|
PR FLUPHENAZINE DECANOATE 25 MG
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS J2680
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Aetna Commercial |
$10.09
|
| Rate for Payer: Aetna Medicare |
$7.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.85
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$7.53
|
| Rate for Payer: BCBS Trust/PPO |
$5.22
|
| Rate for Payer: BCN Commercial |
$5.76
|
| Rate for Payer: BCN Medicare Advantage |
$7.53
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$10.85
|
| Rate for Payer: Cofinity Commercial |
$10.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.91
|
| Rate for Payer: Nomi Health Commercial |
$9.04
|
| Rate for Payer: PACE SWMI |
$7.53
|
| Rate for Payer: PHP Commercial |
$10.54
|
| Rate for Payer: PHP Medicare Advantage |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health Medicare |
$7.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.53
|
| Rate for Payer: UHC Medicare Advantage |
$7.53
|
| Rate for Payer: UMR Bronson Commercial |
$11.04
|
|
|
PR FLUVIRIN VACC, 3 YRS & >, IM
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS Q2037
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$18.62 |
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.62
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: UMR Bronson Commercial |
$9.20
|
|
|
PR FLUZONE VACC, 3 YRS & >, IM
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS Q2038
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna Commercial |
$12.68
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.68
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
|
PR FOLLOW-UP/REASSESSMENT
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS S0316
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Commercial |
$20.00
|
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS Trust/PPO |
$53.36
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: UMR Bronson Commercial |
$140.76
|
|
|
PR FO NONTORSION JOINT CF
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS L3935
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$190.90 |
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: BCN Commercial |
$190.90
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
| Rate for Payer: UMR Bronson Commercial |
$95.22
|
|
|
PR FOOT ARCH SUPP LONGITUD/META
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS L3060
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$65.84 |
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCN Commercial |
$65.84
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: UMR Bronson Commercial |
$18.86
|
|
|
PR FOOT PLAS HEEL STABI PRE OTS
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS L3170
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$48.29 |
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCN Commercial |
$48.29
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: UMR Bronson Commercial |
$23.00
|
|
|
PR FO PIP DIP JNT/SPRNG PRE OTS
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS L3925
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCN Commercial |
$56.76
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.30
|
| Rate for Payer: UMR Bronson Commercial |
$28.52
|
|
|
PR FOREARM/ARM CUFFS FREE MOTIO
|
Professional
|
Both
|
$638.00
|
|
|
Service Code
|
HCPCS L3720
|
| Min. Negotiated Rate |
$255.20 |
| Max. Negotiated Rate |
$590.45 |
| Rate for Payer: BCBS Complete |
$255.20
|
| Rate for Payer: BCN Commercial |
$590.45
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.70
|
| Rate for Payer: UMR Bronson Commercial |
$293.48
|
|
|
PR FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE
|
Professional
|
Both
|
$2,259.00
|
|
|
Service Code
|
HCPCS 15731
|
| Min. Negotiated Rate |
$640.92 |
| Max. Negotiated Rate |
$1,643.91 |
| Rate for Payer: Aetna Commercial |
$1,268.04
|
| Rate for Payer: Aetna Medicare |
$984.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,268.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,362.67
|
| Rate for Payer: BCBS Complete |
$672.97
|
| Rate for Payer: BCBS MAPPO |
$946.30
|
| Rate for Payer: BCBS Trust/PPO |
$852.18
|
| Rate for Payer: BCN Commercial |
$1,643.91
|
| Rate for Payer: BCN Medicare Advantage |
$946.30
|
| Rate for Payer: Cash Price |
$1,807.20
|
| Rate for Payer: Cash Price |
$1,807.20
|
| Rate for Payer: Cofinity Commercial |
$1,362.67
|
| Rate for Payer: Cofinity Commercial |
$1,268.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$946.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$993.62
|
| Rate for Payer: Meridian Medicaid |
$672.97
|
| Rate for Payer: Nomi Health Commercial |
$1,135.56
|
| Rate for Payer: PACE SWMI |
$946.30
|
| Rate for Payer: PHP Commercial |
$1,324.82
|
| Rate for Payer: PHP Medicare Advantage |
$946.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$640.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,468.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,350.94
