|
PR EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
HCPCS 40810
|
| Min. Negotiated Rate |
$79.02 |
| Max. Negotiated Rate |
$667.79 |
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Aetna Commercial |
$153.56
|
| Rate for Payer: Aetna Medicare |
$119.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.02
|
| Rate for Payer: BCBS Complete |
$82.97
|
| Rate for Payer: BCBS MAPPO |
$114.60
|
| Rate for Payer: BCBS Trust/PPO |
$667.79
|
| Rate for Payer: BCN Commercial |
$320.09
|
| Rate for Payer: BCN Medicare Advantage |
$114.60
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cofinity Commercial |
$153.56
|
| Rate for Payer: Cofinity Commercial |
$165.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.33
|
| Rate for Payer: Meridian Medicaid |
$82.97
|
| Rate for Payer: Nomi Health Commercial |
$137.52
|
| Rate for Payer: PACE SWMI |
$114.60
|
| Rate for Payer: PHP Commercial |
$160.44
|
| Rate for Payer: PHP Medicare Advantage |
$114.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.73
|
| Rate for Payer: Priority Health Medicare |
$114.60
|
| Rate for Payer: Priority Health Narrow Network |
$220.73
|
| Rate for Payer: Priority Health SBD |
$220.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.60
|
| Rate for Payer: UHC Medicare Advantage |
$114.60
|
| Rate for Payer: UHCCP Medicaid |
$79.02
|
| Rate for Payer: UMR Bronson Commercial |
$169.74
|
|
|
PR EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 40525
|
| Min. Negotiated Rate |
$355.71 |
| Max. Negotiated Rate |
$1,288.95 |
| Rate for Payer: Aetna Commercial |
$702.60
|
| Rate for Payer: Aetna Medicare |
$545.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$702.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$755.04
|
| Rate for Payer: BCBS Complete |
$373.50
|
| Rate for Payer: BCBS MAPPO |
$524.33
|
| Rate for Payer: BCBS Trust/PPO |
$774.49
|
| Rate for Payer: BCN Commercial |
$808.76
|
| Rate for Payer: BCN Medicare Advantage |
$524.33
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Commercial |
$702.60
|
| Rate for Payer: Cofinity Commercial |
$755.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$524.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$550.55
|
| Rate for Payer: Meridian Medicaid |
$373.50
|
| Rate for Payer: Nomi Health Commercial |
$629.20
|
| Rate for Payer: PACE SWMI |
$524.33
|
| Rate for Payer: PHP Commercial |
$734.06
|
| Rate for Payer: PHP Medicare Advantage |
$524.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$355.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$995.13
|
| Rate for Payer: Priority Health Medicare |
$524.33
|
| Rate for Payer: Priority Health Narrow Network |
$995.13
|
| Rate for Payer: Priority Health SBD |
$995.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$524.33
|
| Rate for Payer: UHC Medicare Advantage |
$524.33
|
| Rate for Payer: UHCCP Medicaid |
$355.71
|
| Rate for Payer: UMR Bronson Commercial |
$912.18
|
|
|
PR EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR
|
Professional
|
Both
|
$726.00
|
|
|
Service Code
|
HCPCS 40510
|
| Min. Negotiated Rate |
$226.42 |
| Max. Negotiated Rate |
$719.83 |
| Rate for Payer: Aetna Commercial |
$445.83
|
| Rate for Payer: Aetna Medicare |
$346.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.10
|
| Rate for Payer: BCBS Complete |
$237.74
|
| Rate for Payer: BCBS MAPPO |
$332.71
|
| Rate for Payer: BCBS Trust/PPO |
$378.26
|
| Rate for Payer: BCN Commercial |
$719.83
|
| Rate for Payer: BCN Medicare Advantage |
$332.71
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cofinity Commercial |
$445.83
|
| Rate for Payer: Cofinity Commercial |
$479.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$332.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$349.35
|
| Rate for Payer: Meridian Medicaid |
$237.74
|
| Rate for Payer: Nomi Health Commercial |
$399.25
|
| Rate for Payer: PACE SWMI |
$332.71
|
| Rate for Payer: PHP Commercial |
$465.79
|
| Rate for Payer: PHP Medicare Advantage |
$332.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$226.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$630.60
|
| Rate for Payer: Priority Health Medicare |
$332.71
|
| Rate for Payer: Priority Health Narrow Network |
$630.60
|
| Rate for Payer: Priority Health SBD |
$630.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$332.71
|
| Rate for Payer: UHC Medicare Advantage |
$332.71
|
| Rate for Payer: UHCCP Medicaid |
$226.42
|
| Rate for Payer: UMR Bronson Commercial |
$333.96
|
|
|
PR EXC LIP V-EXC W/PRIM DIR LINR CLSR
|
Professional
|
Both
|
$1,184.00
|
|
|
Service Code
|
HCPCS 40520
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$769.60 |
| Rate for Payer: Aetna Commercial |
$457.73
|
| Rate for Payer: Aetna Medicare |
$355.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$491.89
|
| Rate for Payer: BCBS Complete |
$244.23
|
| Rate for Payer: BCBS MAPPO |
