|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Facility
|
OP
|
$1,399.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
15240
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$517.63 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna American Axle |
$909.35
|
| Rate for Payer: Aetna Commercial |
$1,189.15
|
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$909.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,982.44
|
| Rate for Payer: BCN Commercial |
$2,982.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$1,119.20
|
| Rate for Payer: Cash Price |
$1,119.20
|
| 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: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| 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: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,189.15
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,189.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Priority Health SBD |
$881.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$831.84
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$756.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: UMR Bronson Commercial |
$517.63
|
| Rate for Payer: VA VA |
$1,792.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,049.25
|
|
|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Professional
|
Both
|
$1,399.00
|
|
|
Service Code
|
HCPCS 15240
|
| Hospital Charge Code |
15240
|
| Min. Negotiated Rate |
$513.12 |
| Max. Negotiated Rate |
$1,357.55 |
| Rate for Payer: Aetna Commercial |
$1,007.40
|
| Rate for Payer: Aetna Medicare |
$781.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,007.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,082.58
|
| Rate for Payer: BCBS Complete |
$538.78
|
| Rate for Payer: BCBS MAPPO |
$751.79
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$1,357.55
|
| Rate for Payer: BCN Medicare Advantage |
$751.79
|
| Rate for Payer: Cash Price |
$1,119.20
|
| Rate for Payer: Cash Price |
$1,119.20
|
| Rate for Payer: Cofinity Commercial |
$1,082.58
|
| Rate for Payer: Cofinity Commercial |
$1,007.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$751.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$789.38
|
| Rate for Payer: Meridian Medicaid |
$538.78
|
| Rate for Payer: Nomi Health Commercial |
$902.15
|
| Rate for Payer: PACE SWMI |
$751.79
|
| Rate for Payer: PHP Commercial |
$1,052.51
|
| Rate for Payer: PHP Medicare Advantage |
$751.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$513.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,080.03
|
| Rate for Payer: Priority Health Medicare |
$751.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,080.03
|
| Rate for Payer: Priority Health SBD |
$1,080.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$751.79
|
| Rate for Payer: UHC Medicare Advantage |
$751.79
|
| Rate for Payer: UHCCP Medicaid |
$513.12
|
| Rate for Payer: UMR Bronson Commercial |
$643.54
|
|
|
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
|
|
|
PR FTH/GFT FREE W/DIR CLSR N/E/E/L EA ADDL 20 SQ CM
|
Professional
|
Both
|
$426.00
|
|
|
Service Code
|
HCPCS 15261
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$301.02 |
| Rate for Payer: Aetna Commercial |
$171.48
|
| Rate for Payer: Aetna Medicare |
$133.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.28
|
| Rate for Payer: BCBS Complete |
$90.13
|
| Rate for Payer: BCBS MAPPO |
$127.97
|
| Rate for Payer: BCN Commercial |
$301.02
|
| Rate for Payer: BCN Medicare Advantage |
$127.97
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cofinity Commercial |
$171.48
|
| Rate for Payer: Cofinity Commercial |
$184.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.37
|
| Rate for Payer: Meridian Medicaid |
$90.13
|
| Rate for Payer: Nomi Health Commercial |
$153.56
|
| Rate for Payer: PACE SWMI |
$127.97
|
| Rate for Payer: PHP Commercial |
$179.16
|
| Rate for Payer: PHP Medicare Advantage |
$127.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.52
|
| Rate for Payer: Priority Health Medicare |
$127.97
|
| Rate for Payer: Priority Health Narrow Network |
$181.52
|
| Rate for Payer: Priority Health SBD |
$181.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.97
|
| Rate for Payer: UHC Medicare Advantage |
$127.97
|
| Rate for Payer: UHCCP Medicaid |
$85.84
|
| Rate for Payer: UMR Bronson Commercial |
$195.96
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 15260
