|
PR EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>
|
Professional
|
Both
|
$1,839.00
|
|
|
Service Code
|
HCPCS 26113
|
| Min. Negotiated Rate |
$530.18 |
| Max. Negotiated Rate |
$1,195.35 |
| Rate for Payer: Aetna Commercial |
$710.44
|
| Rate for Payer: Aetna Medicare |
$551.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.44
|
| Rate for Payer: BCBS Complete |
$735.60
|
| Rate for Payer: BCBS MAPPO |
$530.18
|
| Rate for Payer: BCN Medicare Advantage |
$530.18
|
| Rate for Payer: Cash Price |
$1,471.20
|
| Rate for Payer: Cash Price |
$1,471.20
|
| Rate for Payer: Cofinity Commercial |
$763.46
|
| Rate for Payer: Cofinity Commercial |
$710.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$556.69
|
| Rate for Payer: Nomi Health Commercial |
$636.22
|
| Rate for Payer: PACE SWMI |
$530.18
|
| Rate for Payer: PHP Commercial |
$742.25
|
| Rate for Payer: PHP Medicare Advantage |
$530.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,195.35
|
| Rate for Payer: Priority Health Medicare |
$530.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$530.18
|
| Rate for Payer: UHC Medicare Advantage |
$530.18
|
| Rate for Payer: UMR Bronson Commercial |
$845.94
|
|
|
PR FAA PHYSICAL
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 00180
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: UMR Bronson Commercial |
$61.18
|
|
|
PR FACIAL NERVE FUNCTION STUDIES
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 92516
|
| Min. Negotiated Rate |
$21.24 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Commercial |
$28.46
|
| Rate for Payer: Aetna Medicare |
$22.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.59
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: BCBS MAPPO |
$21.24
|
| Rate for Payer: BCN Medicare Advantage |
$21.24
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$28.46
|
| Rate for Payer: Cofinity Commercial |
$30.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.30
|
| Rate for Payer: Nomi Health Commercial |
$25.49
|
| Rate for Payer: PACE SWMI |
$21.24
|
| Rate for Payer: PHP Commercial |
$29.74
|
| Rate for Payer: PHP Medicare Advantage |
$21.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
| Rate for Payer: Priority Health Medicare |
$21.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.24
|
| Rate for Payer: UHC Medicare Advantage |
$21.24
|
| Rate for Payer: UMR Bronson Commercial |
$58.88
|
|
|
PR FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 97156
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna Medicare |
$27.00
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
| Rate for Payer: UMR Bronson Commercial |
$24.84
|
|
|
PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 90846
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$140.63 |
| Rate for Payer: Aetna Commercial |
$130.86
|
| Rate for Payer: Aetna Medicare |
$101.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.63
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: BCBS MAPPO |
$97.66
|
| Rate for Payer: BCN Medicare Advantage |
$97.66
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$130.86
|
| Rate for Payer: Cofinity Commercial |
$140.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.54
|
| Rate for Payer: Nomi Health Commercial |
$117.19
|
| Rate for Payer: PACE SWMI |
$97.66
|
| Rate for Payer: PHP Commercial |
$136.72
|
| Rate for Payer: PHP Medicare Advantage |
$97.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.65
|
| Rate for Payer: Priority Health Medicare |
$97.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.66
|
| Rate for Payer: UHC Medicare Advantage |
$97.66
|
| Rate for Payer: UMR Bronson Commercial |
$74.06
|
|
|
PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 90847
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$146.61 |
| Rate for Payer: Aetna Commercial |
$136.43
|
| Rate for Payer: Aetna Medicare |
$105.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.43
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS MAPPO |
$101.81
|
| Rate for Payer: BCN Medicare Advantage |
$101.81
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$146.61
|
| Rate for Payer: Cofinity Commercial |
$136.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.90
|
| Rate for Payer: Nomi Health Commercial |
$122.17
|
| Rate for Payer: PACE SWMI |
$101.81
|
| Rate for Payer: PHP Commercial |