$341.59
|
| Rate for Payer: BCBS Trust/PPO |
$423.17
|
| Rate for Payer: BCN Commercial |
$744.75
|
| Rate for Payer: BCN Medicare Advantage |
$341.59
|
| Rate for Payer: Cash Price |
$947.20
|
| Rate for Payer: Cash Price |
$947.20
|
| Rate for Payer: Cofinity Commercial |
$457.73
|
| Rate for Payer: Cofinity Commercial |
$491.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$358.67
|
| Rate for Payer: Meridian Medicaid |
$244.23
|
| Rate for Payer: Nomi Health Commercial |
$409.91
|
| Rate for Payer: PACE SWMI |
$341.59
|
| Rate for Payer: PHP Commercial |
$478.23
|
| Rate for Payer: PHP Medicare Advantage |
$341.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$644.33
|
| Rate for Payer: Priority Health Medicare |
$341.59
|
| Rate for Payer: Priority Health Narrow Network |
$644.33
|
| Rate for Payer: Priority Health SBD |
$644.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$341.59
|
| Rate for Payer: UHC Medicare Advantage |
$341.59
|
| Rate for Payer: UHCCP Medicaid |
$232.60
|
| Rate for Payer: UMR Bronson Commercial |
$544.64
|
|
|
PR EXC LOCAL MALIGNANT TUMOR STOMACH
|
Professional
|
Both
|
$1,843.00
|
|
|
Service Code
|
HCPCS 43611
|
| Min. Negotiated Rate |
$787.17 |
| Max. Negotiated Rate |
$2,200.84 |
| Rate for Payer: Aetna Commercial |
$1,598.33
|
| Rate for Payer: Aetna Medicare |
$1,240.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,598.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,717.60
|
| Rate for Payer: BCBS Complete |
$828.85
|
| Rate for Payer: BCBS MAPPO |
$1,192.78
|
| Rate for Payer: BCBS Trust/PPO |
$787.17
|
| Rate for Payer: BCN Commercial |
$1,790.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.78
|
| Rate for Payer: Cash Price |
$1,474.40
|
| Rate for Payer: Cash Price |
$1,474.40
|
| Rate for Payer: Cofinity Commercial |
$1,598.33
|
| Rate for Payer: Cofinity Commercial |
$1,717.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,252.42
|
| Rate for Payer: Meridian Medicaid |
$828.85
|
| Rate for Payer: Nomi Health Commercial |
$1,431.34
|
| Rate for Payer: PACE SWMI |
$1,192.78
|
| Rate for Payer: PHP Commercial |
$1,669.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,197.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,200.84
|
| Rate for Payer: Priority Health Medicare |
$1,192.78
|
| Rate for Payer: Priority Health Narrow Network |
$2,200.84
|
| Rate for Payer: Priority Health SBD |
$2,200.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,192.78
|
| Rate for Payer: UHC Medicare Advantage |
$1,192.78
|
| Rate for Payer: UHCCP Medicaid |
$789.38
|
| Rate for Payer: UMR Bronson Commercial |
$847.78
|
|
|
PR EXC LOCAL ULCER/BENIGN TUMOR STOMACH
|
Professional
|
Both
|
$3,159.00
|
|
|
Service Code
|
HCPCS 43610
|
| Min. Negotiated Rate |
$627.29 |
| Max. Negotiated Rate |
$2,053.35 |
| Rate for Payer: Aetna Commercial |
$1,271.00
|
| Rate for Payer: Aetna Medicare |
$986.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,271.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,365.85
|
| Rate for Payer: BCBS Complete |
$658.65
|
| Rate for Payer: BCBS MAPPO |
$948.51
|
| Rate for Payer: BCBS Trust/PPO |
$686.26
|
| Rate for Payer: BCN Commercial |
$1,429.87
|
| Rate for Payer: BCN Medicare Advantage |
$948.51
|
| Rate for Payer: Cash Price |
$2,527.20
|
| Rate for Payer: Cash Price |
$2,527.20
|
| Rate for Payer: Cofinity Commercial |
$1,271.00
|
| Rate for Payer: Cofinity Commercial |
$1,365.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$948.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$995.94
|
| Rate for Payer: Meridian Medicaid |
$658.65
|
| Rate for Payer: Nomi Health Commercial |
$1,138.21
|
| Rate for Payer: PACE SWMI |
$948.51
|
| Rate for Payer: PHP Commercial |
$1,327.91
|
| Rate for Payer: PHP Medicare Advantage |
$948.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$627.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,053.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,751.60
|
| Rate for Payer: Priority Health Medicare |
$948.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,751.60
|
| Rate for Payer: Priority Health SBD |
$1,751.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$948.51
|
| Rate for Payer: UHC Medicare Advantage |
$948.51
|
| Rate for Payer: UHCCP Medicaid |
$627.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,453.14
|
|
|
PR EXCLUSION LAA OPEN TM STRNT/THRCM ANY METHOD
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 33268
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$1,025.43 |
| Rate for Payer: Aetna Commercial |
$166.90
|
| Rate for Payer: Aetna Medicare |
$129.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.35
|
| Rate for Payer: BCBS Complete |
$85.21
|
| Rate for Payer: BCBS MAPPO |
$124.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,025.43
|
| Rate for Payer: BCN Commercial |
$186.67
|