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$1,458.22 |
| Rate for Payer: Aetna Commercial |
$1,070.65
|
| Rate for Payer: Aetna Medicare |
$830.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.55
|
| Rate for Payer: BCBS Complete |
$572.09
|
| Rate for Payer: BCBS MAPPO |
$798.99
|
| Rate for Payer: BCBS Trust/PPO |
$35.25
|
| Rate for Payer: BCN Commercial |
$1,458.22
|
| Rate for Payer: BCN Medicare Advantage |
$798.99
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Cofinity Commercial |
$1,070.65
|
| Rate for Payer: Cofinity Commercial |
$1,150.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$798.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$838.94
|
| Rate for Payer: Meridian Medicaid |
$572.09
|
| Rate for Payer: Nomi Health Commercial |
$958.79
|
| Rate for Payer: PACE SWMI |
$798.99
|
| Rate for Payer: PHP Commercial |
$1,118.59
|
| Rate for Payer: PHP Medicare Advantage |
$798.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$544.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,144.60
|
| Rate for Payer: Priority Health Medicare |
$798.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,144.60
|
| Rate for Payer: Priority Health SBD |
$1,144.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$798.99
|
| Rate for Payer: UHC Medicare Advantage |
$798.99
|
| Rate for Payer: UHCCP Medicaid |
$544.85
|
| Rate for Payer: UMR Bronson Commercial |
$782.00
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 SQ CM/<
|
Professional
|
Both
|
$1,689.00
|
|
|
Service Code
|
HCPCS 15220
|
| Min. Negotiated Rate |
$392.99 |
| Max. Negotiated Rate |
$12,622.63 |
| Rate for Payer: Aetna Commercial |
$772.79
|
| Rate for Payer: Aetna Medicare |
$599.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.46
|
| Rate for Payer: BCBS Complete |
$412.64
|
| Rate for Payer: BCBS MAPPO |
$576.71
|
| Rate for Payer: BCBS Trust/PPO |
$12,622.63
|
| Rate for Payer: BCN Commercial |
$1,125.42
|
| Rate for Payer: BCN Medicare Advantage |
$576.71
|
| Rate for Payer: Cash Price |
$1,351.20
|
| Rate for Payer: Cash Price |
$1,351.20
|
| Rate for Payer: Cofinity Commercial |
$772.79
|
| Rate for Payer: Cofinity Commercial |
$830.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$576.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$605.55
|
| Rate for Payer: Meridian Medicaid |
$412.64
|
| Rate for Payer: Nomi Health Commercial |
$692.05
|
| Rate for Payer: PACE SWMI |
$576.71
|
| Rate for Payer: PHP Commercial |
$807.39
|
| Rate for Payer: PHP Medicare Advantage |
$576.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$392.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.08
|
| Rate for Payer: Priority Health Medicare |
$576.71
|
| Rate for Payer: Priority Health Narrow Network |
$828.08
|
| Rate for Payer: Priority Health SBD |
$828.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$576.71
|
| Rate for Payer: UHC Medicare Advantage |
$576.71
|
| Rate for Payer: UHCCP Medicaid |
$392.99
|
| Rate for Payer: UMR Bronson Commercial |
$776.94
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 SQ CM/<
|
Professional
|
Both
|
$1,370.00
|
|
|
Service Code
|
HCPCS 15200
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$1,227.56 |
| Rate for Payer: Aetna Commercial |
$857.98
|
| Rate for Payer: Aetna Medicare |
$665.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$922.00
|
| Rate for Payer: BCBS Complete |
$455.79
|
| Rate for Payer: BCBS MAPPO |
$640.28
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,227.56
|
| Rate for Payer: BCN Medicare Advantage |
$640.28
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cofinity Commercial |
$857.98
|
| Rate for Payer: Cofinity Commercial |
$922.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$640.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.29
|
| Rate for Payer: Meridian Medicaid |
$455.79
|
| Rate for Payer: Nomi Health Commercial |
$768.34
|
| Rate for Payer: PACE SWMI |
$640.28
|
| Rate for Payer: PHP Commercial |
$896.39
|
| Rate for Payer: PHP Medicare Advantage |
$640.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$434.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$914.32
|
| Rate for Payer: Priority Health Medicare |
$640.28
|
| Rate for Payer: Priority Health Narrow Network |
$914.32
|
| Rate for Payer: Priority Health SBD |
$914.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$640.28
