|
PR ESPHGP THRC APPR W/O RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$4,977.00
|
|
|
Service Code
|
HCPCS 43310
|
| Min. Negotiated Rate |
$937.84 |
| Max. Negotiated Rate |
$3,235.05 |
| Rate for Payer: Aetna Commercial |
$1,912.92
|
| Rate for Payer: Aetna Medicare |
$1,484.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,912.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,055.67
|
| Rate for Payer: BCBS Complete |
$984.73
|
| Rate for Payer: BCBS MAPPO |
$1,427.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,024.37
|
| Rate for Payer: BCN Commercial |
$2,135.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,427.55
|
| Rate for Payer: Cash Price |
$3,981.60
|
| Rate for Payer: Cash Price |
$3,981.60
|
| Rate for Payer: Cofinity Commercial |
$1,912.92
|
| Rate for Payer: Cofinity Commercial |
$2,055.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,427.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,498.93
|
| Rate for Payer: Meridian Medicaid |
$984.73
|
| Rate for Payer: Nomi Health Commercial |
$1,713.06
|
| Rate for Payer: PACE SWMI |
$1,427.55
|
| Rate for Payer: PHP Commercial |
$1,998.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,427.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$937.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,235.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,618.45
|
| Rate for Payer: Priority Health Medicare |
$1,427.55
|
| Rate for Payer: Priority Health Narrow Network |
$2,618.45
|
| Rate for Payer: Priority Health SBD |
$2,618.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,427.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,427.55
|
| Rate for Payer: UHCCP Medicaid |
$937.84
|
| Rate for Payer: UMR Bronson Commercial |
$2,289.42
|
|
|
PR ESPHGP THRC APPR W/RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$3,354.00
|
|
|
Service Code
|
HCPCS 43312
|
| Min. Negotiated Rate |
$1,000.04 |
| Max. Negotiated Rate |
$2,795.64 |
| Rate for Payer: Aetna Commercial |
$2,047.94
|
| Rate for Payer: Aetna Medicare |
$1,589.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,047.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,200.77
|
| Rate for Payer: BCBS Complete |
$1,050.04
|
| Rate for Payer: BCBS MAPPO |
$1,528.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,130.03
|
| Rate for Payer: BCN Commercial |
$2,281.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,528.31
|
| Rate for Payer: Cash Price |
$2,683.20
|
| Rate for Payer: Cash Price |
$2,683.20
|
| Rate for Payer: Cofinity Commercial |
$2,047.94
|
| Rate for Payer: Cofinity Commercial |
$2,200.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,528.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,604.73
|
| Rate for Payer: Meridian Medicaid |
$1,050.04
|
| Rate for Payer: Nomi Health Commercial |
$1,833.97
|
| Rate for Payer: PACE SWMI |
$1,528.31
|
| Rate for Payer: PHP Commercial |
$2,139.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,528.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,000.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,180.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,795.64
|
| Rate for Payer: Priority Health Medicare |
$1,528.31
|
| Rate for Payer: Priority Health Narrow Network |
$2,795.64
|
| Rate for Payer: Priority Health SBD |
$2,795.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,528.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,528.31
|
| Rate for Payer: UHCCP Medicaid |
$1,000.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,542.84
|
|
|
PR ESRD RELATED SVC <FULL MONTH 20/>YR OLD
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 90970
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$77.13 |
| Rate for Payer: Aetna Commercial |
$12.26
|
| Rate for Payer: Aetna Medicare |
$9.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.18
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$9.15
|
| Rate for Payer: BCBS Trust/PPO |
$77.13
|
| Rate for Payer: BCN Commercial |
$13.68
|
| Rate for Payer: BCN Medicare Advantage |
$9.15