| Rate for Payer: BCN Medicare Advantage |
$124.55
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cofinity Commercial |
$166.90
|
| Rate for Payer: Cofinity Commercial |
$179.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.78
|
| Rate for Payer: Meridian Medicaid |
$85.21
|
| Rate for Payer: Nomi Health Commercial |
$149.46
|
| Rate for Payer: PACE SWMI |
$124.55
|
| Rate for Payer: PHP Commercial |
$174.37
|
| Rate for Payer: PHP Medicare Advantage |
$124.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.56
|
| Rate for Payer: Priority Health Medicare |
$124.55
|
| Rate for Payer: Priority Health Narrow Network |
$201.56
|
| Rate for Payer: Priority Health SBD |
$201.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.55
|
| Rate for Payer: UHC Medicare Advantage |
$124.55
|
| Rate for Payer: UHCCP Medicaid |
$81.15
|
| Rate for Payer: UMR Bronson Commercial |
$134.32
|
|
|
PR EXCLUSION LEFT ATRIAL APPENDAGE OPEN ANY METHOD
|
Professional
|
Both
|
$2,124.00
|
|
|
Service Code
|
HCPCS 33267
|
| Min. Negotiated Rate |
$659.66 |
| Max. Negotiated Rate |
$5,381.79 |
| Rate for Payer: Aetna Commercial |
$1,344.13
|
| Rate for Payer: Aetna Medicare |
$1,043.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,344.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,444.44
|
| Rate for Payer: BCBS Complete |
$692.64
|
| Rate for Payer: BCBS MAPPO |
$1,003.08
|
| Rate for Payer: BCBS Trust/PPO |
$5,381.79
|
| Rate for Payer: BCN Commercial |
$1,497.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,003.08
|
| Rate for Payer: Cash Price |
$1,699.20
|
| Rate for Payer: Cash Price |
$1,699.20
|
| Rate for Payer: Cofinity Commercial |
$1,344.13
|
| Rate for Payer: Cofinity Commercial |
$1,444.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,003.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,053.23
|
| Rate for Payer: Meridian Medicaid |
$692.64
|
| Rate for Payer: Nomi Health Commercial |
$1,203.70
|
| Rate for Payer: PACE SWMI |
$1,003.08
|
| Rate for Payer: PHP Commercial |
$1,404.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,003.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$659.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,380.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,638.03
|
| Rate for Payer: Priority Health Medicare |
$1,003.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,638.03
|
| Rate for Payer: Priority Health SBD |
$1,638.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,003.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,003.08
|
| Rate for Payer: UHCCP Medicaid |
$659.66
|
| Rate for Payer: UMR Bronson Commercial |
$977.04
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Facility
|
IP
|
$2,114.00
|
|
|
Service Code
|
CPT 44800
|
| Hospital Charge Code |
44800
|
| Min. Negotiated Rate |
$930.16 |
| Max. Negotiated Rate |
$1,902.60 |
| Rate for Payer: Aetna American Axle |
$1,374.10
|
| Rate for Payer: Aetna Commercial |
$1,796.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.10
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cofinity Commercial |
$1,479.80
|
| Rate for Payer: Cofinity Commercial |
$1,818.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,479.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,691.20
|
| Rate for Payer: Healthscope Commercial |
$1,902.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,479.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,585.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,796.90
|
| Rate for Payer: PHP Commercial |
$1,796.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.10
|
| Rate for Payer: Priority Health SBD |
$1,331.82
|
| Rate for Payer: UMR Bronson Commercial |
$930.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,585.50
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Facility
|
OP
|
$2,114.00
|
|
|
Service Code
|
CPT 44800
|
| Hospital Charge Code |
44800
|
| Min. Negotiated Rate |
$758.61 |
| Max. Negotiated Rate |
$2,798.62 |
| Rate for Payer: Aetna American Axle |
$1,374.10
|
| Rate for Payer: Aetna Commercial |
$1,796.90
|
| Rate for Payer: Aetna Medicare |
$1,057.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.10
|
| Rate for Payer: BCBS Complete |
$845.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,798.62
|
| Rate for Payer: BCN Commercial |
$2,798.62
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cofinity Commercial |
$1,818.04
|
| Rate for Payer: Cofinity Commercial |
$1,479.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,479.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,691.20
|
| Rate for Payer: Healthscope Commercial |
$1,902.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,479.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,585.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,796.90
|
| Rate for Payer: PHP Commercial |
$1,796.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.10