|
| Rate for Payer: Priority Health Medicare |
$946.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,350.94
|
| Rate for Payer: Priority Health SBD |
$1,350.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$946.30
|
| Rate for Payer: UHC Medicare Advantage |
$946.30
|
| Rate for Payer: UHCCP Medicaid |
$640.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,039.14
|
|
|
PR FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 54450
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$1,562.18 |
| Rate for Payer: Aetna Commercial |
$73.55
|
| Rate for Payer: Aetna Medicare |
$57.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.04
|
| Rate for Payer: BCBS Complete |
$38.24
|
| Rate for Payer: BCBS MAPPO |
$54.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,562.18
|
| Rate for Payer: BCN Commercial |
$99.20
|
| Rate for Payer: BCN Medicare Advantage |
$54.89
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$79.04
|
| Rate for Payer: Cofinity Commercial |
$73.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.63
|
| Rate for Payer: Meridian Medicaid |
$38.24
|
| Rate for Payer: Nomi Health Commercial |
$65.87
|
| Rate for Payer: PACE SWMI |
$54.89
|
| Rate for Payer: PHP Commercial |
$76.85
|
| Rate for Payer: PHP Medicare Advantage |
$54.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.02
|
| Rate for Payer: Priority Health Medicare |
$54.89
|
| Rate for Payer: Priority Health Narrow Network |
$90.02
|
| Rate for Payer: Priority Health SBD |
$90.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.89
|
| Rate for Payer: UHC Medicare Advantage |
$54.89
|
| Rate for Payer: UHCCP Medicaid |
$36.42
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
|
|
PR FO W/O JOINTS CF
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS L3933
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$184.38 |
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: BCN Commercial |
$184.38
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: UMR Bronson Commercial |
$92.00
|
|
|
PR FRAC FL FACE
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 00100
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: UMR Bronson Commercial |
$187.68
|
|
|
PR FRAC NECK
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 00102
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
|
|
PR FRAC SCARS PER INCH
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00104
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: UMR Bronson Commercial |
$23.46
|
|
|
PR FRAC THGH/ABD/BACK
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS 00103
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: UMR Bronson Commercial |
$211.14
|
|
|
PR FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
HCPCS 30930
|
| Min. Negotiated Rate |
$76.47 |
| Max. Negotiated Rate |
$790.87 |
| Rate for Payer: Aetna Commercial |
$148.86
|
| Rate for Payer: Aetna Medicare |
$115.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.97
|
| Rate for Payer: BCBS Complete |
$80.29
|
| Rate for Payer: BCBS MAPPO |
$111.09
|
| Rate for Payer: BCBS Trust/PPO |
$790.87
|
| Rate for Payer: BCN Commercial |
$173.48
|
| Rate for Payer: BCN Medicare Advantage |
$111.09
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cofinity Commercial |
$159.97
|
| Rate for Payer: Cofinity Commercial |
$148.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.64
|
| Rate for Payer: Meridian Medicaid |
$80.29
|
| Rate for Payer: Nomi Health Commercial |
$133.31
|
| Rate for Payer: PACE SWMI |
$111.09
|
| Rate for Payer: PHP Commercial |
$155.53
|
| Rate for Payer: PHP Medicare Advantage |
$111.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.38
|
| Rate for Payer: Priority Health Medicare |
$111.09
|
| Rate for Payer: Priority Health Narrow Network |
$166.38
|
| Rate for Payer: Priority Health SBD |
$166.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$111.09
|
| Rate for Payer: UHC Medicare Advantage |
$111.09
|
| Rate for Payer: UHCCP Medicaid |
$76.47
|
| Rate for Payer: UMR Bronson Commercial |
$244.72
|
|
|
PR FRAC UP/LOW FACE
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00101
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: UMR Bronson Commercial |
$117.30
|
|
|
PR FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY
|
Professional
|
Both
|
$569.00
|
|
|
Service Code
|
HCPCS 41520
|
| Min. Negotiated Rate |
$162.73 |
| Max. Negotiated Rate |
$653.51 |
| Rate for Payer: Aetna Commercial |
$317.37
|
| Rate for Payer: Aetna Medicare |
$246.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.05
|
| Rate for Payer: BCBS Complete |
$170.87
|
| Rate for Payer: BCBS MAPPO |
$236.84
|
| Rate for Payer: BCBS Trust/PPO |
$653.51
|
| Rate for Payer: BCN Commercial |
$541.46
|
| Rate for Payer: BCN Medicare Advantage |
$236.84
|
| Rate for Payer: Cash Price |
$455.20
|
