantage |
$309.99
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cofinity Commercial |
$415.39
|
| Rate for Payer: Cofinity Commercial |
$446.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.49
|
| Rate for Payer: Meridian Medicaid |
$215.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$340.99
|
| Rate for Payer: Nomi Health Commercial |
$371.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$841.50
|
| Rate for Payer: PACE SWMI |
$309.99
|
| Rate for Payer: PHP Commercial |
$433.99
|
| Rate for Payer: PHP Medicare Advantage |
$309.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$549.90
|
| Rate for Payer: Priority Health Medicare |
$309.99
|
| Rate for Payer: Priority Health SBD |
$549.90
|
| Rate for Payer: Priority Health Tiered Network |
$549.90
|
| Rate for Payer: Railroad Medicare Medicare |
$309.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$571.26
|
| Rate for Payer: UHC Core |
$571.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$309.99
|
| Rate for Payer: UHC Exchange |
$571.26
|
| Rate for Payer: UHC Medicaid |
$204.91
|
| Rate for Payer: UHCCP Medicaid |
$204.91
|
| Rate for Payer: UMR Bronson Commercial |
$516.12
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Facility
|
OP
|
$1,122.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
26115
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$415.14 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna American Axle |
$729.30
|
| Rate for Payer: Aetna Commercial |
$953.70
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,840.46
|
| Rate for Payer: BCN Commercial |
$1,840.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cofinity Advantage |
$785.40
|
| Rate for Payer: Cofinity Commercial |
$964.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$1,009.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$785.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$841.50
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.70
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$841.50
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$953.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health SBD |
$706.86
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: UMR Bronson Commercial |
$415.14
|
| Rate for Payer: VA VA |
$1,645.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$841.50
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Professional
|
Both
|
$1,122.00
|
|
|
Service Code
|
HCPCS 26115
|
| Hospital Charge Code |
26115
|
| Min. Negotiated Rate |
$204.91 |
| Max. Negotiated Rate |
$841.50 |
| Rate for Payer: Aetna Commercial |
$415.39
|
| Rate for Payer: Aetna Medicare |
$322.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$415.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.39
|
| Rate for Payer: BCBS Complete |
$215.16
|
| Rate for Payer: BCBS MAPPO |
$309.99
|
| Rate for Payer: BCN Commercial |
$514.42
|
| Rate for Payer: BCN Medicare Advantage |
$309.99
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cofinity Commercial |
$415.39
|
| Rate for Payer: Cofinity Commercial |
$446.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.49
|
| Rate for Payer: Meridian Medicaid |
$215.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$340.99
|
| Rate for Payer: Nomi Health Commercial |
$371.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$841.50
|
| Rate for Payer: PACE SWMI |
$309.99
|
| Rate for Payer: PHP Commercial |
$433.99
|
| Rate for Payer: PHP Medicare Advantage |
$309.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$549.90
|
| Rate for Payer: Priority Health Medicare |
$309.99
|
| Rate for Payer: Priority Health SBD |
$549.90
|
| Rate for Payer: Priority Health Tiered Network |
$549.90
|
| Rate for Payer: Railroad Medicare Medicare |
$309.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$571.26
|
| Rate for Payer: UHC Core |
$571.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$309.99
|
| Rate for Payer: UHC Exchange |
$571.26
|
| Rate for Payer: UHC Medicaid |
$204.91
|
| Rate for Payer: UHCCP Medicaid |
$204.91
|
| Rate for Payer: UMR Bronson Commercial |
$516.12
|
|
|
PR EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM
|
Professional
|
Both
|
$1,730.00
|
|
|
Service Code
|
HCPCS 26116
|
| Min. Negotiated Rate |
$315.03 |
| Max. Negotiated Rate |
$1,297.50 |
| Rate for Payer: Aetna Commercial |
$642.03
|
| Rate for Payer: Aetna Medicare |
$498.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$642.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$689.95
|
| Rate for Payer: BCBS Complete |
$330.78
|
| Rate for Payer: BCBS MAPPO |
$479.13
|
| Rate for Payer: BCN Commercial |
$809.22
|
| Rate for Payer: BCN Medicare Advantage |
$479.13
|
| Rate for Payer: Cash Price |