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$12.26
|
| Rate for Payer: Cofinity Commercial |
$13.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.61
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: Nomi Health Commercial |
$10.98
|
| Rate for Payer: PACE SWMI |
$9.15
|
| Rate for Payer: PHP Commercial |
$12.81
|
| Rate for Payer: PHP Medicare Advantage |
$9.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.66
|
| Rate for Payer: Priority Health Medicare |
$9.15
|
| Rate for Payer: Priority Health Narrow Network |
$12.66
|
| Rate for Payer: Priority Health SBD |
$12.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.15
|
| Rate for Payer: UHC Medicare Advantage |
$9.15
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
| Rate for Payer: UMR Bronson Commercial |
$6.44
|
|
|
PR ESRD RELATED SVC MONTHLY 20&/>YR OLD 1 VISIT
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 90962
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$291.25 |
| Rate for Payer: Aetna Commercial |
$256.23
|
| Rate for Payer: Aetna Medicare |
$198.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.36
|
| Rate for Payer: BCBS Complete |
$135.98
|
| Rate for Payer: BCBS MAPPO |
$191.22
|
| Rate for Payer: BCBS Trust/PPO |
$136.83
|
| Rate for Payer: BCN Commercial |
$291.25
|
| Rate for Payer: BCN Medicare Advantage |
$191.22
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cofinity Commercial |
$256.23
|
| Rate for Payer: Cofinity Commercial |
$275.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.78
|
| Rate for Payer: Meridian Medicaid |
$135.98
|
| Rate for Payer: Nomi Health Commercial |
$229.46
|
| Rate for Payer: PACE SWMI |
$191.22
|
| Rate for Payer: PHP Commercial |
$267.71
|
| Rate for Payer: PHP Medicare Advantage |
$191.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.29
|
| Rate for Payer: Priority Health Medicare |
$191.22
|
| Rate for Payer: Priority Health Narrow Network |
$272.29
|
| Rate for Payer: Priority Health SBD |
$272.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.22
|
| Rate for Payer: UHC Medicare Advantage |
$191.22
|
| Rate for Payer: UHCCP Medicaid |
$129.50
|
| Rate for Payer: UMR Bronson Commercial |
$147.20
|
|
|
PR ESRD RELATED SVC MONTHLY 20/>YR OLD 2/3 VISITS
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 90961
|
| Min. Negotiated Rate |
$103.02 |
| Max. Negotiated Rate |
$423.20 |
| Rate for Payer: Aetna Commercial |
$372.64
|
| Rate for Payer: Aetna Medicare |
$289.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.45
|
| Rate for Payer: BCBS Complete |
$196.81
|
| Rate for Payer: BCBS MAPPO |
$278.09
|
| Rate for Payer: BCBS Trust/PPO |
$103.02
|
| Rate for Payer: BCN Commercial |
$423.20
|
| Rate for Payer: BCN Medicare Advantage |
$278.09
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cofinity Commercial |
$372.64
|
| Rate for Payer: Cofinity Commercial |
$400.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$291.99
|
| Rate for Payer: Meridian Medicaid |
$196.81
|
| Rate for Payer: Nomi Health Commercial |
$333.71
|
| Rate for Payer: PACE SWMI |
$278.09
|
| Rate for Payer: PHP Commercial |
$389.33
|
| Rate for Payer: PHP Medicare Advantage |
$278.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.42
|
| Rate for Payer: Priority Health Medicare |
$278.09
|
| Rate for Payer: Priority Health Narrow Network |
$394.42
|
| Rate for Payer: Priority Health SBD |
$394.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.09
|
| Rate for Payer: UHC Medicare Advantage |
$278.09
|
| Rate for Payer: UHCCP Medicaid |
$187.44
|
| Rate for Payer: UMR Bronson Commercial |
$190.44
|
|
|
PR ESRD RELATED SVC MONTHLY 20&/> YR OLD 4/> VISITS
|
Professional
|
Both
|
$492.00
|
|
|
Service Code
|
HCPCS 90960
|
| Min. Negotiated Rate |
$225.78 |
| Max. Negotiated Rate |
$508.71 |
| Rate for Payer: Aetna Commercial |
$449.45
|
| Rate for Payer: Aetna Medicare |
$348.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.99
|
| Rate for Payer: BCBS Complete |
$237.07
|
| Rate for Payer: BCBS MAPPO |
$335.41
|
| Rate for Payer: BCBS Trust/PPO |