|
| Rate for Payer: Priority Health SBD |
$1,331.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$834.47
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$758.61
|
| Rate for Payer: UMR Bronson Commercial |
$782.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,585.50
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$2,114.00
|
|
|
Service Code
|
HCPCS 44800
|
| Min. Negotiated Rate |
$332.30 |
| Max. Negotiated Rate |
$1,397.22 |
| Rate for Payer: Aetna Commercial |
$1,006.11
|
| Rate for Payer: Aetna Medicare |
$780.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,006.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,081.20
|
| Rate for Payer: BCBS Complete |
$525.13
|
| Rate for Payer: BCBS MAPPO |
$750.83
|
| Rate for Payer: BCBS Trust/PPO |
$332.30
|
| Rate for Payer: BCN Commercial |
$1,133.25
|
| Rate for Payer: BCN Medicare Advantage |
$750.83
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cofinity Commercial |
$1,006.11
|
| Rate for Payer: Cofinity Commercial |
$1,081.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$750.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$788.37
|
| Rate for Payer: Meridian Medicaid |
$525.13
|
| Rate for Payer: Nomi Health Commercial |
$901.00
|
| Rate for Payer: PACE SWMI |
$750.83
|
| Rate for Payer: PHP Commercial |
$1,051.16
|
| Rate for Payer: PHP Medicare Advantage |
$750.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,397.22
|
| Rate for Payer: Priority Health Medicare |
$750.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,397.22
|
| Rate for Payer: Priority Health SBD |
$1,397.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$750.83
|
| Rate for Payer: UHC Medicare Advantage |
$750.83
|
| Rate for Payer: UHCCP Medicaid |
$500.12
|
| Rate for Payer: UMR Bronson Commercial |
$972.44
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$2,114.00
|
|
|
Service Code
|
HCPCS 44800
|
| Hospital Charge Code |
44800
|
| Min. Negotiated Rate |
$332.30 |
| Max. Negotiated Rate |
$1,397.22 |
| Rate for Payer: Aetna Commercial |
$1,006.11
|
| Rate for Payer: Aetna Medicare |
$780.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,006.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,081.20
|
| Rate for Payer: BCBS Complete |
$525.13
|
| Rate for Payer: BCBS MAPPO |
$750.83
|
| Rate for Payer: BCBS Trust/PPO |
$332.30
|
| Rate for Payer: BCN Commercial |
$1,133.25
|
| Rate for Payer: BCN Medicare Advantage |
$750.83
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cofinity Commercial |
$1,081.20
|
| Rate for Payer: Cofinity Commercial |
$1,006.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$750.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$788.37
|
| Rate for Payer: Meridian Medicaid |
$525.13
|
| Rate for Payer: Nomi Health Commercial |
$901.00
|
| Rate for Payer: PACE SWMI |
$750.83
|
| Rate for Payer: PHP Commercial |
$1,051.16
|
| Rate for Payer: PHP Medicare Advantage |
$750.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,397.22
|
| Rate for Payer: Priority Health Medicare |
$750.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,397.22
|
| Rate for Payer: Priority Health SBD |
$1,397.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$750.83
|
| Rate for Payer: UHC Medicare Advantage |
$750.83
|
| Rate for Payer: UHCCP Medicaid |
$500.12
|
| Rate for Payer: UMR Bronson Commercial |
$972.44
|
|
|
PR EXC MUCOSA VESTIBULE MOUTH AS DON GRF
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 40818
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$762.87 |
| Rate for Payer: Aetna Commercial |
$330.67
|
| Rate for Payer: Aetna Medicare |
$256.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.35
|
| Rate for Payer: BCBS Complete |
$178.92
|
| Rate for Payer: BCBS MAPPO |
$246.77
|
| Rate for Payer: BCBS Trust/PPO |
$762.87
|
| Rate for Payer: BCN Commercial |
$539.99
|
| Rate for Payer: BCN Medicare Advantage |
$246.77
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cofinity Commercial |
$330.67
|
| Rate for Payer: Cofinity Commercial |
$355.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$259.11
|
| Rate for Payer: Meridian Medicaid |
$178.92
|
| Rate for Payer: Nomi Health Commercial |
$296.12
|
| Rate for Payer: PACE SWMI |
$246.77
|
| Rate for Payer: PHP Commercial |
$345.48
|
| Rate for Payer: PHP Medicare Advantage |
$246.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$170.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$476.68
|
| Rate for Payer: Priority Health Medicare |
$246.77
|
| Rate for Payer: Priority Health Narrow Network |
$476.68
|
| Rate for Payer: Priority Health SBD |
$476.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$246.77
|
| Rate for Payer: UHC Medicare Advantage |
$246.77
|
| Rate for Payer: UHCCP Medicaid |
$170.40
|
| Rate for Payer: UMR Bronson Commercial |
$268.18