$1,384.00
|
| Rate for Payer: Cash Price |
$1,384.00
|
| Rate for Payer: Cofinity Commercial |
$642.03
|
| Rate for Payer: Cofinity Commercial |
$689.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$479.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$503.09
|
| Rate for Payer: Meridian Medicaid |
$330.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$527.04
|
| Rate for Payer: Nomi Health Commercial |
$574.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,297.50
|
| Rate for Payer: PACE SWMI |
$479.13
|
| Rate for Payer: PHP Commercial |
$670.78
|
| Rate for Payer: PHP Medicare Advantage |
$479.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$315.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$865.03
|
| Rate for Payer: Priority Health Medicare |
$479.13
|
| Rate for Payer: Priority Health SBD |
$865.03
|
| Rate for Payer: Priority Health Tiered Network |
$865.03
|
| Rate for Payer: Railroad Medicare Medicare |
$479.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$911.71
|
| Rate for Payer: UHC Core |
$911.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$479.13
|
| Rate for Payer: UHC Exchange |
$911.71
|
| Rate for Payer: UHC Medicaid |
$315.03
|
| Rate for Payer: UHCCP Medicaid |
$315.03
|
| Rate for Payer: UMR Bronson Commercial |
$795.80
|
|
|
PR EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR
|
Professional
|
Both
|
$5,703.00
|
|
|
Service Code
|
HCPCS 51500
|
| Min. Negotiated Rate |
$369.98 |
| Max. Negotiated Rate |
$4,277.25 |
| Rate for Payer: Aetna Commercial |
$764.98
|
| Rate for Payer: Aetna Medicare |
$593.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.07
|
| Rate for Payer: BCBS Complete |
$388.48
|
| Rate for Payer: BCBS MAPPO |
$570.88
|
| Rate for Payer: BCN Commercial |
$958.11
|
| Rate for Payer: BCN Medicare Advantage |
$570.88
|
| Rate for Payer: Cash Price |
$4,562.40
|
| Rate for Payer: Cash Price |
$4,562.40
|
| Rate for Payer: Cofinity Commercial |
$764.98
|
| Rate for Payer: Cofinity Commercial |
$822.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$599.42
|
| Rate for Payer: Meridian Medicaid |
$388.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$627.97
|
| Rate for Payer: Nomi Health Commercial |
$685.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,277.25
|
| Rate for Payer: PACE SWMI |
$570.88
|
| Rate for Payer: PHP Commercial |
$799.23
|
| Rate for Payer: PHP Medicare Advantage |
$570.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,043.70
|
| Rate for Payer: Priority Health Medicare |
$570.88
|
| Rate for Payer: Priority Health SBD |
$1,043.70
|
| Rate for Payer: Priority Health Tiered Network |
$1,043.70
|
| Rate for Payer: Railroad Medicare Medicare |
$570.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,121.13
|
| Rate for Payer: UHC Core |
$1,121.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$570.88
|
| Rate for Payer: UHC Exchange |
$1,121.13
|
| Rate for Payer: UHC Medicaid |
$369.98
|
| Rate for Payer: UHCCP Medicaid |
$369.98
|
| Rate for Payer: UMR Bronson Commercial |
$2,623.38
|
|
|
PR EXC URETHRAL DIVERTICULUM SPX FEMALE
|
Professional
|
Both
|
$1,183.00
|
|
|
Service Code
|
HCPCS 53230
|
| Min. Negotiated Rate |
$353.37 |
| Max. Negotiated Rate |
$1,072.59 |
| Rate for Payer: Aetna Commercial |
$731.77
|
| Rate for Payer: Aetna Medicare |
$567.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$731.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$786.38
|
| Rate for Payer: BCBS Complete |
$371.04
|
| Rate for Payer: BCBS MAPPO |
$546.10
|
| Rate for Payer: BCN Commercial |
$916.28
|
| Rate for Payer: BCN Medicare Advantage |
$546.10
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cofinity Commercial |
$731.77
|
| Rate for Payer: Cofinity Commercial |
$786.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$546.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$573.40
|
| Rate for Payer: Meridian Medicaid |
$371.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$600.71
|
| Rate for Payer: Nomi Health Commercial |
$655.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$887.25
|
| Rate for Payer: PACE SWMI |
$546.10
|
| Rate for Payer: PHP Commercial |
$764.54
|
| Rate for Payer: PHP Medicare Advantage |
$546.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$353.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$998.14
|
| Rate for Payer: Priority Health Medicare |
$546.10
|
| Rate for Payer: Priority Health SBD |
$998.14
|
| Rate for Payer: Priority Health Tiered Network |
$998.14
|
| Rate for Payer: Railroad Medicare Medicare |
$546.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,072.59
|
| Rate for Payer: UHC Core |
$1,072.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$546.10