|
| Rate for Payer: UHC Medicare Advantage |
$640.28
|
| Rate for Payer: UHCCP Medicaid |
$434.09
|
| Rate for Payer: UMR Bronson Commercial |
$630.20
|
|
|
PR FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA ADDL
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS 15241
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Aetna Commercial |
$136.43
|
| Rate for Payer: Aetna Medicare |
$105.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.61
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCBS MAPPO |
$101.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: BCN Commercial |
$253.63
|
| Rate for Payer: BCN Medicare Advantage |
$101.81
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cofinity Commercial |
$136.43
|
| Rate for Payer: Cofinity Commercial |
$146.61
|
| 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: Meridian Medicaid |
$71.35
|
| 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 Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.58
|
| Rate for Payer: Priority Health Medicare |
$101.81
|
| Rate for Payer: Priority Health Narrow Network |
$143.58
|
| Rate for Payer: Priority Health SBD |
$143.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.81
|
| Rate for Payer: UHC Medicare Advantage |
$101.81
|
| Rate for Payer: UHCCP Medicaid |
$67.95
|
| Rate for Payer: UMR Bronson Commercial |
$163.30
|
|
|
PR FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 SQ CM
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
HCPCS 15221
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$190.59 |
| Rate for Payer: Aetna Commercial |
$88.32
|
| Rate for Payer: Aetna Medicare |
$68.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.91
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS MAPPO |
$65.91
|
| Rate for Payer: BCBS Trust/PPO |
$150.00
|
| Rate for Payer: BCN Commercial |
$190.59
|
| Rate for Payer: BCN Medicare Advantage |
$65.91
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cofinity Commercial |
$88.32
|
| Rate for Payer: Cofinity Commercial |
$94.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.21
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Nomi Health Commercial |
$79.09
|
| Rate for Payer: PACE SWMI |
$65.91
|
| Rate for Payer: PHP Commercial |
$92.27
|
| Rate for Payer: PHP Medicare Advantage |
$65.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.56
|
| Rate for Payer: Priority Health Medicare |
$65.91
|
| Rate for Payer: Priority Health Narrow Network |
$92.56
|
| Rate for Payer: Priority Health SBD |
$92.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.91
|
| Rate for Payer: UHC Medicare Advantage |
$65.91
|
| Rate for Payer: UHCCP Medicaid |
$43.88
|
| Rate for Payer: UMR Bronson Commercial |
$130.64
|
|
|
PR FT INSERT UCB BERKELEY SHELL
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS L3000
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$324.23 |
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCN Commercial |
$324.23
|
| 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 FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 95961
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$455.45 |
| Rate for Payer: Aetna Commercial |
$403.13
|
| Rate for Payer: Aetna Medicare |
$312.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$403.13
|
| Rate for Payer: BCBS Complete |
$106.01
|
| Rate for Payer: BCBS MAPPO |
$300.84
|
| Rate for Payer: BCBS Trust/PPO |
$173.28
|
| Rate for Payer: BCN Commercial |
$455.45
|
| Rate for Payer: BCN Medicare Advantage |
$300.84
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Cofinity Commercial |
$403.13
|
| Rate for Payer: Cofinity Commercial |
$433.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$315.88
|
| Rate for Payer: Meridian Medicaid |
$106.01
|
| Rate for Payer: Nomi Health Commercial |
$361.01
|
| Rate for Payer: PACE SWMI |
$300.84
|
| Rate for Payer: PHP Commercial |
$421.18
|
| Rate for Payer: PHP Medicare Advantage |
$300.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$445.53
|
| Rate for Payer: Priority Health Medicare |
$300.84
|
| Rate for Payer: Priority Health Narrow Network |
$445.53
|
| Rate for Payer: Priority Health SBD |
$215.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.84
|
| Rate for Payer: UHC Medicare Advantage |
$300.84
|
| Rate for Payer: UHCCP Medicaid |
$100.96
|
| Rate for Payer: UMR Bronson Commercial |
$236.44