$226.11
|
| Rate for Payer: BCN Commercial |
$508.71
|
| Rate for Payer: BCN Medicare Advantage |
$335.41
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$449.45
|
| Rate for Payer: Cofinity Commercial |
$482.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$352.18
|
| Rate for Payer: Meridian Medicaid |
$237.07
|
| Rate for Payer: Nomi Health Commercial |
$402.49
|
| Rate for Payer: PACE SWMI |
$335.41
|
| Rate for Payer: PHP Commercial |
$469.57
|
| Rate for Payer: PHP Medicare Advantage |
$335.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$474.93
|
| Rate for Payer: Priority Health Medicare |
$335.41
|
| Rate for Payer: Priority Health Narrow Network |
$474.93
|
| Rate for Payer: Priority Health SBD |
$474.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$335.41
|
| Rate for Payer: UHC Medicare Advantage |
$335.41
|
| Rate for Payer: UHCCP Medicaid |
$225.78
|
| Rate for Payer: UMR Bronson Commercial |
$226.32
|
|
|
PR ESRD SVC HOME DIALYSIS FULL MONTH 20 YR OLD
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 90966
|
| Min. Negotiated Rate |
$187.44 |
| Max. Negotiated Rate |
$422.71 |
| Rate for Payer: Aetna Commercial |
$372.64
|
| Rate for Payer: Aetna Medicare |
$289.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.45
|
| Rate for Payer: BCBS Complete |
$196.81
|
| Rate for Payer: BCBS MAPPO |
$278.09
|
| Rate for Payer: BCBS Trust/PPO |
$211.32
|
| Rate for Payer: BCN Commercial |
$422.71
|
| Rate for Payer: BCN Medicare Advantage |
$278.09
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cofinity Commercial |
$400.45
|
| Rate for Payer: Cofinity Commercial |
$372.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$291.99
|
| Rate for Payer: Meridian Medicaid |
$196.81
|
| Rate for Payer: Nomi Health Commercial |
$333.71
|
| Rate for Payer: PACE SWMI |
$278.09
|
| Rate for Payer: PHP Commercial |
$389.33
|
| Rate for Payer: PHP Medicare Advantage |
$278.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.42
|
| Rate for Payer: Priority Health Medicare |
$278.09
|
| Rate for Payer: Priority Health Narrow Network |
$394.42
|
| Rate for Payer: Priority Health SBD |
$394.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.09
|
| Rate for Payer: UHC Medicare Advantage |
$278.09
|
| Rate for Payer: UHCCP Medicaid |
$187.44
|
| Rate for Payer: UMR Bronson Commercial |
$195.50
|
|
|
PR ESW BY PHYS W/ANES INVG LAT HUMERL EPICONDYLE
|
Professional
|
Both
|
$2,655.00
|
|
|
Service Code
|
HCPCS 0102T
|
| Min. Negotiated Rate |
$132.14 |
| Max. Negotiated Rate |
$2,753.41 |
| Rate for Payer: Aetna Commercial |
$391.44
|
| Rate for Payer: Aetna Medicare |
$1,327.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.44
|
| Rate for Payer: BCBS Complete |
$1,062.00
|
| Rate for Payer: BCBS Trust/PPO |
$132.14
|
| Rate for Payer: BCN Commercial |
$2,753.41
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,725.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,221.30
|
|
|
PR ETHMOIDECTOMY INTRANASAL ANTERIOR
|
Professional
|
Both
|
$2,550.00
|
|
|
Service Code
|
HCPCS 31200
|
| Min. Negotiated Rate |
$398.74 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: Aetna Commercial |
$764.36
|
| Rate for Payer: Aetna Medicare |
$593.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$821.40
|
| Rate for Payer: BCBS Complete |
$418.68
|
| Rate for Payer: BCBS MAPPO |
$570.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,062.94
|
| Rate for Payer: BCN Commercial |
$920.18
|
| Rate for Payer: BCN Medicare Advantage |
$570.42
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cofinity Commercial |
$764.36
|
| Rate for Payer: Cofinity Commercial |
$821.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$598.94
|
| Rate for Payer: Meridian Medicaid |
$418.68
|
| Rate for Payer: Nomi Health Commercial |
$684.50
|
| Rate for Payer: PACE SWMI |
$570.42
|
| Rate for Payer: PHP Commercial |
$798.59
|
| Rate for Payer: PHP Medicare Advantage |
$570.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$875.95
|
| Rate for Payer: Priority Health Medicare |
$570.42
|