|
| Rate for Payer: UHC Exchange |
$1,072.59
|
| Rate for Payer: UHC Medicaid |
$353.37
|
| Rate for Payer: UHCCP Medicaid |
$353.37
|
| Rate for Payer: UMR Bronson Commercial |
$544.18
|
|
|
PR EXC VARICOCELE/LIGATION SPERMATIC VEINS ABDL
|
Professional
|
Both
|
$2,207.00
|
|
|
Service Code
|
HCPCS 55535
|
| Min. Negotiated Rate |
$253.68 |
| Max. Negotiated Rate |
$1,655.25 |
| Rate for Payer: Aetna Commercial |
$522.77
|
| Rate for Payer: Aetna Medicare |
$405.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$561.79
|
| Rate for Payer: BCBS Complete |
$266.36
|
| Rate for Payer: BCBS MAPPO |
$390.13
|
| Rate for Payer: BCN Commercial |
$648.87
|
| Rate for Payer: BCN Medicare Advantage |
$390.13
|
| Rate for Payer: Cash Price |
$1,765.60
|
| Rate for Payer: Cash Price |
$1,765.60
|
| Rate for Payer: Cofinity Commercial |
$522.77
|
| Rate for Payer: Cofinity Commercial |
$561.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.64
|
| Rate for Payer: Meridian Medicaid |
$266.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$429.14
|
| Rate for Payer: Nomi Health Commercial |
$468.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,655.25
|
| Rate for Payer: PACE SWMI |
$390.13
|
| Rate for Payer: PHP Commercial |
$546.18
|
| Rate for Payer: PHP Medicare Advantage |
$390.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$253.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$706.82
|
| Rate for Payer: Priority Health Medicare |
$390.13
|
| Rate for Payer: Priority Health SBD |
$706.82
|
| Rate for Payer: Priority Health Tiered Network |
$706.82
|
| Rate for Payer: Railroad Medicare Medicare |
$390.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$755.75
|
| Rate for Payer: UHC Core |
$755.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$390.13
|
| Rate for Payer: UHC Exchange |
$755.75
|
| Rate for Payer: UHC Medicaid |
$253.68
|
| Rate for Payer: UHCCP Medicaid |
$253.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,015.22
|
|
|
PR EXC VARICOCELE/LIGATION SPERMATIC VEINS SPX
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 55530
|
| Min. Negotiated Rate |
$208.31 |
| Max. Negotiated Rate |
$616.17 |
| Rate for Payer: Aetna Commercial |
$428.55
|
| Rate for Payer: Aetna Medicare |
$332.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.53
|
| Rate for Payer: BCBS Complete |
$218.73
|
| Rate for Payer: BCBS MAPPO |
$319.81
|
| Rate for Payer: BCN Commercial |
$531.85
|
| Rate for Payer: BCN Medicare Advantage |
$319.81
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$428.55
|
| Rate for Payer: Cofinity Commercial |
$460.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$335.80
|
| Rate for Payer: Meridian Medicaid |
$218.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$351.79
|
| Rate for Payer: Nomi Health Commercial |
$383.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$506.25
|
| Rate for Payer: PACE SWMI |
$319.81
|
| Rate for Payer: PHP Commercial |
$447.73
|
| Rate for Payer: PHP Medicare Advantage |
$319.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$579.35
|
| Rate for Payer: Priority Health Medicare |
$319.81
|
| Rate for Payer: Priority Health SBD |
$579.35
|
| Rate for Payer: Priority Health Tiered Network |
$579.35
|
| Rate for Payer: Railroad Medicare Medicare |
$319.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$616.17
|
| Rate for Payer: UHC Core |
$616.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$319.81
|
| Rate for Payer: UHC Exchange |
$616.17
|
| Rate for Payer: UHC Medicaid |
$208.31
|
| Rate for Payer: UHCCP Medicaid |
$208.31
|
| Rate for Payer: UMR Bronson Commercial |
$310.50
|
|
|
PR EXC VARICOCELE/LIGATION VEINS W/HERNIA RPR
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 55540
|
| Min. Negotiated Rate |
$344.42 |
| Max. Negotiated Rate |
$977.64 |
| Rate for Payer: Aetna Commercial |
$713.15
|
| Rate for Payer: Aetna Medicare |
$553.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$713.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$766.37
|
| Rate for Payer: BCBS Complete |
$361.64
|
| Rate for Payer: BCBS MAPPO |
$532.20
|
| Rate for Payer: BCN Commercial |
$842.58
|
| Rate for Payer: BCN Medicare Advantage |
$532.20
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cofinity Commercial |
$713.15
|
| Rate for Payer: Cofinity Commercial |
$766.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$532.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$558.81
|
| Rate for Payer: Meridian Medicaid |
$361.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$585.42
|
| Rate for Payer: Nomi Health Commercial |
$638.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$612.00
|
| Rate for Payer: PACE SWMI |
$532.20
|