| Rate for Payer: Cash Price |
$455.20
|
| Rate for Payer: Cofinity Commercial |
$341.05
|
| Rate for Payer: Cofinity Commercial |
$317.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.68
|
| Rate for Payer: Meridian Medicaid |
$170.87
|
| Rate for Payer: Nomi Health Commercial |
$284.21
|
| Rate for Payer: PACE SWMI |
$236.84
|
| Rate for Payer: PHP Commercial |
$331.58
|
| Rate for Payer: PHP Medicare Advantage |
$236.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$454.01
|
| Rate for Payer: Priority Health Medicare |
$236.84
|
| Rate for Payer: Priority Health Narrow Network |
$454.01
|
| Rate for Payer: Priority Health SBD |
$454.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.84
|
| Rate for Payer: UHC Medicare Advantage |
$236.84
|
| Rate for Payer: UHCCP Medicaid |
$162.73
|
| Rate for Payer: UMR Bronson Commercial |
$261.74
|
|
|
PR FRENULOTOMY PENIS
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 54164
|
| Min. Negotiated Rate |
$126.31 |
| Max. Negotiated Rate |
$1,012.75 |
| Rate for Payer: Aetna Commercial |
$249.01
|
| Rate for Payer: Aetna Medicare |
$193.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.60
|
| Rate for Payer: BCBS Complete |
$132.63
|
| Rate for Payer: BCBS MAPPO |
$185.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,012.75
|
| Rate for Payer: BCN Commercial |
$280.99
|
| Rate for Payer: BCN Medicare Advantage |
$185.83
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$249.01
|
| Rate for Payer: Cofinity Commercial |
$267.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.12
|
| Rate for Payer: Meridian Medicaid |
$132.63
|
| Rate for Payer: Nomi Health Commercial |
$223.00
|
| Rate for Payer: PACE SWMI |
$185.83
|
| Rate for Payer: PHP Commercial |
$260.16
|
| Rate for Payer: PHP Medicare Advantage |
$185.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.64
|
| Rate for Payer: Priority Health Medicare |
$185.83
|
| Rate for Payer: Priority Health Narrow Network |
$312.64
|
| Rate for Payer: Priority Health SBD |
$312.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.83
|
| Rate for Payer: UHC Medicare Advantage |
$185.83
|
| Rate for Payer: UHCCP Medicaid |
$126.31
|
| Rate for Payer: UMR Bronson Commercial |
$379.50
|
|
|
PR FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK
|
Professional
|
Both
|
$1,503.00
|
|
|
Service Code
|
HCPCS 15570
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$1,331.65 |
| Rate for Payer: Aetna Commercial |
$932.44
|
| Rate for Payer: Aetna Medicare |
$723.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,002.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$932.44
|
| Rate for Payer: BCBS Complete |
$493.15
|
| Rate for Payer: BCBS MAPPO |
$695.85
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$1,331.65
|
| Rate for Payer: BCN Medicare Advantage |
$695.85
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Cofinity Commercial |
$1,002.02
|
| Rate for Payer: Cofinity Commercial |
$932.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$730.64
|
| Rate for Payer: Meridian Medicaid |
$493.15
|
| Rate for Payer: Nomi Health Commercial |
$835.02
|
| Rate for Payer: PACE SWMI |
$695.85
|
| Rate for Payer: PHP Commercial |
$974.19
|
| Rate for Payer: PHP Medicare Advantage |
$695.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$469.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$988.83
|
| Rate for Payer: Priority Health Medicare |
$695.85
|
| Rate for Payer: Priority Health Narrow Network |
$988.83
|
| Rate for Payer: Priority Health SBD |
$988.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.85
|
| Rate for Payer: UHC Medicare Advantage |
$695.85
|
| Rate for Payer: UHCCP Medicaid |
$469.67
|
| Rate for Payer: UMR Bronson Commercial |
$691.38
|
|
|
PR FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL
|
Professional
|
Both
|
$1,623.00
|
|
|
Service Code
|
HCPCS 15576
|
| Min. Negotiated Rate |
$418.12 |
| Max. Negotiated Rate |
$4,106.40 |
| Rate for Payer: Aetna Commercial |
$824.33
|
| Rate for Payer: Aetna Medicare |
$639.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$824.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.84
|
| Rate for Payer: BCBS Complete |
$439.03
|
| Rate for Payer: BCBS MAPPO |
$615.17
|
| Rate for Payer: BCBS Trust/PPO |
$4,106.40
|
| Rate for Payer: BCN Commercial |
$1,142.53
|
| Rate for Payer: BCN Medicare Advantage |
$615.17
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cofinity Commercial |
$824.33
|
| Rate for Payer: Cofinity Commercial |
$885.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$645.93
|
| Rate for Payer: Meridian Medicaid |
$439.03
|
| Rate for Payer: Nomi Health Commercial |
$738.20
|
| Rate for Payer: PACE SWMI |
$615.17
|
| Rate for Payer: PHP Commercial |
$861.24
|
| Rate for Payer: PHP Medicare Advantage |
$615.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$418.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$876.84