| Rate for Payer: Priority Health Narrow Network |
$875.95
|
| Rate for Payer: Priority Health SBD |
$875.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$570.42
|
| Rate for Payer: UHC Medicare Advantage |
$570.42
|
| Rate for Payer: UHCCP Medicaid |
$398.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,173.00
|
|
|
PR ETHMOIDECTOMY INTRANASAL TOTAL
|
Professional
|
Both
|
$1,534.00
|
|
|
Service Code
|
HCPCS 31201
|
| Min. Negotiated Rate |
$498.21 |
| Max. Negotiated Rate |
$1,178.69 |
| Rate for Payer: Aetna Commercial |
$970.96
|
| Rate for Payer: Aetna Medicare |
$753.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,043.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$970.96
|
| Rate for Payer: BCBS Complete |
$523.12
|
| Rate for Payer: BCBS MAPPO |
$724.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,073.51
|
| Rate for Payer: BCN Commercial |
$1,178.69
|
| Rate for Payer: BCN Medicare Advantage |
$724.60
|
| Rate for Payer: Cash Price |
$1,227.20
|
| Rate for Payer: Cash Price |
$1,227.20
|
| Rate for Payer: Cofinity Commercial |
$1,043.42
|
| Rate for Payer: Cofinity Commercial |
$970.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$724.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$760.83
|
| Rate for Payer: Meridian Medicaid |
$523.12
|
| Rate for Payer: Nomi Health Commercial |
$869.52
|
| Rate for Payer: PACE SWMI |
$724.60
|
| Rate for Payer: PHP Commercial |
$1,014.44
|
| Rate for Payer: PHP Medicare Advantage |
$724.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$498.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,091.46
|
| Rate for Payer: Priority Health Medicare |
$724.60
|
| Rate for Payer: Priority Health Narrow Network |
$1,091.46
|
| Rate for Payer: Priority Health SBD |
$1,091.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$724.60
|
| Rate for Payer: UHC Medicare Advantage |
$724.60
|
| Rate for Payer: UHCCP Medicaid |
$498.21
|
| Rate for Payer: UMR Bronson Commercial |
$705.64
|
|
|
PR ETONOGESTREL IMPLANT SYSTEM
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS J7307
|
| Min. Negotiated Rate |
$626.98 |
| Max. Negotiated Rate |
$1,351.89 |
| Rate for Payer: Aetna Commercial |
$1,092.48
|
| Rate for Payer: Aetna Medicare |
$681.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,092.48
|
| Rate for Payer: BCBS Complete |
$1,351.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,107.77
|
| Rate for Payer: BCN Commercial |
$1,107.77
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Meridian Medicaid |
$1,351.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,287.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.95
|
| Rate for Payer: UHCCP Medicaid |
$1,287.51
|
| Rate for Payer: UMR Bronson Commercial |
$626.98
|
|
|
PR EUFLEXXA INJ PER DOSE
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS J7323
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$191.75 |
| Rate for Payer: Aetna Commercial |
$153.41
|
| Rate for Payer: Aetna Medicare |
$119.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.85
|
| Rate for Payer: BCBS Complete |
$118.00
|
| Rate for Payer: BCBS MAPPO |
$114.48
|
| Rate for Payer: BCBS Trust/PPO |
$129.70
|
| Rate for Payer: BCN Commercial |
$137.68
|
| Rate for Payer: BCN Medicare Advantage |
$114.48
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cofinity Commercial |
$164.85
|
| Rate for Payer: Cofinity Commercial |
$153.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.21
|
| Rate for Payer: Nomi Health Commercial |
$137.38
|
| Rate for Payer: PACE SWMI |
$114.48
|
| Rate for Payer: PHP Commercial |
$160.27
|
| Rate for Payer: PHP Medicare Advantage |
$114.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.75
|
| Rate for Payer: Priority Health Medicare |
$114.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.48
|
| Rate for Payer: UHC Medicare Advantage |
$114.48
|
| Rate for Payer: UMR Bronson Commercial |
$135.70
|
|
|
PR EVACUATION SUBUNGUAL HEMATOMA
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 11740
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$116.11 |