| Rate for Payer: PHP Commercial |
$745.08
|
| Rate for Payer: PHP Medicare Advantage |
$532.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$344.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$917.84
|
| Rate for Payer: Priority Health Medicare |
$532.20
|
| Rate for Payer: Priority Health SBD |
$917.84
|
| Rate for Payer: Priority Health Tiered Network |
$917.84
|
| Rate for Payer: Railroad Medicare Medicare |
$532.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$977.64
|
| Rate for Payer: UHC Core |
$977.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$532.20
|
| Rate for Payer: UHC Exchange |
$977.64
|
| Rate for Payer: UHC Medicaid |
$344.42
|
| Rate for Payer: UHCCP Medicaid |
$344.42
|
| Rate for Payer: UMR Bronson Commercial |
$375.36
|
|
|
PR EXC XTRPARENCHYMAL LESION TESTIS
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 54512
|
| Min. Negotiated Rate |
$312.68 |
| Max. Negotiated Rate |
$949.71 |
| Rate for Payer: Aetna Commercial |
$646.82
|
| Rate for Payer: Aetna Medicare |
$502.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$695.09
|
| Rate for Payer: BCBS Complete |
$328.31
|
| Rate for Payer: BCBS MAPPO |
$482.70
|
| Rate for Payer: BCN Commercial |
$810.21
|
| Rate for Payer: BCN Medicare Advantage |
$482.70
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cofinity Commercial |
$646.82
|
| Rate for Payer: Cofinity Commercial |
$695.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$482.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$506.83
|
| Rate for Payer: Meridian Medicaid |
$328.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$530.97
|
| Rate for Payer: Nomi Health Commercial |
$579.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$858.75
|
| Rate for Payer: PACE SWMI |
$482.70
|
| Rate for Payer: PHP Commercial |
$675.78
|
| Rate for Payer: PHP Medicare Advantage |
$482.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$312.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$882.59
|
| Rate for Payer: Priority Health Medicare |
$482.70
|
| Rate for Payer: Priority Health SBD |
$882.59
|
| Rate for Payer: Priority Health Tiered Network |
$882.59
|
| Rate for Payer: Railroad Medicare Medicare |
$482.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$949.71
|
| Rate for Payer: UHC Core |
$949.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$482.70
|
| Rate for Payer: UHC Exchange |
$949.71
|
| Rate for Payer: UHC Medicaid |
$312.68
|
| Rate for Payer: UHCCP Medicaid |
$312.68
|
| Rate for Payer: UMR Bronson Commercial |
$526.70
|
|
|
PR EXERCISE EQUIPMENT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS A9300
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.75
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
|
|
PR EXISION OF SUBLINGUAL GLAND
|
Professional
|
Both
|
$790.00
|
|
|
Service Code
|
HCPCS 42450
|
| Min. Negotiated Rate |
$210.02 |
| Max. Negotiated Rate |
$673.51 |
| Rate for Payer: Aetna Commercial |
$427.29
|
| Rate for Payer: Aetna Medicare |
$331.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$459.17
|
| Rate for Payer: BCBS Complete |
$220.52
|
| Rate for Payer: BCBS MAPPO |
$318.87
|
| Rate for Payer: BCN Commercial |
$552.76
|
| Rate for Payer: BCN Medicare Advantage |
$318.87
|
| Rate for Payer: Cash Price |
$632.00
|
| Rate for Payer: Cash Price |
$632.00
|
| Rate for Payer: Cofinity Commercial |
$459.17
|
| Rate for Payer: Cofinity Commercial |
$427.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$334.81
|
| Rate for Payer: Meridian Medicaid |
$220.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$350.76
|
| Rate for Payer: Nomi Health Commercial |
$382.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$592.50
|
| Rate for Payer: PACE SWMI |
$318.87
|
| Rate for Payer: PHP Commercial |
$446.42
|
| Rate for Payer: PHP Medicare Advantage |
$318.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$673.51
|
| Rate for Payer: Priority Health Medicare |
$318.87
|
| Rate for Payer: Priority Health SBD |
$673.51
|
| Rate for Payer: Priority Health Tiered Network |
$673.51
|
| Rate for Payer: Railroad Medicare Medicare |
$318.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$620.45
|
| Rate for Payer: UHC Core |
$620.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$318.87
|
| Rate for Payer: UHC Exchange |
$620.45
|
| Rate for Payer: UHC Medicaid |
$210.02
|
| Rate for Payer: UHCCP Medicaid |
$210.02
|
| Rate for Payer: UMR Bronson Commercial |
$363.40
|
|
|
PR EXPL CONGENITAL ATRESIA BILE DUCTS
|
Professional
|
Both
|
$2,989.00
|
|
|
Service Code
|
HCPCS 47700
|
| Min. Negotiated Rate |
$643.05 |
| Max. Negotiated Rate |
$2,241.75 |
| Rate for Payer: Aetna Commercial |
$1,337.88
|
| Rate for Payer: Aetna Medicare |