$142.53
|
| Rate for Payer: PHP Medicare Advantage |
$101.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health Medicare |
$101.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.81
|
| Rate for Payer: UHC Medicare Advantage |
$101.81
|
| Rate for Payer: UMR Bronson Commercial |
$93.84
|
|
|
PR FASCIA LATA GRAFT INCISION & AREA EXPOSURE
|
Professional
|
Both
|
$1,077.00
|
|
|
Service Code
|
HCPCS 20922
|
| Min. Negotiated Rate |
$430.80 |
| Max. Negotiated Rate |
$700.05 |
| Rate for Payer: Aetna Commercial |
$645.54
|
| Rate for Payer: Aetna Medicare |
$501.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$645.54
|
| Rate for Payer: BCBS Complete |
$430.80
|
| Rate for Payer: BCBS MAPPO |
$481.75
|
| Rate for Payer: BCN Medicare Advantage |
$481.75
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cofinity Commercial |
$693.72
|
| Rate for Payer: Cofinity Commercial |
$645.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$481.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$505.84
|
| Rate for Payer: Nomi Health Commercial |
$578.10
|
| Rate for Payer: PACE SWMI |
$481.75
|
| Rate for Payer: PHP Commercial |
$674.45
|
| Rate for Payer: PHP Medicare Advantage |
$481.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.05
|
| Rate for Payer: Priority Health Medicare |
$481.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$481.75
|
| Rate for Payer: UHC Medicare Advantage |
$481.75
|
| Rate for Payer: UMR Bronson Commercial |
$495.42
|
|
|
PR FASCIECTOMY PLANTAR FASCIA PARTIAL SPX
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 28060
|
| Min. Negotiated Rate |
$344.40 |
| Max. Negotiated Rate |
$633.75 |
| Rate for Payer: Aetna Commercial |
$461.50
|
| Rate for Payer: Aetna Medicare |
$358.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.50
|
| Rate for Payer: BCBS Complete |
$390.00
|
| Rate for Payer: BCBS MAPPO |
$344.40
|
| Rate for Payer: BCN Medicare Advantage |
$344.40
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cofinity Commercial |
$495.94
|
| Rate for Payer: Cofinity Commercial |
$461.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$344.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$361.62
|
| Rate for Payer: Nomi Health Commercial |
$413.28
|
| Rate for Payer: PACE SWMI |
$344.40
|
| Rate for Payer: PHP Commercial |
$482.16
|
| Rate for Payer: PHP Medicare Advantage |
$344.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.75
|
| Rate for Payer: Priority Health Medicare |
$344.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$344.40
|
| Rate for Payer: UHC Medicare Advantage |
$344.40
|
| Rate for Payer: UMR Bronson Commercial |
$448.50
|
|
|
PR FASCIOTOMY FOOT&/TOE
|
Professional
|
Both
|
$719.00
|
|
|
Service Code
|
HCPCS 28008
|
| Min. Negotiated Rate |
$281.98 |
| Max. Negotiated Rate |
$467.35 |
| Rate for Payer: Aetna Commercial |
$377.85
|
| Rate for Payer: Aetna Medicare |
$293.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$406.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.85
|
| Rate for Payer: BCBS Complete |
$287.60
|
| Rate for Payer: BCBS MAPPO |
$281.98
|
| Rate for Payer: BCN Medicare Advantage |
$281.98
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cofinity Commercial |
$406.05
|
| Rate for Payer: Cofinity Commercial |
$377.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$296.08
|
| Rate for Payer: Nomi Health Commercial |
$338.38
|
| Rate for Payer: PACE SWMI |
$281.98
|
| Rate for Payer: PHP Commercial |
$394.77
|
| Rate for Payer: PHP Medicare Advantage |
$281.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.35
|
| Rate for Payer: Priority Health Medicare |
$281.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$281.98
|
| Rate for Payer: UHC Medicare Advantage |
$281.98
|
| Rate for Payer: UMR Bronson Commercial |
$330.74
|
|
|
PR FASCIOTOMY FOOT&/TOE
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
28008
|
| Min. Negotiated Rate |
$266.03 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna American Axle |
$467.35
|
| Rate for Payer: Aetna Commercial |
$611.15
|
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cofinity Commercial |
$618.34
|
| Rate for Payer: Cofinity Commercial |
$503.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$503.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$647.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$503.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$539.25