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV
|
Professional
|
Both
|
$1,905.00
|
|
|
Service Code
|
HCPCS 64788
|
| Min. Negotiated Rate |
$161.13 |
| Max. Negotiated Rate |
$1,238.25 |
| Rate for Payer: Aetna Commercial |
$525.72
|
| Rate for Payer: Aetna Medicare |
$408.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.96
|
| Rate for Payer: BCBS Complete |
$279.56
|
| Rate for Payer: BCBS MAPPO |
$392.33
|
| Rate for Payer: BCBS Trust/PPO |
$161.13
|
| Rate for Payer: BCN Commercial |
$595.21
|
| Rate for Payer: BCN Medicare Advantage |
$392.33
|
| Rate for Payer: Cash Price |
$1,524.00
|
| Rate for Payer: Cash Price |
$1,524.00
|
| Rate for Payer: Cofinity Commercial |
$525.72
|
| Rate for Payer: Cofinity Commercial |
$564.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.95
|
| Rate for Payer: Meridian Medicaid |
$279.56
|
| Rate for Payer: Nomi Health Commercial |
$470.80
|
| Rate for Payer: PACE SWMI |
$392.33
|
| Rate for Payer: PHP Commercial |
$549.26
|
| Rate for Payer: PHP Medicare Advantage |
$392.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,238.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$707.49
|
| Rate for Payer: Priority Health Medicare |
$392.33
|
| Rate for Payer: Priority Health Narrow Network |
$707.49
|
| Rate for Payer: Priority Health SBD |
$707.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.33
|
| Rate for Payer: UHC Medicare Advantage |
$392.33
|
| Rate for Payer: UHCCP Medicaid |
$266.25
|
| Rate for Payer: UMR Bronson Commercial |
$876.30
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA EXTNSV
|
Professional
|
Both
|
$2,003.00
|
|
|
Service Code
|
HCPCS 64792
|
| Min. Negotiated Rate |
$209.74 |
| Max. Negotiated Rate |
$1,850.03 |
| Rate for Payer: Aetna Commercial |
$1,399.96
|
| Rate for Payer: Aetna Medicare |
$1,086.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,399.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,504.44
|
| Rate for Payer: BCBS Complete |
$732.68
|
| Rate for Payer: BCBS MAPPO |
$1,044.75
|
| Rate for Payer: BCBS Trust/PPO |
$209.74
|
| Rate for Payer: BCN Commercial |
$1,559.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,044.75
|
| Rate for Payer: Cash Price |
$1,602.40
|
| Rate for Payer: Cash Price |
$1,602.40
|
| Rate for Payer: Cofinity Commercial |
$1,399.96
|
| Rate for Payer: Cofinity Commercial |
$1,504.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,044.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,096.99
|
| Rate for Payer: Meridian Medicaid |
$732.68
|
| Rate for Payer: Nomi Health Commercial |
$1,253.70
|
| Rate for Payer: PACE SWMI |
$1,044.75
|
| Rate for Payer: PHP Commercial |
$1,462.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,044.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$697.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,301.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,850.03
|
| Rate for Payer: Priority Health Medicare |
$1,044.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,850.03
|
| Rate for Payer: Priority Health SBD |
$1,850.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,044.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,044.75
|
| Rate for Payer: UHCCP Medicaid |
$697.79
|
| Rate for Payer: UMR Bronson Commercial |
$921.38
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV
|
Professional
|
Both
|
$2,381.00
|
|
|
Service Code
|
HCPCS 64790
|
| Min. Negotiated Rate |
$160.07 |
| Max. Negotiated Rate |
$1,547.65 |
| Rate for Payer: Aetna Commercial |
$1,112.94
|
| Rate for Payer: Aetna Medicare |
$863.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,112.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,195.99
|
| Rate for Payer: BCBS Complete |
$583.73
|
| Rate for Payer: BCBS MAPPO |
$830.55
|
| Rate for Payer: BCBS Trust/PPO |
$160.07
|
| Rate for Payer: BCN Commercial |
$1,243.68
|
| Rate for Payer: BCN Medicare Advantage |
$830.55
|
| Rate for Payer: Cash Price |
$1,904.80
|
| Rate for Payer: Cash Price |
$1,904.80
|
| Rate for Payer: Cofinity Commercial |
$1,112.94
|
| Rate for Payer: Cofinity Commercial |
$1,195.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$830.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$872.08
|
| Rate for Payer: Meridian Medicaid |
$583.73
|
| Rate for Payer: Nomi Health Commercial |
$996.66
|
| Rate for Payer: PACE SWMI |
$830.55
|
| Rate for Payer: PHP Commercial |
$1,162.77
|
| Rate for Payer: PHP Medicare Advantage |
$830.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$555.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,465.02
|
| Rate for Payer: Priority Health Medicare |
$830.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,465.02
|
| Rate for Payer: Priority Health SBD |
$1,465.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$830.55
|
| Rate for Payer: UHC Medicare Advantage |
$830.55
|
| Rate for Payer: UHCCP Medicaid |