$1,038.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,337.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,437.72
|
| Rate for Payer: BCBS Complete |
$675.20
|
| Rate for Payer: BCBS MAPPO |
$998.42
|
| Rate for Payer: BCN Commercial |
$1,594.03
|
| Rate for Payer: BCN Medicare Advantage |
$998.42
|
| Rate for Payer: Cash Price |
$2,391.20
|
| Rate for Payer: Cash Price |
$2,391.20
|
| Rate for Payer: Cofinity Commercial |
$1,337.88
|
| Rate for Payer: Cofinity Commercial |
$1,437.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$998.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,048.34
|
| Rate for Payer: Meridian Medicaid |
$675.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,098.26
|
| Rate for Payer: Nomi Health Commercial |
$1,198.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,241.75
|
| Rate for Payer: PACE SWMI |
$998.42
|
| Rate for Payer: PHP Commercial |
$1,397.79
|
| Rate for Payer: PHP Medicare Advantage |
$998.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,942.23
|
| Rate for Payer: Priority Health Medicare |
$998.42
|
| Rate for Payer: Priority Health SBD |
$1,942.23
|
| Rate for Payer: Priority Health Tiered Network |
$1,942.23
|
| Rate for Payer: Railroad Medicare Medicare |
$998.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,879.46
|
| Rate for Payer: UHC Core |
$1,879.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$998.42
|
| Rate for Payer: UHC Exchange |
$1,879.46
|
| Rate for Payer: UHC Medicaid |
$643.05
|
| Rate for Payer: UHCCP Medicaid |
$643.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,374.94
|
|
|
PR EXPLORATION EPIDIDYMIS W/WO BIOPSY
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 54865
|
| Min. Negotiated Rate |
$214.28 |
| Max. Negotiated Rate |
$627.72 |
| Rate for Payer: Aetna Commercial |
$439.96
|
| Rate for Payer: Aetna Medicare |
$341.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$472.80
|
| Rate for Payer: BCBS Complete |
$224.99
|
| Rate for Payer: BCBS MAPPO |
$328.33
|
| Rate for Payer: BCN Commercial |
$545.29
|
| Rate for Payer: BCN Medicare Advantage |
$328.33
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Commercial |
$439.96
|
| Rate for Payer: Cofinity Commercial |
$472.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$344.75
|
| Rate for Payer: Meridian Medicaid |
$224.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$361.16
|
| Rate for Payer: Nomi Health Commercial |
$394.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.75
|
| Rate for Payer: PACE SWMI |
$328.33
|
| Rate for Payer: PHP Commercial |
$459.66
|
| Rate for Payer: PHP Medicare Advantage |
$328.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$214.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$593.99
|
| Rate for Payer: Priority Health Medicare |
$328.33
|
| Rate for Payer: Priority Health SBD |
$593.99
|
| Rate for Payer: Priority Health Tiered Network |
$593.99
|
| Rate for Payer: Railroad Medicare Medicare |
$328.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$627.72
|
| Rate for Payer: UHC Core |
$627.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$328.33
|
| Rate for Payer: UHC Exchange |
$627.72
|
| Rate for Payer: UHC Medicaid |
$214.28
|
| Rate for Payer: UHCCP Medicaid |
$214.28
|
| Rate for Payer: UMR Bronson Commercial |
$318.78
|
|
|
PR EXPLORATION, FEMORAL ARTERY
|
Professional
|
Both
|
$1,610.00
|
|
|
Service Code
|
HCPCS 35721
|
| Min. Negotiated Rate |
$644.00 |
| Max. Negotiated Rate |
$1,207.50 |
| Rate for Payer: Aetna Medicare |
$805.00
|
| Rate for Payer: BCBS Complete |
$644.00
|
| Rate for Payer: Cash Price |
$1,288.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,207.50
|
| Rate for Payer: UMR Bronson Commercial |
$740.60
|
|
|
PR EXPLORATION N/FLWD SURG LOWER EXTREMITY ARTERY
|
Professional
|
Both
|
$897.00
|
|
|
Service Code
|
HCPCS 35703
|
| Min. Negotiated Rate |
$242.18 |
| Max. Negotiated Rate |
$743.10 |
| Rate for Payer: Aetna Commercial |
$510.10
|
| Rate for Payer: Aetna Medicare |
$395.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$548.16
|
| Rate for Payer: BCBS Complete |
$254.29
|
| Rate for Payer: BCBS MAPPO |
$380.67
|
| Rate for Payer: BCN Commercial |
$615.50
|
| Rate for Payer: BCN Medicare Advantage |
$380.67
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cofinity Commercial |
$548.16
|
| Rate for Payer: Cofinity Commercial |
$510.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$380.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$399.70
|
| Rate for Payer: Meridian Medicaid |
$254.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$418.74
|
| Rate for Payer: Nomi Health Commercial |
$456.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$672.75
|