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.15
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$611.15
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.35
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Priority Health SBD |
$452.97
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: UMR Bronson Commercial |
$266.03
|
| Rate for Payer: VA VA |
$3,164.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$539.25
|
|
|
PR FASCIOTOMY FOOT&/TOE
|
Professional
|
Both
|
$719.00
|
|
|
Service Code
|
HCPCS 28008
|
| Hospital Charge Code |
28008
|
| Min. Negotiated Rate |
$281.98 |
| Max. Negotiated Rate |
$467.35 |
| Rate for Payer: Aetna Commercial |
$377.85
|
| Rate for Payer: Aetna Medicare |
$293.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$406.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.85
|
| Rate for Payer: BCBS Complete |
$287.60
|
| Rate for Payer: BCBS MAPPO |
$281.98
|
| Rate for Payer: BCN Medicare Advantage |
$281.98
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cofinity Commercial |
$377.85
|
| Rate for Payer: Cofinity Commercial |
$406.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$296.08
|
| Rate for Payer: Nomi Health Commercial |
$338.38
|
| Rate for Payer: PACE SWMI |
$281.98
|
| Rate for Payer: PHP Commercial |
$394.77
|
| Rate for Payer: PHP Medicare Advantage |
$281.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.35
|
| Rate for Payer: Priority Health Medicare |
$281.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$281.98
|
| Rate for Payer: UHC Medicare Advantage |
$281.98
|
| Rate for Payer: UMR Bronson Commercial |
$330.74
|
|
|
PR FASCIOTOMY FOOT&/TOE
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
28008
|
| Min. Negotiated Rate |
$316.36 |
| Max. Negotiated Rate |
$647.10 |
| Rate for Payer: Aetna American Axle |
$467.35
|
| Rate for Payer: Aetna Commercial |
$611.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.35
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cofinity Commercial |
$503.30
|
| Rate for Payer: Cofinity Commercial |
$618.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$503.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.20
|
| Rate for Payer: Healthscope Commercial |
$647.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$503.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$539.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.15
|
| Rate for Payer: PHP Commercial |
$611.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.35
|
| Rate for Payer: Priority Health SBD |
$452.97
|
| Rate for Payer: UMR Bronson Commercial |
$316.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$539.25
|
|
|
PR FASCIOTOMY HIP/THIGH ANY TYPE
|
Professional
|
Both
|
$3,485.00
|
|
|
Service Code
|
HCPCS 27025
|
| Min. Negotiated Rate |
$902.59 |
| Max. Negotiated Rate |
$2,265.25 |
| Rate for Payer: Aetna Commercial |
$1,209.47
|
| Rate for Payer: Aetna Medicare |
$938.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,299.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,209.47
|
| Rate for Payer: BCBS Complete |
$1,394.00
|
| Rate for Payer: BCBS MAPPO |
$902.59
|
| Rate for Payer: BCN Medicare Advantage |
$902.59
|
| Rate for Payer: Cash Price |
$2,788.00
|
| Rate for Payer: Cash Price |
$2,788.00
|
| Rate for Payer: Cofinity Commercial |
$1,299.73
|
| Rate for Payer: Cofinity Commercial |
$1,209.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$902.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$947.72
|
| Rate for Payer: Nomi Health Commercial |
$1,083.11
|
| Rate for Payer: PACE SWMI |
$902.59
|
| Rate for Payer: PHP Commercial |
$1,263.63
|
| Rate for Payer: PHP Medicare Advantage |
$902.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,265.25
|
| Rate for Payer: Priority Health Medicare |
$902.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$902.59
|
| Rate for Payer: UHC Medicare Advantage |
$902.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,603.10
|
|
|
PR FASCIOTOMY ILIOTIBIAL OPEN
|
Professional
|
Both
|
$1,323.00
|
|
|
Service Code
|
HCPCS 27305
|
| Min. Negotiated Rate |
$468.34 |
| Max. Negotiated Rate |
$859.95 |
| Rate for Payer: Aetna Commercial |
$627.58
|
| Rate for Payer: Aetna Medicare |