|
|
|
PR FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 92250
|
| Min. Negotiated Rate |
$12.99 |
| Max. Negotiated Rate |
$1,952.60 |
| Rate for Payer: Aetna Commercial |
$45.21
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.59
|
| Rate for Payer: BCBS Complete |
$13.64
|
| Rate for Payer: BCBS MAPPO |
$33.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,952.60
|
| Rate for Payer: BCN Commercial |
$54.24
|
| Rate for Payer: BCN Medicare Advantage |
$33.74
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$45.21
|
| Rate for Payer: Cofinity Commercial |
$48.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.43
|
| Rate for Payer: Meridian Medicaid |
$13.64
|
| Rate for Payer: Nomi Health Commercial |
$40.49
|
| Rate for Payer: PACE SWMI |
$33.74
|
| Rate for Payer: PHP Commercial |
$47.24
|
| Rate for Payer: PHP Medicare Advantage |
$33.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.09
|
| Rate for Payer: Priority Health Medicare |
$33.74
|
| Rate for Payer: Priority Health Narrow Network |
$46.09
|
| Rate for Payer: Priority Health SBD |
$25.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.74
|
| Rate for Payer: UHC Medicare Advantage |
$33.74
|
| Rate for Payer: UHCCP Medicaid |
$12.99
|
| Rate for Payer: UMR Bronson Commercial |
$57.04
|
|
|
PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 93304
|
| Min. Negotiated Rate |
$22.15 |
| Max. Negotiated Rate |
$799.32 |
| Rate for Payer: Aetna Commercial |
$182.62
|
| Rate for Payer: Aetna Medicare |
$141.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.24
|
| Rate for Payer: BCBS Complete |
$23.26
|
| Rate for Payer: BCBS MAPPO |
$136.28
|
| Rate for Payer: BCBS Trust/PPO |
$799.32
|
| Rate for Payer: BCN Commercial |
$227.24
|
| Rate for Payer: BCN Medicare Advantage |
$136.28
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cofinity Commercial |
$182.62
|
| Rate for Payer: Cofinity Commercial |
$196.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.09
|
| Rate for Payer: Meridian Medicaid |
$23.26
|
| Rate for Payer: Nomi Health Commercial |
$163.54
|
| Rate for Payer: PACE SWMI |
$136.28
|
| Rate for Payer: PHP Commercial |
$190.79
|
| Rate for Payer: PHP Medicare Advantage |
$136.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.41
|
| Rate for Payer: Priority Health Medicare |
$136.28
|
| Rate for Payer: Priority Health Narrow Network |
$219.41
|
| Rate for Payer: Priority Health SBD |
$49.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.28
|
| Rate for Payer: UHC Medicare Advantage |
$136.28
|
| Rate for Payer: UHCCP Medicaid |
$22.15
|
| Rate for Payer: UMR Bronson Commercial |
$150.42
|
|
|
PR FUROSEMIDE INJECTION
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J1940
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$0.59
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.59
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: UMR Bronson Commercial |
$1.84
|
|
|
PR GARAMYCIN GENTAMICIN INJ
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J1580
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Aetna Medicare |
$2.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.77
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS MAPPO |
$2.62
|
| Rate for Payer: BCBS Trust/PPO |
$0.88
|
| Rate for Payer: BCN Commercial |
$0.68
|
| Rate for Payer: BCN Medicare Advantage |
$2.62
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.75
|
| Rate for Payer: Nomi Health Commercial |
$3.14
|
| Rate for Payer: PACE SWMI |
$2.62
|
| Rate for Payer: PHP Commercial |
$3.66
|
| Rate for Payer: PHP Medicare Advantage |
$2.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: Priority Health Medicare |
$2.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.62
|
| Rate for Payer: UHC Medicare Advantage |
$2.62
|
| Rate for Payer: UMR Bronson Commercial |
$1.84
|
|
|
PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 94727
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$251.47 |
| Rate for Payer: Aetna Commercial |
$54.54
|
| Rate for Payer: Aetna Medicare |
$42.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.61
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS MAPPO |
$40.70
|
| Rate for Payer: BCBS Trust/PPO |
$251.47
|
| Rate for Payer: BCN Commercial |
$63.53
|
| Rate for Payer: BCN Medicare Advantage |
$40.70
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$54.54