| Rate for Payer: PACE SWMI |
$380.67
|
| Rate for Payer: PHP Commercial |
$532.94
|
| Rate for Payer: PHP Medicare Advantage |
$380.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$242.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$661.89
|
| Rate for Payer: Priority Health Medicare |
$380.67
|
| Rate for Payer: Priority Health SBD |
$661.89
|
| Rate for Payer: Priority Health Tiered Network |
$661.89
|
| Rate for Payer: Railroad Medicare Medicare |
$380.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$743.10
|
| Rate for Payer: UHC Core |
$743.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$380.67
|
| Rate for Payer: UHC Exchange |
$743.10
|
| Rate for Payer: UHC Medicaid |
$242.18
|
| Rate for Payer: UHCCP Medicaid |
$242.18
|
| Rate for Payer: UMR Bronson Commercial |
$412.62
|
|
|
PR EXPLORATION N/FLWD SURG NECK ARTERY
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 35701
|
| Min. Negotiated Rate |
$244.52 |
| Max. Negotiated Rate |
$774.04 |
| Rate for Payer: Aetna Commercial |
$510.14
|
| Rate for Payer: Aetna Medicare |
$395.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$548.21
|
| Rate for Payer: BCBS Complete |
$256.75
|
| Rate for Payer: BCBS MAPPO |
$380.70
|
| Rate for Payer: BCN Commercial |
$652.85
|
| Rate for Payer: BCN Medicare Advantage |
$380.70
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cofinity Commercial |
$510.14
|
| Rate for Payer: Cofinity Commercial |
$548.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$380.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$399.74
|
| Rate for Payer: Meridian Medicaid |
$256.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$418.77
|
| Rate for Payer: Nomi Health Commercial |
$456.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$701.25
|
| Rate for Payer: PACE SWMI |
$380.70
|
| Rate for Payer: PHP Commercial |
$532.98
|
| Rate for Payer: PHP Medicare Advantage |
$380.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$244.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$702.06
|
| Rate for Payer: Priority Health Medicare |
$380.70
|
| Rate for Payer: Priority Health SBD |
$702.06
|
| Rate for Payer: Priority Health Tiered Network |
$702.06
|
| Rate for Payer: Railroad Medicare Medicare |
$380.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$774.04
|
| Rate for Payer: UHC Core |
$774.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$380.70
|
| Rate for Payer: UHC Exchange |
$774.04
|
| Rate for Payer: UHC Medicaid |
$244.52
|
| Rate for Payer: UHCCP Medicaid |
$244.52
|
| Rate for Payer: UMR Bronson Commercial |
$430.10
|
|
|
PR EXPLORATION N/FLWD SURG UPPER EXTREMITY ARTERY
|
Professional
|
Both
|
$932.00
|
|
|
Service Code
|
HCPCS 35702
|
| Min. Negotiated Rate |
$237.28 |
| Max. Negotiated Rate |
$729.93 |
| Rate for Payer: Aetna Commercial |
$498.20
|
| Rate for Payer: Aetna Medicare |
$386.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.38
|
| Rate for Payer: BCBS Complete |
$249.14
|
| Rate for Payer: BCBS MAPPO |
$371.79
|
| Rate for Payer: BCN Commercial |
$606.54
|
| Rate for Payer: BCN Medicare Advantage |
$371.79
|
| Rate for Payer: Cash Price |
$745.60
|
| Rate for Payer: Cash Price |
$745.60
|
| Rate for Payer: Cofinity Commercial |
$498.20
|
| Rate for Payer: Cofinity Commercial |
$535.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.38
|
| Rate for Payer: Meridian Medicaid |
$249.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$408.97
|
| Rate for Payer: Nomi Health Commercial |
$446.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$699.00
|
| Rate for Payer: PACE SWMI |
$371.79
|
| Rate for Payer: PHP Commercial |
$520.51
|
| Rate for Payer: PHP Medicare Advantage |
$371.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$237.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$652.26
|
| Rate for Payer: Priority Health Medicare |
$371.79
|
| Rate for Payer: Priority Health SBD |
$652.26
|
| Rate for Payer: Priority Health Tiered Network |
$652.26
|
| Rate for Payer: Railroad Medicare Medicare |
$371.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.93
|
| Rate for Payer: UHC Core |
$729.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.79
|
| Rate for Payer: UHC Exchange |
$729.93
|
| Rate for Payer: UHC Medicaid |
$237.28
|
| Rate for Payer: UHCCP Medicaid |
$237.28
|
| Rate for Payer: UMR Bronson Commercial |
$428.72
|
|
|
PR EXPLORATION OF ARTERY/VEIN
|
Professional
|
Both
|
$1,347.00
|
|
|
Service Code
|
HCPCS 35761
|
| Min. Negotiated Rate |
$538.80 |
| Max. Negotiated Rate |
$1,010.25 |
| Rate for Payer: Aetna Medicare |
$673.50
|
| Rate for Payer: BCBS Complete |
$538.80
|
| Rate for Payer: Cash Price |
$1,077.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,010.25
|