$487.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.58
|
| Rate for Payer: BCBS Complete |
$529.20
|
| Rate for Payer: BCBS MAPPO |
$468.34
|
| Rate for Payer: BCN Medicare Advantage |
$468.34
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Cofinity Commercial |
$674.41
|
| Rate for Payer: Cofinity Commercial |
$627.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$468.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$491.76
|
| Rate for Payer: Nomi Health Commercial |
$562.01
|
| Rate for Payer: PACE SWMI |
$468.34
|
| Rate for Payer: PHP Commercial |
$655.68
|
| Rate for Payer: PHP Medicare Advantage |
$468.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.95
|
| Rate for Payer: Priority Health Medicare |
$468.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$468.34
|
| Rate for Payer: UHC Medicare Advantage |
$468.34
|
| Rate for Payer: UMR Bronson Commercial |
$608.58
|
|
|
PR FASCIOTOMY PALMAR OPEN PARTIAL
|
Professional
|
Both
|
$1,368.00
|
|
|
Service Code
|
HCPCS 26045
|
| Min. Negotiated Rate |
$458.19 |
| Max. Negotiated Rate |
$889.20 |
| Rate for Payer: Aetna Commercial |
$613.97
|
| Rate for Payer: Aetna Medicare |
$476.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$659.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$613.97
|
| Rate for Payer: BCBS Complete |
$547.20
|
| Rate for Payer: BCBS MAPPO |
$458.19
|
| Rate for Payer: BCN Medicare Advantage |
$458.19
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cofinity Commercial |
$659.79
|
| Rate for Payer: Cofinity Commercial |
$613.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$458.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$481.10
|
| Rate for Payer: Nomi Health Commercial |
$549.83
|
| Rate for Payer: PACE SWMI |
$458.19
|
| Rate for Payer: PHP Commercial |
$641.47
|
| Rate for Payer: PHP Medicare Advantage |
$458.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.20
|
| Rate for Payer: Priority Health Medicare |
$458.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$458.19
|
| Rate for Payer: UHC Medicare Advantage |
$458.19
|
| Rate for Payer: UMR Bronson Commercial |
$629.28
|
|
|
PR FASCIOTOMY PALMAR PERCUTANEOUS
|
Professional
|
Both
|
$930.00
|
|
|
Service Code
|
HCPCS 26040
|
| Min. Negotiated Rate |
$306.15 |
| Max. Negotiated Rate |
$604.50 |
| Rate for Payer: Aetna Commercial |
$410.24
|
| Rate for Payer: Aetna Medicare |
$318.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.24
|
| Rate for Payer: BCBS Complete |
$372.00
|
| Rate for Payer: BCBS MAPPO |
$306.15
|
| Rate for Payer: BCN Medicare Advantage |
$306.15
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cofinity Commercial |
$440.86
|
| Rate for Payer: Cofinity Commercial |
$410.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$306.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.46
|
| Rate for Payer: Nomi Health Commercial |
$367.38
|
| Rate for Payer: PACE SWMI |
$306.15
|
| Rate for Payer: PHP Commercial |
$428.61
|
| Rate for Payer: PHP Medicare Advantage |
$306.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.50
|
| Rate for Payer: Priority Health Medicare |
$306.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$306.15
|
| Rate for Payer: UHC Medicare Advantage |
$306.15
|
| Rate for Payer: UMR Bronson Commercial |
$427.80
|
|
|
PR FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT
|
Professional
|
Both
|
$2,361.00
|
|
|
Service Code
|
HCPCS 26121
|
| Min. Negotiated Rate |
$580.37 |
| Max. Negotiated Rate |
$1,534.65 |
| Rate for Payer: Aetna Commercial |
$777.70
|
| Rate for Payer: Aetna Medicare |
$603.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$835.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$777.70
|
| Rate for Payer: BCBS Complete |
$944.40
|
| Rate for Payer: BCBS MAPPO |
$580.37
|
| Rate for Payer: BCN Medicare Advantage |
$580.37
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cofinity Commercial |
$835.73
|
| Rate for Payer: Cofinity Commercial |
$777.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$580.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$609.39
|
| Rate for Payer: Nomi Health Commercial |
$696.44
|
| Rate for Payer: PACE SWMI |
$580.37
|
| Rate for Payer: PHP Commercial |
$812.52
|
| Rate for Payer: PHP Medicare Advantage |
$580.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.65