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.74
|
| Rate for Payer: Meridian Medicaid |
$7.83
|
| Rate for Payer: Nomi Health Commercial |
$48.84
|
| Rate for Payer: PACE SWMI |
$40.70
|
| Rate for Payer: PHP Commercial |
$56.98
|
| Rate for Payer: PHP Medicare Advantage |
$40.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.62
|
| Rate for Payer: Priority Health Medicare |
$40.70
|
| Rate for Payer: Priority Health Narrow Network |
$60.62
|
| Rate for Payer: Priority Health SBD |
$15.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.70
|
| Rate for Payer: UHC Medicare Advantage |
$40.70
|
| Rate for Payer: UHCCP Medicaid |
$7.46
|
| Rate for Payer: UMR Bronson Commercial |
$56.58
|
|
|
PR GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 43753
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$192.83 |
| Rate for Payer: Aetna Commercial |
$27.80
|
| Rate for Payer: Aetna Medicare |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.88
|
| Rate for Payer: BCBS Complete |
$14.31
|
| Rate for Payer: BCBS MAPPO |
$20.75
|
| Rate for Payer: BCBS Trust/PPO |
$192.83
|
| Rate for Payer: BCN Commercial |
$31.27
|
| Rate for Payer: BCN Medicare Advantage |
$20.75
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$27.80
|
| Rate for Payer: Cofinity Commercial |
$29.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.79
|
| Rate for Payer: Meridian Medicaid |
$14.31
|
| Rate for Payer: Nomi Health Commercial |
$24.90
|
| Rate for Payer: PACE SWMI |
$20.75
|
| Rate for Payer: PHP Commercial |
$29.05
|
| Rate for Payer: PHP Medicare Advantage |
$20.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.17
|
| Rate for Payer: Priority Health Medicare |
$20.75
|
| Rate for Payer: Priority Health Narrow Network |
$38.17
|
| Rate for Payer: Priority Health SBD |
$38.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.75
|
| Rate for Payer: UHC Medicare Advantage |
$20.75
|
| Rate for Payer: UHCCP Medicaid |
$13.63
|
| Rate for Payer: UMR Bronson Commercial |
$23.00
|
|
|
PR GASTROCNEMIUS RECESSION
|
Professional
|
Both
|
$1,518.00
|
|
|
Service Code
|
HCPCS 27687
|
| Min. Negotiated Rate |
$296.71 |
| Max. Negotiated Rate |
$2,402.71 |
| Rate for Payer: Aetna Commercial |
$585.22
|
| Rate for Payer: Aetna Medicare |
$454.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.89
|
| Rate for Payer: BCBS Complete |
$311.55
|
| Rate for Payer: BCBS MAPPO |
$436.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,402.71
|
| Rate for Payer: BCN Commercial |
$666.06
|
| Rate for Payer: BCN Medicare Advantage |
$436.73
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cofinity Commercial |
$585.22
|
| Rate for Payer: Cofinity Commercial |
$628.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$436.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$458.57
|
| Rate for Payer: Meridian Medicaid |
$311.55
|
| Rate for Payer: Nomi Health Commercial |
$524.08
|
| Rate for Payer: PACE SWMI |
$436.73
|
| Rate for Payer: PHP Commercial |
$611.42
|
| Rate for Payer: PHP Medicare Advantage |
$436.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$296.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$986.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$702.74
|
| Rate for Payer: Priority Health Medicare |
$436.73
|
| Rate for Payer: Priority Health Narrow Network |
$702.74
|
| Rate for Payer: Priority Health SBD |
$702.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$436.73
|
| Rate for Payer: UHC Medicare Advantage |
$436.73
|
| Rate for Payer: UHCCP Medicaid |
$296.71
|
| Rate for Payer: UMR Bronson Commercial |
$698.28
|
|
|
PR GASTRODUODENOSTOMY
|
Professional
|
Both
|
$2,486.00
|
|
|
Service Code
|
HCPCS 43810
|
| Min. Negotiated Rate |
$486.56 |
| Max. Negotiated Rate |
$1,823.20 |
| Rate for Payer: Aetna Commercial |
$1,328.28
|
| Rate for Payer: Aetna Medicare |
$1,030.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,328.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,427.40
|
| Rate for Payer: BCBS Complete |
$687.73
|
| Rate for Payer: BCBS MAPPO |
$991.25
|
| Rate for Payer: BCBS Trust/PPO |
$486.56
|
| Rate for Payer: BCN Commercial |
$1,485.09
|
| Rate for Payer: BCN Medicare Advantage |
$991.25
|
| Rate for Payer: Cash Price |
$1,988.80
|
| Rate for Payer: Cash Price |
$1,988.80
|
| Rate for Payer: Cofinity Commercial |
$1,328.28
|
| Rate for Payer: Cofinity Commercial |