$555.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,095.26
|
|
|
PR EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 64774
|
| Min. Negotiated Rate |
$266.26 |
| Max. Negotiated Rate |
$791.70 |
| Rate for Payer: Aetna Commercial |
$554.29
|
| Rate for Payer: Aetna Medicare |
$430.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$554.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.66
|
| Rate for Payer: BCBS Complete |
$293.87
|
| Rate for Payer: BCBS MAPPO |
$413.65
|
| Rate for Payer: BCBS Trust/PPO |
$266.26
|
| Rate for Payer: BCN Commercial |
$627.46
|
| Rate for Payer: BCN Medicare Advantage |
$413.65
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$554.29
|
| Rate for Payer: Cofinity Commercial |
$595.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$413.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$434.33
|
| Rate for Payer: Meridian Medicaid |
$293.87
|
| Rate for Payer: Nomi Health Commercial |
$496.38
|
| Rate for Payer: PACE SWMI |
$413.65
|
| Rate for Payer: PHP Commercial |
$579.11
|
| Rate for Payer: PHP Medicare Advantage |
$413.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$279.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$739.90
|
| Rate for Payer: Priority Health Medicare |
$413.65
|
| Rate for Payer: Priority Health Narrow Network |
$739.90
|
| Rate for Payer: Priority Health SBD |
$739.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$413.65
|
| Rate for Payer: UHC Medicare Advantage |
$413.65
|
| Rate for Payer: UHCCP Medicaid |
$279.88
|
| Rate for Payer: UMR Bronson Commercial |
$560.28
|
|
|
PR EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT
|
Professional
|
Both
|
$1,259.00
|
|
|
Service Code
|
HCPCS 64776
|
| Min. Negotiated Rate |
$262.42 |
| Max. Negotiated Rate |
$818.35 |
| Rate for Payer: Aetna Commercial |
$518.42
|
| Rate for Payer: Aetna Medicare |
$402.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$518.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$557.11
|
| Rate for Payer: BCBS Complete |
$275.54
|
| Rate for Payer: BCBS MAPPO |
$386.88
|
| Rate for Payer: BCBS Trust/PPO |
$302.19
|
| Rate for Payer: BCN Commercial |
$584.95
|
| Rate for Payer: BCN Medicare Advantage |
$386.88
|
| Rate for Payer: Cash Price |
$1,007.20
|
| Rate for Payer: Cash Price |
$1,007.20
|
| Rate for Payer: Cofinity Commercial |
$557.11
|
| Rate for Payer: Cofinity Commercial |
$518.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$386.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$406.22
|
| Rate for Payer: Meridian Medicaid |
$275.54
|
| Rate for Payer: Nomi Health Commercial |
$464.26
|
| Rate for Payer: PACE SWMI |
$386.88
|
| Rate for Payer: PHP Commercial |
$541.63
|
| Rate for Payer: PHP Medicare Advantage |
$386.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$262.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$700.09
|
| Rate for Payer: Priority Health Medicare |
$386.88
|
| Rate for Payer: Priority Health Narrow Network |
$700.09
|
| Rate for Payer: Priority Health SBD |
$700.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$386.88
|
| Rate for Payer: UHC Medicare Advantage |
$386.88
|
| Rate for Payer: UHCCP Medicaid |
$262.42
|
| Rate for Payer: UMR Bronson Commercial |
$579.14
|
|
|
PR EXC NEUROMA HAND/FOOT EA NRV XCP SM DGT
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 64783
|
| Min. Negotiated Rate |
$136.96 |
| Max. Negotiated Rate |
$362.83 |
| Rate for Payer: Aetna Commercial |
$276.84
|
| Rate for Payer: Aetna Medicare |
$214.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.50
|
| Rate for Payer: BCBS Complete |
$143.81
|
| Rate for Payer: BCBS MAPPO |
$206.60
|
| Rate for Payer: BCN Commercial |
$311.78
|
| Rate for Payer: BCN Medicare Advantage |
$206.60
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$276.84
|
| Rate for Payer: Cofinity Commercial |
$297.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.93
|
| Rate for Payer: Meridian Medicaid |
$143.81
|
| Rate for Payer: Nomi Health Commercial |
$247.92
|
| Rate for Payer: PACE SWMI |
$206.60
|
| Rate for Payer: PHP Commercial |
$289.24
|
| Rate for Payer: PHP Medicare Advantage |
$206.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$362.83
|
| Rate for Payer: Priority Health Medicare |
$206.60
|
| Rate for Payer: Priority Health Narrow Network |
$362.83
|
| Rate for Payer: Priority Health SBD |
$362.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.60
|
| Rate for Payer: UHC Medicare Advantage |
$206.60
|
| Rate for Payer: UHCCP Medicaid |
$136.96
|
| Rate for Payer: UMR Bronson Commercial |
$204.70
|
|
|
PR EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE
|
Professional
|
Both
|
$1,694.00
|
|
|
Service Code
|
HCPCS 64782
|
| Min. Negotiated Rate |
$298.84 |
| Max. Negotiated Rate |
$1,101.10 |
| Rate for Payer: Aetna Commercial |
$591.70
|
| Rate for Payer: Aetna Medicare |