|
| Rate for Payer: Priority Health Medicare |
$580.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$580.37
|
| Rate for Payer: UHC Medicare Advantage |
$580.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,086.06
|
|
|
PR FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR
|
Professional
|
Both
|
$2,952.00
|
|
|
Service Code
|
HCPCS 26123
|
| Min. Negotiated Rate |
$809.00 |
| Max. Negotiated Rate |
$1,918.80 |
| Rate for Payer: Aetna Commercial |
$1,084.06
|
| Rate for Payer: Aetna Medicare |
$841.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,164.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.06
|
| Rate for Payer: BCBS Complete |
$1,180.80
|
| Rate for Payer: BCBS MAPPO |
$809.00
|
| Rate for Payer: BCN Medicare Advantage |
$809.00
|
| Rate for Payer: Cash Price |
$2,361.60
|
| Rate for Payer: Cash Price |
$2,361.60
|
| Rate for Payer: Cofinity Commercial |
$1,164.96
|
| Rate for Payer: Cofinity Commercial |
$1,084.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$809.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$849.45
|
| Rate for Payer: Nomi Health Commercial |
$970.80
|
| Rate for Payer: PACE SWMI |
$809.00
|
| Rate for Payer: PHP Commercial |
$1,132.60
|
| Rate for Payer: PHP Medicare Advantage |
$809.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,918.80
|
| Rate for Payer: Priority Health Medicare |
$809.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$809.00
|
| Rate for Payer: UHC Medicare Advantage |
$809.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,357.92
|
|
|
PR FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR
|
Professional
|
Both
|
$885.00
|
|
|
Service Code
|
HCPCS 26125
|
| Min. Negotiated Rate |
$257.96 |
| Max. Negotiated Rate |
$575.25 |
| Rate for Payer: Aetna Commercial |
$345.67
|
| Rate for Payer: Aetna Medicare |
$268.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.67
|
| Rate for Payer: BCBS Complete |
$354.00
|
| Rate for Payer: BCBS MAPPO |
$257.96
|
| Rate for Payer: BCN Medicare Advantage |
$257.96
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cofinity Commercial |
$371.46
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.86
|
| Rate for Payer: Nomi Health Commercial |
$309.55
|
| Rate for Payer: PACE SWMI |
$257.96
|
| Rate for Payer: PHP Commercial |
$361.14
|
| Rate for Payer: PHP Medicare Advantage |
$257.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.25
|
| Rate for Payer: Priority Health Medicare |
$257.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.96
|
| Rate for Payer: UHC Medicare Advantage |
$257.96
|
| Rate for Payer: UMR Bronson Commercial |
$407.10
|
|
|
PR FECAL BLOOD SCRN IMMUNOASSAY
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS G0328
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$25.99 |
| Rate for Payer: Aetna Commercial |
$24.19
|
| Rate for Payer: Aetna Medicare |
$18.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.19
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$18.05
|
| Rate for Payer: BCN Medicare Advantage |
$18.05
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$25.99
|
| Rate for Payer: Cofinity Commercial |
$24.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.95
|
| Rate for Payer: Nomi Health Commercial |
$21.66
|
| Rate for Payer: PACE SWMI |
$18.05
|
| Rate for Payer: PHP Commercial |
$25.27
|
| Rate for Payer: PHP Medicare Advantage |
$18.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health Medicare |
$18.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.05
|
| Rate for Payer: UHC Medicare Advantage |
$18.05
|
| Rate for Payer: UMR Bronson Commercial |
$17.48
|
|
|
PR FECAL MICROBIOTA PREP INSTIL
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS G0455
|
| Min. Negotiated Rate |
$67.10 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Commercial |
$89.91
|
| Rate for Payer: Aetna Medicare |
$69.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.91
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS MAPPO |
$67.10
|
| Rate for Payer: BCN Medicare Advantage |
$67.10
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$96.62
|
| Rate for Payer: Cofinity Commercial |
$89.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.45
|
| Rate for Payer: Nomi Health Commercial |
$80.52
|
| Rate for Payer: PACE SWMI |
$67.10
|
| Rate for Payer: PHP Commercial |