| Rate for Payer: Aetna Commercial |
$40.86
|
| Rate for Payer: Aetna Medicare |
$31.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.91
|
| Rate for Payer: BCBS Complete |
$22.14
|
| Rate for Payer: BCBS MAPPO |
$30.49
|
| Rate for Payer: BCBS Trust/PPO |
$116.11
|
| Rate for Payer: BCN Commercial |
$67.15
|
| Rate for Payer: BCN Medicare Advantage |
$30.49
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$43.91
|
| Rate for Payer: Cofinity Commercial |
$40.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.01
|
| Rate for Payer: Meridian Medicaid |
$22.14
|
| Rate for Payer: Nomi Health Commercial |
$36.59
|
| Rate for Payer: PACE SWMI |
$30.49
|
| Rate for Payer: PHP Commercial |
$42.69
|
| Rate for Payer: PHP Medicare Advantage |
$30.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.80
|
| Rate for Payer: Priority Health Medicare |
$30.49
|
| Rate for Payer: Priority Health Narrow Network |
$43.80
|
| Rate for Payer: Priority Health SBD |
$43.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.49
|
| Rate for Payer: UHC Medicare Advantage |
$30.49
|
| Rate for Payer: UHCCP Medicaid |
$21.09
|
| Rate for Payer: UMR Bronson Commercial |
$37.72
|
|
|
PR EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 92626
|
| Min. Negotiated Rate |
$47.29 |
| Max. Negotiated Rate |
$126.57 |
| Rate for Payer: Aetna Commercial |
$93.52
|
| Rate for Payer: Aetna Medicare |
$72.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.52
|
| Rate for Payer: BCBS Complete |
$49.65
|
| Rate for Payer: BCBS MAPPO |
$69.79
|
| Rate for Payer: BCN Commercial |
$126.57
|
| Rate for Payer: BCN Medicare Advantage |
$69.79
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$100.50
|
| Rate for Payer: Cofinity Commercial |
$93.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.28
|
| Rate for Payer: Meridian Medicaid |
$49.65
|
| Rate for Payer: Nomi Health Commercial |
$83.75
|
| Rate for Payer: PACE SWMI |
$69.79
|
| Rate for Payer: PHP Commercial |
$97.71
|
| Rate for Payer: PHP Medicare Advantage |
$69.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.51
|
| Rate for Payer: Priority Health Medicare |
$69.79
|
| Rate for Payer: Priority Health Narrow Network |
$99.51
|
| Rate for Payer: Priority Health SBD |
$99.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.79
|
| Rate for Payer: UHC Medicare Advantage |
$69.79
|
| Rate for Payer: UHCCP Medicaid |
$47.29
|
| Rate for Payer: UMR Bronson Commercial |
$84.64
|
|
|
PR EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 92627
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$29.81 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna Medicare |
$17.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.56
|
| Rate for Payer: BCBS Complete |
$11.63
|
| Rate for Payer: BCBS MAPPO |
$16.36
|
| Rate for Payer: BCN Commercial |
$29.81
|
| Rate for Payer: BCN Medicare Advantage |
$16.36
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$21.92
|
| Rate for Payer: Cofinity Commercial |
$23.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.18
|
| Rate for Payer: Meridian Medicaid |
$11.63
|
| Rate for Payer: Nomi Health Commercial |
$19.63
|
| Rate for Payer: PACE SWMI |
$16.36
|
| Rate for Payer: PHP Commercial |
$22.90
|
| Rate for Payer: PHP Medicare Advantage |
$16.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.52
|
| Rate for Payer: Priority Health Medicare |
$16.36
|
| Rate for Payer: Priority Health Narrow Network |
$23.52
|
| Rate for Payer: Priority Health SBD |
$23.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.36
|
| Rate for Payer: UHC Medicare Advantage |
$16.36
|
| Rate for Payer: UHCCP Medicaid |
$11.08
|
| Rate for Payer: UMR Bronson Commercial |
$20.24
|
|
|
PR EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 92620
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$295.85 |
| Rate for Payer: Aetna Commercial |
$99.83
|
| Rate for Payer: Aetna Medicare |
$77.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.83
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS MAPPO |