|
| Rate for Payer: Priority Health Medicare |
$615.17
|
| Rate for Payer: Priority Health Narrow Network |
$876.84
|
| Rate for Payer: Priority Health SBD |
$876.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.17
|
| Rate for Payer: UHC Medicare Advantage |
$615.17
|
| Rate for Payer: UHCCP Medicaid |
$418.12
|
| Rate for Payer: UMR Bronson Commercial |
$746.58
|
|
|
PR FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS
|
Professional
|
Both
|
$1,566.00
|
|
|
Service Code
|
HCPCS 15572
|
| Min. Negotiated Rate |
$475.84 |
| Max. Negotiated Rate |
$6,341.25 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Medicare |
$730.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,011.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.62
|
| Rate for Payer: BCBS Complete |
$499.63
|
| Rate for Payer: BCBS MAPPO |
$702.70
|
| Rate for Payer: BCBS Trust/PPO |
$6,341.25
|
| Rate for Payer: BCN Commercial |
$1,290.60
|
| Rate for Payer: BCN Medicare Advantage |
$702.70
|
| Rate for Payer: Cash Price |
$1,252.80
|
| Rate for Payer: Cash Price |
$1,252.80
|
| Rate for Payer: Cofinity Commercial |
$1,011.89
|
| Rate for Payer: Cofinity Commercial |
$941.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$702.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$737.84
|
| Rate for Payer: Meridian Medicaid |
$499.63
|
| Rate for Payer: Nomi Health Commercial |
$843.24
|
| Rate for Payer: PACE SWMI |
$702.70
|
| Rate for Payer: PHP Commercial |
$983.78
|
| Rate for Payer: PHP Medicare Advantage |
$702.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$475.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,017.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,000.11
|
| Rate for Payer: Priority Health Medicare |
$702.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,000.11
|
| Rate for Payer: Priority Health SBD |
$1,000.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$702.70
|
| Rate for Payer: UHC Medicare Advantage |
$702.70
|
| Rate for Payer: UHCCP Medicaid |
$475.84
|
| Rate for Payer: UMR Bronson Commercial |
$720.36
|
|
|
PR FRMJ DIR/TUBE PEDCL W/WOTR FH/CH/CH/M/N/AX/G/H/F
|
Professional
|
Both
|
$1,918.00
|
|
|
Service Code
|
HCPCS 15574
|
| Min. Negotiated Rate |
$145.43 |
| Max. Negotiated Rate |
$1,283.75 |
| Rate for Payer: Aetna Commercial |
$922.68
|
| Rate for Payer: Aetna Medicare |
$716.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$922.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$991.54
|
| Rate for Payer: BCBS Complete |
$489.12
|
| Rate for Payer: BCBS MAPPO |
$688.57
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: BCN Commercial |
$1,283.75
|
| Rate for Payer: BCN Medicare Advantage |
$688.57
|
| Rate for Payer: Cash Price |
$1,534.40
|
| Rate for Payer: Cash Price |
$1,534.40
|
| Rate for Payer: Cofinity Commercial |
$922.68
|
| Rate for Payer: Cofinity Commercial |
$991.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$688.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.00
|
| Rate for Payer: Meridian Medicaid |
$489.12
|
| Rate for Payer: Nomi Health Commercial |
$826.28
|
| Rate for Payer: PACE SWMI |
$688.57
|
| Rate for Payer: PHP Commercial |
$964.00
|
| Rate for Payer: PHP Medicare Advantage |
$688.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,246.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,003.72
|
| Rate for Payer: Priority Health Medicare |
$688.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,003.72
|
| Rate for Payer: Priority Health SBD |
$1,003.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$688.57
|
| Rate for Payer: UHC Medicare Advantage |
$688.57
|
| Rate for Payer: UHCCP Medicaid |
$465.83
|
| Rate for Payer: UMR Bronson Commercial |
$882.28
|
|
|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Facility
|
IP
|
$1,399.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
15240
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$615.56 |
| Max. Negotiated Rate |
$1,259.10 |
| Rate for Payer: Aetna American Axle |
$909.35
|
| Rate for Payer: Aetna Commercial |
$1,189.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$909.35
|
| Rate for Payer: Cash Price |
$1,119.20
|
| Rate for Payer: Cofinity Commercial |
$1,203.14
|
| Rate for Payer: Cofinity Commercial |
$979.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$979.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,119.20
|
| Rate for Payer: Healthscope Commercial |
$1,259.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$979.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,049.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,189.15
|
| Rate for Payer: PHP Commercial |
$1,189.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.35
|
| Rate for Payer: Priority Health SBD |
$881.37
|
| Rate for Payer: UMR Bronson Commercial |
$615.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,049.25
|
|