$1,427.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$991.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,040.81
|
| Rate for Payer: Meridian Medicaid |
$687.73
|
| Rate for Payer: Nomi Health Commercial |
$1,189.50
|
| Rate for Payer: PACE SWMI |
$991.25
|
| Rate for Payer: PHP Commercial |
$1,387.75
|
| Rate for Payer: PHP Medicare Advantage |
$991.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$654.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,615.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,823.20
|
| Rate for Payer: Priority Health Medicare |
$991.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,823.20
|
| Rate for Payer: Priority Health SBD |
$1,823.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$991.25
|
| Rate for Payer: UHC Medicare Advantage |
$991.25
|
| Rate for Payer: UHCCP Medicaid |
$654.98
|
| Rate for Payer: UMR Bronson Commercial |
$1,143.56
|
|
|
PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT
|
Professional
|
Both
|
$343.00
|
|
|
Service Code
|
HCPCS 91034
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$1,518.86 |
| Rate for Payer: Aetna Commercial |
$225.66
|
| Rate for Payer: Aetna Commercial |
$225.66
|
| Rate for Payer: Aetna Medicare |
$175.14
|
| Rate for Payer: Aetna Medicare |
$175.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.66
|
| Rate for Payer: BCBS Complete |
$32.43
|
| Rate for Payer: BCBS Complete |
$32.43
|
| Rate for Payer: BCBS MAPPO |
$168.40
|
| Rate for Payer: BCBS MAPPO |
$168.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,518.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,518.86
|
| Rate for Payer: BCN Commercial |
$281.97
|
| Rate for Payer: BCN Commercial |
$281.97
|
| Rate for Payer: BCN Medicare Advantage |
$168.40
|
| Rate for Payer: BCN Medicare Advantage |
$168.40
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Cofinity Commercial |
$225.66
|
| Rate for Payer: Cofinity Commercial |
$242.50
|
| Rate for Payer: Cofinity Commercial |
$242.50
|
| Rate for Payer: Cofinity Commercial |
$225.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.82
|
| Rate for Payer: Meridian Medicaid |
$32.43
|
| Rate for Payer: Meridian Medicaid |
$32.43
|
| Rate for Payer: Nomi Health Commercial |
$202.08
|
| Rate for Payer: Nomi Health Commercial |
$202.08
|
| Rate for Payer: PACE SWMI |
$168.40
|
| Rate for Payer: PACE SWMI |
$168.40
|
| Rate for Payer: PHP Commercial |
$235.76
|
| Rate for Payer: PHP Commercial |
$235.76
|
| Rate for Payer: PHP Medicare Advantage |
$168.40
|
| Rate for Payer: PHP Medicare Advantage |
$168.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.63
|
| Rate for Payer: Priority Health Medicare |
$168.40
|
| Rate for Payer: Priority Health Medicare |
$168.40
|
| Rate for Payer: Priority Health Narrow Network |
$259.63
|
| Rate for Payer: Priority Health Narrow Network |
$259.63
|
| Rate for Payer: Priority Health SBD |
$66.04
|
| Rate for Payer: Priority Health SBD |
$66.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.40
|
| Rate for Payer: UHC Medicare Advantage |
$168.40
|
| Rate for Payer: UHC Medicare Advantage |
$168.40
|
| Rate for Payer: UHCCP Medicaid |
$30.89
|
| Rate for Payer: UHCCP Medicaid |
$30.89
|
| Rate for Payer: UMR Bronson Commercial |
$57.04
|
| Rate for Payer: UMR Bronson Commercial |
$157.78
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 91037
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$963.09 |
| Rate for Payer: Aetna Commercial |
$199.89
|
| Rate for Payer: Aetna Commercial |
$199.89
|
| Rate for Payer: Aetna Medicare |
$155.14
|
| Rate for Payer: Aetna Medicare |
$155.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.89
|
| Rate for Payer: BCBS Complete |
$32.20
|
| Rate for Payer: BCBS Complete |
$32.20
|
| Rate for Payer: BCBS MAPPO |
$149.17
|
| Rate for Payer: BCBS MAPPO |
$149.17
|
| Rate for Payer: BCBS Trust/PPO |
$963.09
|
| Rate for Payer: BCBS Trust/PPO |
$963.09
|
| Rate for Payer: BCN Commercial |
$246.78
|
| Rate for Payer: BCN Commercial |
$246.78
|
| Rate for Payer: BCN Medicare Advantage |
$149.17
|
| Rate for Payer: BCN Medicare Advantage |
$149.17
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cofinity Commercial |
$199.89
|
| Rate for Payer: Cofinity Commercial |
$214.80
|
| Rate for Payer: Cofinity Commercial |
$214.80
|
| Rate for Payer: Cofinity Commercial |
$199.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.63