$459.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$591.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.86
|
| Rate for Payer: BCBS Complete |
$313.78
|
| Rate for Payer: BCBS MAPPO |
$441.57
|
| Rate for Payer: BCBS Trust/PPO |
$306.94
|
| Rate for Payer: BCN Commercial |
$666.56
|
| Rate for Payer: BCN Medicare Advantage |
$441.57
|
| Rate for Payer: Cash Price |
$1,355.20
|
| Rate for Payer: Cash Price |
$1,355.20
|
| Rate for Payer: Cofinity Commercial |
$591.70
|
| Rate for Payer: Cofinity Commercial |
$635.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$441.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$463.65
|
| Rate for Payer: Meridian Medicaid |
$313.78
|
| Rate for Payer: Nomi Health Commercial |
$529.88
|
| Rate for Payer: PACE SWMI |
$441.57
|
| Rate for Payer: PHP Commercial |
$618.20
|
| Rate for Payer: PHP Medicare Advantage |
$441.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,101.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$784.25
|
| Rate for Payer: Priority Health Medicare |
$441.57
|
| Rate for Payer: Priority Health Narrow Network |
$784.25
|
| Rate for Payer: Priority Health SBD |
$784.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$441.57
|
| Rate for Payer: UHC Medicare Advantage |
$441.57
|
| Rate for Payer: UHCCP Medicaid |
$298.84
|
| Rate for Payer: UMR Bronson Commercial |
$779.24
|
|
|
PR EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC
|
Professional
|
Both
|
$2,489.00
|
|
|
Service Code
|
HCPCS 64784
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$1,617.85 |
| Rate for Payer: Aetna Commercial |
$940.63
|
| Rate for Payer: Aetna Medicare |
$730.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,010.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.63
|
| Rate for Payer: BCBS Complete |
$496.05
|
| Rate for Payer: BCBS MAPPO |
$701.96
|
| Rate for Payer: BCBS Trust/PPO |
$128.38
|
| Rate for Payer: BCN Commercial |
$1,063.36
|
| Rate for Payer: BCN Medicare Advantage |
$701.96
|
| Rate for Payer: Cash Price |
$1,991.20
|
| Rate for Payer: Cash Price |
$1,991.20
|
| Rate for Payer: Cofinity Commercial |
$1,010.82
|
| Rate for Payer: Cofinity Commercial |
$940.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$701.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$737.06
|
| Rate for Payer: Meridian Medicaid |
$496.05
|
| Rate for Payer: Nomi Health Commercial |
$842.35
|
| Rate for Payer: PACE SWMI |
$701.96
|
| Rate for Payer: PHP Commercial |
$982.74
|
| Rate for Payer: PHP Medicare Advantage |
$701.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,617.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,244.91
|
| Rate for Payer: Priority Health Medicare |
$701.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,244.91
|
| Rate for Payer: Priority Health SBD |
$1,244.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$701.96
|
| Rate for Payer: UHC Medicare Advantage |
$701.96
|
| Rate for Payer: UHCCP Medicaid |
$472.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,144.94
|
|
|
PR EXC PRESAC/SACROCOCCYGEAL TUMOR
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 49215
|
| Min. Negotiated Rate |
$757.05 |
| Max. Negotiated Rate |
$3,963.18 |
| Rate for Payer: Aetna Commercial |
$2,857.43
|
| Rate for Payer: Aetna Medicare |
$2,217.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,857.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,070.67
|
| Rate for Payer: BCBS Complete |
$1,484.82
|
| Rate for Payer: BCBS MAPPO |
$2,132.41
|
| Rate for Payer: BCBS Trust/PPO |
$757.05
|
| Rate for Payer: BCN Commercial |
$3,195.95
|
| Rate for Payer: BCN Medicare Advantage |
$2,132.41
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cofinity Commercial |
$2,857.43
|
| Rate for Payer: Cofinity Commercial |
$3,070.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,132.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,239.03
|
| Rate for Payer: Meridian Medicaid |
$1,484.82
|
| Rate for Payer: Nomi Health Commercial |
$2,558.89
|
| Rate for Payer: PACE SWMI |
$2,132.41
|
| Rate for Payer: PHP Commercial |
$2,985.37
|
| Rate for Payer: PHP Medicare Advantage |
$2,132.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,414.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,600.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,963.18
|
| Rate for Payer: Priority Health Medicare |
$2,132.41
|
| Rate for Payer: Priority Health Narrow Network |
$3,963.18
|
| Rate for Payer: Priority Health SBD |
$3,963.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,132.41
|
| Rate for Payer: UHC Medicare Advantage |
$2,132.41
|
| Rate for Payer: UHCCP Medicaid |
$1,414.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,840.00
|
|
|
PR EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$1,787.00
|
|
|
Service Code
|
HCPCS 42415