$93.94
|
| Rate for Payer: PHP Medicare Advantage |
$67.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health Medicare |
$67.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.10
|
| Rate for Payer: UHC Medicare Advantage |
$67.10
|
| Rate for Payer: UMR Bronson Commercial |
$93.84
|
|
|
PR FERN TEST
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS Q0114
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$14.03 |
| Rate for Payer: Aetna Commercial |
$13.05
|
| Rate for Payer: Aetna Medicare |
$10.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.05
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$9.74
|
| Rate for Payer: BCN Medicare Advantage |
$9.74
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$13.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.23
|
| Rate for Payer: Nomi Health Commercial |
$11.69
|
| Rate for Payer: PACE SWMI |
$9.74
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: PHP Medicare Advantage |
$9.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: Priority Health Medicare |
$9.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.74
|
| Rate for Payer: UHC Medicare Advantage |
$9.74
|
| Rate for Payer: UMR Bronson Commercial |
$2.76
|
|
|
PR FETAL CONTRACTION STRESS TEST
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 59020
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$106.60 |
| Rate for Payer: Aetna Commercial |
$88.69
|
| Rate for Payer: Aetna Medicare |
$68.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.69
|
| Rate for Payer: BCBS Complete |
$65.60
|
| Rate for Payer: BCBS MAPPO |
$66.19
|
| Rate for Payer: BCN Medicare Advantage |
$66.19
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$95.31
|
| Rate for Payer: Cofinity Commercial |
$88.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.50
|
| Rate for Payer: Nomi Health Commercial |
$79.43
|
| Rate for Payer: PACE SWMI |
$66.19
|
| Rate for Payer: PHP Commercial |
$92.67
|
| Rate for Payer: PHP Medicare Advantage |
$66.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.60
|
| Rate for Payer: Priority Health Medicare |
$66.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.19
|
| Rate for Payer: UHC Medicare Advantage |
$66.19
|
| Rate for Payer: UMR Bronson Commercial |
$75.44
|
|
|
PR FETAL FLUID DRAINAGE W/ULTRASOUND GUIDANCE
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 59074
|
| Min. Negotiated Rate |
$301.73 |
| Max. Negotiated Rate |
$547.30 |
| Rate for Payer: Aetna Commercial |
$404.32
|
| Rate for Payer: Aetna Medicare |
$313.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.32
|
| Rate for Payer: BCBS Complete |
$336.80
|
| Rate for Payer: BCBS MAPPO |
$301.73
|
| Rate for Payer: BCN Medicare Advantage |
$301.73
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$434.49
|
| Rate for Payer: Cofinity Commercial |
$404.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$316.82
|
| Rate for Payer: Nomi Health Commercial |
$362.08
|
| Rate for Payer: PACE SWMI |
$301.73
|
| Rate for Payer: PHP Commercial |
$422.42
|
| Rate for Payer: PHP Medicare Advantage |
$301.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health Medicare |
$301.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$301.73
|
| Rate for Payer: UHC Medicare Advantage |
$301.73
|
| Rate for Payer: UMR Bronson Commercial |
$387.32
|
|
|
PR FETAL NONSTRESS TEST
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 59025
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$66.70 |
| Rate for Payer: Aetna Commercial |
$62.07
|
| Rate for Payer: Aetna Medicare |
$48.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.07
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS MAPPO |
$46.32
|
| Rate for Payer: BCN Medicare Advantage |
$46.32
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$66.70
|
| Rate for Payer: Cofinity Commercial |
$62.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.64
|
| Rate for Payer: Nomi Health Commercial |
$55.58
|
| Rate for Payer: PACE SWMI |
$46.32
|
| Rate for Payer: PHP Commercial |
$64.85
|
| Rate for Payer: PHP Medicare Advantage |
$46.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health Medicare |
$46.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.32
|
| Rate for Payer: UHC Medicare Advantage |
$46.32
|
| Rate for Payer: UMR Bronson Commercial |
$46.92
|
|