|
| Rate for Payer: Meridian Medicaid |
$32.20
|
| Rate for Payer: Meridian Medicaid |
$32.20
|
| Rate for Payer: Nomi Health Commercial |
$179.00
|
| Rate for Payer: Nomi Health Commercial |
$179.00
|
| Rate for Payer: PACE SWMI |
$149.17
|
| Rate for Payer: PACE SWMI |
$149.17
|
| Rate for Payer: PHP Commercial |
$208.84
|
| Rate for Payer: PHP Commercial |
$208.84
|
| Rate for Payer: PHP Medicare Advantage |
$149.17
|
| Rate for Payer: PHP Medicare Advantage |
$149.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.86
|
| Rate for Payer: Priority Health Medicare |
$149.17
|
| Rate for Payer: Priority Health Medicare |
$149.17
|
| Rate for Payer: Priority Health Narrow Network |
$228.86
|
| Rate for Payer: Priority Health Narrow Network |
$228.86
|
| Rate for Payer: Priority Health SBD |
$64.68
|
| Rate for Payer: Priority Health SBD |
$64.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.17
|
| Rate for Payer: UHC Medicare Advantage |
$149.17
|
| Rate for Payer: UHC Medicare Advantage |
$149.17
|
| Rate for Payer: UHCCP Medicaid |
$30.67
|
| Rate for Payer: UHCCP Medicaid |
$30.67
|
| Rate for Payer: UMR Bronson Commercial |
$143.52
|
| Rate for Payer: UMR Bronson Commercial |
$44.62
|
|
|
PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 91035
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$976.30 |
| Rate for Payer: Aetna Commercial |
$525.51
|
| Rate for Payer: Aetna Commercial |
$525.51
|
| Rate for Payer: Aetna Medicare |
$407.86
|
| Rate for Payer: Aetna Medicare |
$407.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.51
|
| Rate for Payer: BCBS Complete |
$53.68
|
| Rate for Payer: BCBS Complete |
$53.68
|
| Rate for Payer: BCBS MAPPO |
$392.17
|
| Rate for Payer: BCBS MAPPO |
$392.17
|
| Rate for Payer: BCBS Trust/PPO |
$976.30
|
| Rate for Payer: BCBS Trust/PPO |
$976.30
|
| Rate for Payer: BCN Commercial |
$677.30
|
| Rate for Payer: BCN Commercial |
$677.30
|
| Rate for Payer: BCN Medicare Advantage |
$392.17
|
| Rate for Payer: BCN Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cofinity Commercial |
$525.51
|
| Rate for Payer: Cofinity Commercial |
$564.72
|
| Rate for Payer: Cofinity Commercial |
$564.72
|
| Rate for Payer: Cofinity Commercial |
$525.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.78
|
| Rate for Payer: Meridian Medicaid |
$53.68
|
| Rate for Payer: Meridian Medicaid |
$53.68
|
| Rate for Payer: Nomi Health Commercial |
$470.60
|
| Rate for Payer: Nomi Health Commercial |
$470.60
|
| Rate for Payer: PACE SWMI |
$392.17
|
| Rate for Payer: PACE SWMI |
$392.17
|
| Rate for Payer: PHP Commercial |
$549.04
|
| Rate for Payer: PHP Commercial |
$549.04
|
| Rate for Payer: PHP Medicare Advantage |
$392.17
|
| Rate for Payer: PHP Medicare Advantage |
$392.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$616.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$616.95
|
| Rate for Payer: Priority Health Medicare |
$392.17
|
| Rate for Payer: Priority Health Medicare |
$392.17
|
| Rate for Payer: Priority Health Narrow Network |
$616.95
|
| Rate for Payer: Priority Health Narrow Network |
$616.95
|
| Rate for Payer: Priority Health SBD |
$108.11
|
| Rate for Payer: Priority Health SBD |
$108.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.17
|
| Rate for Payer: UHC Medicare Advantage |
$392.17
|
| Rate for Payer: UHC Medicare Advantage |
$392.17
|
| Rate for Payer: UHCCP Medicaid |
$51.12
|
| Rate for Payer: UHCCP Medicaid |
$51.12
|
| Rate for Payer: UMR Bronson Commercial |
$77.74
|
| Rate for Payer: UMR Bronson Commercial |
$402.50
|
|
|
PR GASTROJEJUNOSTOMY W/O VAGOTOMY
|
Professional
|
Both
|
$2,621.00
|
|
|
Service Code
|
HCPCS 43820
|
| Min. Negotiated Rate |
$864.78 |
| Max. Negotiated Rate |
$2,409.05 |
| Rate for Payer: Aetna Commercial |
$1,752.87
|
| Rate for Payer: Aetna Medicare |
$1,360.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,752.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,883.68
|
| Rate for Payer: BCBS Complete |
$908.02
|
| Rate for Payer: BCBS MAPPO |
$1,308.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,050.26
|
| Rate for Payer: BCN Commercial |
$1,961.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,308.11
|
| Rate for Payer: Cash Price |
$2,096.80
|
| Rate for Payer: Cash Price |
$2,096.80
|
| Rate for Payer: Cofinity Commercial |
$1,752.87
|
| Rate for Payer: Cofinity Commercial |