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$1,903.13 |
| Rate for Payer: Aetna Commercial |
$1,358.10
|
| Rate for Payer: Aetna Medicare |
$1,054.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,358.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,459.45
|
| Rate for Payer: BCBS Complete |
$715.46
|
| Rate for Payer: BCBS MAPPO |
$1,013.51
|
| Rate for Payer: BCBS Trust/PPO |
$284.75
|
| Rate for Payer: BCN Commercial |
$1,551.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,013.51
|
| Rate for Payer: Cash Price |
$1,429.60
|
| Rate for Payer: Cash Price |
$1,429.60
|
| Rate for Payer: Cofinity Commercial |
$1,358.10
|
| Rate for Payer: Cofinity Commercial |
$1,459.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,013.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,064.19
|
| Rate for Payer: Meridian Medicaid |
$715.46
|
| Rate for Payer: Nomi Health Commercial |
$1,216.21
|
| Rate for Payer: PACE SWMI |
$1,013.51
|
| Rate for Payer: PHP Commercial |
$1,418.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,013.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$681.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,161.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,903.13
|
| Rate for Payer: Priority Health Medicare |
$1,013.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,903.13
|
| Rate for Payer: Priority Health SBD |
$1,903.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,013.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,013.51
|
| Rate for Payer: UHCCP Medicaid |
$681.39
|
| Rate for Payer: UMR Bronson Commercial |
$822.02
|
|
|
PR EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ
|
Professional
|
Both
|
$1,184.00
|
|
|
Service Code
|
HCPCS 42410
|
| Min. Negotiated Rate |
$160.60 |
| Max. Negotiated Rate |
$1,136.52 |
| Rate for Payer: Aetna Commercial |
$806.63
|
| Rate for Payer: Aetna Medicare |
$626.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$806.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.82
|
| Rate for Payer: BCBS Complete |
$426.50
|
| Rate for Payer: BCBS MAPPO |
$601.96
|
| Rate for Payer: BCBS Trust/PPO |
$160.60
|
| Rate for Payer: BCN Commercial |
$926.05
|
| Rate for Payer: BCN Medicare Advantage |
$601.96
|
| Rate for Payer: Cash Price |
$947.20
|
| Rate for Payer: Cash Price |
$947.20
|
| Rate for Payer: Cofinity Commercial |
$806.63
|
| Rate for Payer: Cofinity Commercial |
$866.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$601.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$632.06
|
| Rate for Payer: Meridian Medicaid |
$426.50
|
| Rate for Payer: Nomi Health Commercial |
$722.35
|
| Rate for Payer: PACE SWMI |
$601.96
|
| Rate for Payer: PHP Commercial |
$842.74
|
| Rate for Payer: PHP Medicare Advantage |
$601.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$406.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,136.52
|
| Rate for Payer: Priority Health Medicare |
$601.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,136.52
|
| Rate for Payer: Priority Health SBD |
$1,136.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$601.96
|
| Rate for Payer: UHC Medicare Advantage |
$601.96
|
| Rate for Payer: UHCCP Medicaid |
$406.19
|
| Rate for Payer: UMR Bronson Commercial |
$544.64
|
|
|
PR EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$2,032.00
|
|
|
Service Code
|
HCPCS 42420
|
| Min. Negotiated Rate |
$279.47 |
| Max. Negotiated Rate |
$2,128.06 |
| Rate for Payer: Aetna Commercial |
$1,521.56
|
| Rate for Payer: Aetna Medicare |
$1,180.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,521.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,635.11
|
| Rate for Payer: BCBS Complete |
$800.67
|
| Rate for Payer: BCBS MAPPO |
$1,135.49
|
| Rate for Payer: BCBS Trust/PPO |
$279.47
|
| Rate for Payer: BCN Commercial |
$1,737.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,135.49
|
| Rate for Payer: Cash Price |
$1,625.60
|
| Rate for Payer: Cash Price |
$1,625.60
|
| Rate for Payer: Cofinity Commercial |
$1,521.56
|
| Rate for Payer: Cofinity Commercial |
$1,635.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,135.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,192.26
|
| Rate for Payer: Meridian Medicaid |
$800.67
|
| Rate for Payer: Nomi Health Commercial |
$1,362.59
|
| Rate for Payer: PACE SWMI |
$1,135.49
|
| Rate for Payer: PHP Commercial |
$1,589.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,135.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,128.06
|
| Rate for Payer: Priority Health Medicare |
$1,135.49
|
| Rate for Payer: Priority Health Narrow Network |
$2,128.06
|
| Rate for Payer: Priority Health SBD |
$2,128.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,135.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,135.49
|
| Rate for Payer: UHCCP Medicaid |
$762.54
|
| Rate for Payer: UMR Bronson Commercial |
$934.72
|
|