$74.50
|
| Rate for Payer: BCBS Trust/PPO |
$295.85
|
| Rate for Payer: BCN Commercial |
$129.01
|
| Rate for Payer: BCN Medicare Advantage |
$74.50
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$107.28
|
| Rate for Payer: Cofinity Commercial |
$99.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.22
|
| Rate for Payer: Nomi Health Commercial |
$89.40
|
| Rate for Payer: PACE SWMI |
$74.50
|
| Rate for Payer: PHP Commercial |
$104.30
|
| Rate for Payer: PHP Medicare Advantage |
$74.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.84
|
| Rate for Payer: Priority Health Medicare |
$74.50
|
| Rate for Payer: Priority Health Narrow Network |
$105.84
|
| Rate for Payer: Priority Health SBD |
$105.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.50
|
| Rate for Payer: UHC Medicare Advantage |
$74.50
|
| Rate for Payer: UMR Bronson Commercial |
$77.28
|
|
|
PR EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 92621
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$281.58 |
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: Aetna Medicare |
$18.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.33
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS MAPPO |
$17.59
|
| Rate for Payer: BCBS Trust/PPO |
$281.58
|
| Rate for Payer: BCN Commercial |
$31.76
|
| Rate for Payer: BCN Medicare Advantage |
$17.59
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$25.33
|
| Rate for Payer: Cofinity Commercial |
$23.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.47
|
| Rate for Payer: Nomi Health Commercial |
$21.11
|
| Rate for Payer: PACE SWMI |
$17.59
|
| Rate for Payer: PHP Commercial |
$24.63
|
| Rate for Payer: PHP Medicare Advantage |
$17.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.88
|
| Rate for Payer: Priority Health Medicare |
$17.59
|
| Rate for Payer: Priority Health Narrow Network |
$24.88
|
| Rate for Payer: Priority Health SBD |
$24.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.59
|
| Rate for Payer: UHC Medicare Advantage |
$17.59
|
| Rate for Payer: UMR Bronson Commercial |
$18.40
|
|
|
PR EVAL OF ORTHOTIC/PROSTH USE, EA 15 MIN
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 97762
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: UMR Bronson Commercial |
$34.50
|
|
|
PR EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 92523
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$1,440.15 |
| Rate for Payer: Aetna Commercial |
$288.80
|
| Rate for Payer: Aetna Medicare |
$224.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.35
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS MAPPO |
$215.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,440.15
|
| Rate for Payer: BCN Commercial |
$331.82
|
| Rate for Payer: BCN Medicare Advantage |
$215.52
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$310.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.30
|
| Rate for Payer: Nomi Health Commercial |
$258.62
|
| Rate for Payer: PACE SWMI |
$215.52
|
| Rate for Payer: PHP Commercial |
$301.73
|
| Rate for Payer: PHP Medicare Advantage |
$215.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$309.39
|
| Rate for Payer: Priority Health Medicare |
$215.52
|
| Rate for Payer: Priority Health Narrow Network |
$309.39
|
| Rate for Payer: Priority Health SBD |
$309.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.52
|
| Rate for Payer: UHC Medicare Advantage |
$215.52
|
| Rate for Payer: UMR Bronson Commercial |
$164.22
|
|
|
PR EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 92521
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$1,170.71 |
| Rate for Payer: Aetna Commercial |
$168.73
|
| Rate for Payer: Aetna Medicare |
$130.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.32
|
| Rate for Payer: BCBS Complete |
$84.40
|
| Rate for Payer: BCBS MAPPO |
$125.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,170.71
|
| Rate for Payer: BCN Commercial |
$193.52
|
| Rate for Payer: BCN Medicare Advantage |
$125.92
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cofinity Commercial |
$181.32
|