$1,883.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,308.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,373.52
|
| Rate for Payer: Meridian Medicaid |
$908.02
|
| Rate for Payer: Nomi Health Commercial |
$1,569.73
|
| Rate for Payer: PACE SWMI |
$1,308.11
|
| Rate for Payer: PHP Commercial |
$1,831.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,308.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$864.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,703.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,409.05
|
| Rate for Payer: Priority Health Medicare |
$1,308.11
|
| Rate for Payer: Priority Health Narrow Network |
$2,409.05
|
| Rate for Payer: Priority Health SBD |
$2,409.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,308.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,308.11
|
| Rate for Payer: UHCCP Medicaid |
$864.78
|
| Rate for Payer: UMR Bronson Commercial |
$1,205.66
|
|
|
PR GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE
|
Professional
|
Both
|
$2,581.00
|
|
|
Service Code
|
HCPCS 43825
|
| Min. Negotiated Rate |
$669.36 |
| Max. Negotiated Rate |
$2,349.98 |
| Rate for Payer: Aetna Commercial |
$1,711.54
|
| Rate for Payer: Aetna Medicare |
$1,328.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,711.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,839.27
|
| Rate for Payer: BCBS Complete |
$886.11
|
| Rate for Payer: BCBS MAPPO |
$1,277.27
|
| Rate for Payer: BCBS Trust/PPO |
$669.36
|
| Rate for Payer: BCN Commercial |
$1,915.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,277.27
|
| Rate for Payer: Cash Price |
$2,064.80
|
| Rate for Payer: Cash Price |
$2,064.80
|
| Rate for Payer: Cofinity Commercial |
$1,711.54
|
| Rate for Payer: Cofinity Commercial |
$1,839.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,277.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,341.13
|
| Rate for Payer: Meridian Medicaid |
$886.11
|
| Rate for Payer: Nomi Health Commercial |
$1,532.72
|
| Rate for Payer: PACE SWMI |
$1,277.27
|
| Rate for Payer: PHP Commercial |
$1,788.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,277.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$843.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,349.98
|
| Rate for Payer: Priority Health Medicare |
$1,277.27
|
| Rate for Payer: Priority Health Narrow Network |
$2,349.98
|
| Rate for Payer: Priority Health SBD |
$2,349.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,277.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,277.27
|
| Rate for Payer: UHCCP Medicaid |
$843.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,187.26
|
|
|
PR GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ
|
Professional
|
Both
|
$2,821.00
|
|
|
Service Code
|
HCPCS 43840
|
| Min. Negotiated Rate |
$75.56 |
| Max. Negotiated Rate |
$2,434.10 |
| Rate for Payer: Aetna Commercial |
$1,772.31
|
| Rate for Payer: Aetna Medicare |
$1,375.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,772.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,904.57
|
| Rate for Payer: BCBS Complete |
$917.86
|
| Rate for Payer: BCBS MAPPO |
$1,322.62
|
| Rate for Payer: BCBS Trust/PPO |
$75.56
|
| Rate for Payer: BCN Commercial |
$1,984.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,322.62
|
| Rate for Payer: Cash Price |
$2,256.80
|
| Rate for Payer: Cash Price |
$2,256.80
|
| Rate for Payer: Cofinity Commercial |
$1,772.31
|
| Rate for Payer: Cofinity Commercial |
$1,904.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,322.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,388.75
|
| Rate for Payer: Meridian Medicaid |
$917.86
|
| Rate for Payer: Nomi Health Commercial |
$1,587.14
|
| Rate for Payer: PACE SWMI |
$1,322.62
|
| Rate for Payer: PHP Commercial |
$1,851.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,322.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$874.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,833.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,434.10
|
| Rate for Payer: Priority Health Medicare |
$1,322.62
|
| Rate for Payer: Priority Health Narrow Network |
$2,434.10
|
| Rate for Payer: Priority Health SBD |
$2,434.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,322.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,322.62
|
| Rate for Payer: UHCCP Medicaid |
$874.15
|
| Rate for Payer: UMR Bronson Commercial |
$1,297.66
|
|