| Rate for Payer: UMR Bronson Commercial |
$619.62
|
|
|
PR EXPLORATION PENETRATING WOUND SPX CHEST
|
Professional
|
Both
|
$1,182.00
|
|
|
Service Code
|
HCPCS 20101
|
| Min. Negotiated Rate |
$128.65 |
| Max. Negotiated Rate |
$886.50 |
| Rate for Payer: Aetna Commercial |
$267.20
|
| Rate for Payer: Aetna Medicare |
$207.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.14
|
| Rate for Payer: BCBS Complete |
$135.08
|
| Rate for Payer: BCBS MAPPO |
$199.40
|
| Rate for Payer: BCN Commercial |
$315.23
|
| Rate for Payer: BCN Medicare Advantage |
$199.40
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cofinity Commercial |
$287.14
|
| Rate for Payer: Cofinity Commercial |
$267.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.37
|
| Rate for Payer: Meridian Medicaid |
$135.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.34
|
| Rate for Payer: Nomi Health Commercial |
$239.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$886.50
|
| Rate for Payer: PACE SWMI |
$199.40
|
| Rate for Payer: PHP Commercial |
$279.16
|
| Rate for Payer: PHP Medicare Advantage |
$199.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.96
|
| Rate for Payer: Priority Health Medicare |
$199.40
|
| Rate for Payer: Priority Health SBD |
$336.96
|
| Rate for Payer: Priority Health Tiered Network |
$336.96
|
| Rate for Payer: Railroad Medicare Medicare |
$199.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.91
|
| Rate for Payer: UHC Core |
$371.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.40
|
| Rate for Payer: UHC Exchange |
$371.91
|
| Rate for Payer: UHC Medicaid |
$128.65
|
| Rate for Payer: UHCCP Medicaid |
$128.65
|
| Rate for Payer: UMR Bronson Commercial |
$543.72
|
|
|
PR EXPLORATION PENETRATING WOUND SPX EXTREMITY
|
Professional
|
Both
|
$1,872.00
|
|
|
Service Code
|
HCPCS 20103
|
| Min. Negotiated Rate |
$201.92 |
| Max. Negotiated Rate |
$1,404.00 |
| Rate for Payer: Aetna Commercial |
$417.62
|
| Rate for Payer: Aetna Medicare |
$324.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.79
|
| Rate for Payer: BCBS Complete |
$212.02
|
| Rate for Payer: BCBS MAPPO |
$311.66
|
| Rate for Payer: BCN Commercial |
$518.90
|
| Rate for Payer: BCN Medicare Advantage |
$311.66
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cofinity Commercial |
$417.62
|
| Rate for Payer: Cofinity Commercial |
$448.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$327.24
|
| Rate for Payer: Meridian Medicaid |
$212.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$342.83
|
| Rate for Payer: Nomi Health Commercial |
$373.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,404.00
|
| Rate for Payer: PACE SWMI |
$311.66
|
| Rate for Payer: PHP Commercial |
$436.32
|
| Rate for Payer: PHP Medicare Advantage |
$311.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$554.68
|
| Rate for Payer: Priority Health Medicare |
$311.66
|
| Rate for Payer: Priority Health SBD |
$554.68
|
| Rate for Payer: Priority Health Tiered Network |
$554.68
|
| Rate for Payer: Railroad Medicare Medicare |
$311.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.72
|
| Rate for Payer: UHC Core |
$608.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$311.66
|
| Rate for Payer: UHC Exchange |
$608.72
|
| Rate for Payer: UHC Medicaid |
$201.92
|
| Rate for Payer: UHCCP Medicaid |
$201.92
|
| Rate for Payer: UMR Bronson Commercial |
$861.12
|
|
|
PR EXPLORATION PENETRATING WOUND SPX NECK
|
Professional
|
Both
|
$1,997.00
|
|
|
Service Code
|
HCPCS 20100
|
| Min. Negotiated Rate |
$348.04 |
| Max. Negotiated Rate |
$1,497.75 |
| Rate for Payer: Aetna Commercial |
$728.57
|
| Rate for Payer: Aetna Medicare |
$565.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$728.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$782.94
|
| Rate for Payer: BCBS Complete |
$365.44
|
| Rate for Payer: BCBS MAPPO |
$543.71
|
| Rate for Payer: BCN Commercial |
$899.85
|
| Rate for Payer: BCN Medicare Advantage |
$543.71
|
| Rate for Payer: Cash Price |
$1,597.60
|
| Rate for Payer: Cash Price |
$1,597.60
|
| Rate for Payer: Cofinity Commercial |
$728.57
|
| Rate for Payer: Cofinity Commercial |
$782.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$543.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$570.90
|
| Rate for Payer: Meridian Medicaid |
$365.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$598.08
|
| Rate for Payer: Nomi Health Commercial |
$652.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,497.75
|
| Rate for Payer: PACE SWMI |
$543.71
|
| Rate for Payer: PHP Commercial |
$761.19
|
| Rate for Payer: PHP Medicare Advantage |
$543.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$961.91
|
| Rate for Payer: Priority Health Medicare |
$543.71