| Rate for Payer: Cofinity Commercial |
$168.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.22
|
| Rate for Payer: Nomi Health Commercial |
$151.10
|
| Rate for Payer: PACE SWMI |
$125.92
|
| Rate for Payer: PHP Commercial |
$176.29
|
| Rate for Payer: PHP Medicare Advantage |
$125.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.48
|
| Rate for Payer: Priority Health Medicare |
$125.92
|
| Rate for Payer: Priority Health Narrow Network |
$180.48
|
| Rate for Payer: Priority Health SBD |
$180.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.92
|
| Rate for Payer: UHC Medicare Advantage |
$125.92
|
| Rate for Payer: UMR Bronson Commercial |
$97.06
|
|
|
PR EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 92522
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$1,580.15 |
| Rate for Payer: Aetna Commercial |
$140.77
|
| Rate for Payer: Aetna Medicare |
$109.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.27
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS MAPPO |
$105.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,580.15
|
| Rate for Payer: BCN Commercial |
$161.75
|
| Rate for Payer: BCN Medicare Advantage |
$105.05
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$151.27
|
| Rate for Payer: Cofinity Commercial |
$140.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.30
|
| Rate for Payer: Nomi Health Commercial |
$126.06
|
| Rate for Payer: PACE SWMI |
$105.05
|
| Rate for Payer: PHP Commercial |
$147.07
|
| Rate for Payer: PHP Medicare Advantage |
$105.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.07
|
| Rate for Payer: Priority Health Medicare |
$105.05
|
| Rate for Payer: Priority Health Narrow Network |
$151.07
|
| Rate for Payer: Priority Health SBD |
$151.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.05
|
| Rate for Payer: UHC Medicare Advantage |
$105.05
|
| Rate for Payer: UMR Bronson Commercial |
$78.66
|
|
|
PR EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART 1ST
|
Professional
|
Both
|
$1,105.00
|
|
|
Service Code
|
HCPCS 61650
|
| Min. Negotiated Rate |
$318.04 |
| Max. Negotiated Rate |
$990.71 |
| Rate for Payer: Aetna Commercial |
$770.85
|
| Rate for Payer: Aetna Medicare |
$598.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$828.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$770.85
|
| Rate for Payer: BCBS Complete |
$393.84
|
| Rate for Payer: BCBS MAPPO |
$575.26
|
| Rate for Payer: BCBS Trust/PPO |
$318.04
|
| Rate for Payer: BCN Commercial |
$832.21
|
| Rate for Payer: BCN Medicare Advantage |
$575.26
|
| Rate for Payer: Cash Price |
$884.00
|
| Rate for Payer: Cash Price |
$884.00
|
| Rate for Payer: Cofinity Commercial |
$828.37
|
| Rate for Payer: Cofinity Commercial |
$770.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$575.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$604.02
|
| Rate for Payer: Meridian Medicaid |
$393.84
|
| Rate for Payer: Nomi Health Commercial |
$690.31
|
| Rate for Payer: PACE SWMI |
$575.26
|
| Rate for Payer: PHP Commercial |
$805.36
|
| Rate for Payer: PHP Medicare Advantage |
$575.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$718.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$990.71
|
| Rate for Payer: Priority Health Medicare |
$575.26
|
| Rate for Payer: Priority Health Narrow Network |
$990.71
|
| Rate for Payer: Priority Health SBD |
$990.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$575.26
|
| Rate for Payer: UHC Medicare Advantage |
$575.26
|
| Rate for Payer: UHCCP Medicaid |
$375.09
|
| Rate for Payer: UMR Bronson Commercial |
$508.30
|
|
|
PR EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART ADDL
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 61651
|
| Min. Negotiated Rate |
$160.18 |
| Max. Negotiated Rate |
$423.13 |
| Rate for Payer: Aetna Commercial |
$329.12
|
| Rate for Payer: Aetna Medicare |
$255.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.68
|
| Rate for Payer: BCBS Complete |
$168.19
|
| Rate for Payer: BCBS MAPPO |
$245.61
|
| Rate for Payer: BCBS Trust/PPO |
$301.13
|