|
| Rate for Payer: Priority Health SBD |
$961.91
|
| Rate for Payer: Priority Health Tiered Network |
$961.91
|
| Rate for Payer: Railroad Medicare Medicare |
$543.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,070.07
|
| Rate for Payer: UHC Core |
$1,070.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$543.71
|
| Rate for Payer: UHC Exchange |
$1,070.07
|
| Rate for Payer: UHC Medicaid |
$348.04
|
| Rate for Payer: UHCCP Medicaid |
$348.04
|
| Rate for Payer: UMR Bronson Commercial |
$918.62
|
|
|
PR EXPLORATION POPLITEAL ARTERY
|
Professional
|
Both
|
$1,111.00
|
|
|
Service Code
|
HCPCS 35741
|
| Min. Negotiated Rate |
$444.40 |
| Max. Negotiated Rate |
$833.25 |
| Rate for Payer: Aetna Medicare |
$555.50
|
| Rate for Payer: BCBS Complete |
$444.40
|
| Rate for Payer: Cash Price |
$888.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$833.25
|
| Rate for Payer: UMR Bronson Commercial |
$511.06
|
|
|
PR EXPLORATION SPINAL FUSION
|
Professional
|
Both
|
$5,330.00
|
|
|
Service Code
|
HCPCS 22830
|
| Min. Negotiated Rate |
$504.81 |
| Max. Negotiated Rate |
$3,997.50 |
| Rate for Payer: Aetna Commercial |
$1,043.35
|
| Rate for Payer: Aetna Medicare |
$809.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,043.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,121.21
|
| Rate for Payer: BCBS Complete |
$530.05
|
| Rate for Payer: BCBS MAPPO |
$778.62
|
| Rate for Payer: BCN Commercial |
$1,255.41
|
| Rate for Payer: BCN Medicare Advantage |
$778.62
|
| Rate for Payer: Cash Price |
$4,264.00
|
| Rate for Payer: Cash Price |
$4,264.00
|
| Rate for Payer: Cofinity Commercial |
$1,121.21
|
| Rate for Payer: Cofinity Commercial |
$1,043.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$778.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$817.55
|
| Rate for Payer: Meridian Medicaid |
$530.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$856.48
|
| Rate for Payer: Nomi Health Commercial |
$934.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,997.50
|
| Rate for Payer: PACE SWMI |
$778.62
|
| Rate for Payer: PHP Commercial |
$1,090.07
|
| Rate for Payer: PHP Medicare Advantage |
$778.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$504.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,342.01
|
| Rate for Payer: Priority Health Medicare |
$778.62
|
| Rate for Payer: Priority Health SBD |
$1,342.01
|
| Rate for Payer: Priority Health Tiered Network |
$1,342.01
|
| Rate for Payer: Railroad Medicare Medicare |
$778.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,434.98
|
| Rate for Payer: UHC Core |
$1,434.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$778.62
|
| Rate for Payer: UHC Exchange |
$1,434.98
|
| Rate for Payer: UHC Medicaid |
$504.81
|
| Rate for Payer: UHCCP Medicaid |
$504.81
|
| Rate for Payer: UMR Bronson Commercial |
$2,451.80
|
|
|
PR EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX
|
Professional
|
Both
|
$2,424.00
|
|
|
Service Code
|
HCPCS 49000
|
| Min. Negotiated Rate |
$464.77 |
| Max. Negotiated Rate |
$1,818.00 |
| Rate for Payer: Aetna Commercial |
$968.36
|
| Rate for Payer: Aetna Medicare |
$751.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,040.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$968.36
|
| Rate for Payer: BCBS Complete |
$488.01
|
| Rate for Payer: BCBS MAPPO |
$722.66
|
| Rate for Payer: BCN Commercial |
$1,158.31
|
| Rate for Payer: BCN Medicare Advantage |
$722.66
|
| Rate for Payer: Cash Price |
$1,939.20
|
| Rate for Payer: Cash Price |
$1,939.20
|
| Rate for Payer: Cofinity Commercial |
$1,040.63
|
| Rate for Payer: Cofinity Commercial |
$968.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$758.79
|
| Rate for Payer: Meridian Medicaid |
$488.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$794.93
|
| Rate for Payer: Nomi Health Commercial |
$867.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,818.00
|
| Rate for Payer: PACE SWMI |
$722.66
|
| Rate for Payer: PHP Commercial |
$1,011.72
|
| Rate for Payer: PHP Medicare Advantage |
$722.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$464.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,411.32
|
| Rate for Payer: Priority Health Medicare |
$722.66
|
| Rate for Payer: Priority Health SBD |
$1,411.32
|
| Rate for Payer: Priority Health Tiered Network |
$1,411.32
|
| Rate for Payer: Railroad Medicare Medicare |
$722.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,367.78
|
| Rate for Payer: UHC Core |
$1,367.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$722.66
|
| Rate for Payer: UHC Exchange |
$1,367.78
|
| Rate for Payer: UHC Medicaid |
$464.77
|
| Rate for Payer: UHCCP Medicaid |
$464.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,115.04
|
|