| Rate for Payer: BCN Commercial |
$358.20
|
| Rate for Payer: BCN Medicare Advantage |
$245.61
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$329.12
|
| Rate for Payer: Cofinity Commercial |
$353.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$257.89
|
| Rate for Payer: Meridian Medicaid |
$168.19
|
| Rate for Payer: Nomi Health Commercial |
$294.73
|
| Rate for Payer: PACE SWMI |
$245.61
|
| Rate for Payer: PHP Commercial |
$343.85
|
| Rate for Payer: PHP Medicare Advantage |
$245.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$423.13
|
| Rate for Payer: Priority Health Medicare |
$245.61
|
| Rate for Payer: Priority Health Narrow Network |
$423.13
|
| Rate for Payer: Priority Health SBD |
$423.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$245.61
|
| Rate for Payer: UHC Medicare Advantage |
$245.61
|
| Rate for Payer: UHCCP Medicaid |
$160.18
|
| Rate for Payer: UMR Bronson Commercial |
$216.20
|
|
|
PR EVASC PLACEMENT ILIAC ARTERY OCCLUSION DEVICE
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 34808
|
| Min. Negotiated Rate |
$125.88 |
| Max. Negotiated Rate |
$314.31 |
| Rate for Payer: Aetna Commercial |
$260.72
|
| Rate for Payer: Aetna Medicare |
$202.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.18
|
| Rate for Payer: BCBS Complete |
$132.17
|
| Rate for Payer: BCBS MAPPO |
$194.57
|
| Rate for Payer: BCBS Trust/PPO |
$212.38
|
| Rate for Payer: BCN Commercial |
$287.83
|
| Rate for Payer: BCN Medicare Advantage |
$194.57
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$260.72
|
| Rate for Payer: Cofinity Commercial |
$280.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.30
|
| Rate for Payer: Meridian Medicaid |
$132.17
|
| Rate for Payer: Nomi Health Commercial |
$233.48
|
| Rate for Payer: PACE SWMI |
$194.57
|
| Rate for Payer: PHP Commercial |
$272.40
|
| Rate for Payer: PHP Medicare Advantage |
$194.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$314.31
|
| Rate for Payer: Priority Health Medicare |
$194.57
|
| Rate for Payer: Priority Health Narrow Network |
$314.31
|
| Rate for Payer: Priority Health SBD |
$314.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.57
|
| Rate for Payer: UHC Medicare Advantage |
$194.57
|
| Rate for Payer: UHCCP Medicaid |
$125.88
|
| Rate for Payer: UMR Bronson Commercial |
$204.70
|
|
|
PR EVASC RPR DPLMNT AORTO-AORTIC NDGFT
|
Professional
|
Both
|
$2,588.00
|
|
|
Service Code
|
HCPCS 34701
|
| Min. Negotiated Rate |
$772.13 |
| Max. Negotiated Rate |
$1,920.42 |
| Rate for Payer: Aetna Commercial |
$1,587.82
|
| Rate for Payer: Aetna Medicare |
$1,232.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,587.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,706.31
|
| Rate for Payer: BCBS Complete |
$810.74
|
| Rate for Payer: BCBS MAPPO |
$1,184.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.71
|
| Rate for Payer: BCN Commercial |
$1,763.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,184.94
|
| Rate for Payer: Cash Price |
$2,070.40
|
| Rate for Payer: Cash Price |
$2,070.40
|
| Rate for Payer: Cofinity Commercial |
$1,587.82
|
| Rate for Payer: Cofinity Commercial |
$1,706.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,184.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,244.19
|
| Rate for Payer: Meridian Medicaid |
$810.74
|
| Rate for Payer: Nomi Health Commercial |
$1,421.93
|
| Rate for Payer: PACE SWMI |
$1,184.94
|
| Rate for Payer: PHP Commercial |
$1,658.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,184.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$772.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,682.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,920.42
|
| Rate for Payer: Priority Health Medicare |
$1,184.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,920.42
|
| Rate for Payer: Priority Health SBD |
$1,920.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,184.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,184.94
|
| Rate for Payer: UHCCP Medicaid |
$772.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,190.48
|
|
