|
PR HOPD MNTL HLT, 30-60 MIN
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS C7901
|
| 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 HOPD MNTL HLT, EA ADDL
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS C7902
|
| 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 HOSPICE CARE SUPERVISION
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
HCPCS G0182
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$141.03 |
| Rate for Payer: Aetna Commercial |
$131.24
|
| Rate for Payer: Aetna Medicare |
$101.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.03
|
| Rate for Payer: BCBS Complete |
$76.40
|
| Rate for Payer: BCBS MAPPO |
$97.94
|
| Rate for Payer: BCN Medicare Advantage |
$97.94
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cofinity Commercial |
$131.24
|
| Rate for Payer: Cofinity Commercial |
$141.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.84
|
| Rate for Payer: Nomi Health Commercial |
$117.53
|
| Rate for Payer: PACE SWMI |
$97.94
|
| Rate for Payer: PHP Commercial |
$137.12
|
| Rate for Payer: PHP Medicare Advantage |
$97.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.15
|
| Rate for Payer: Priority Health Medicare |
$97.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.94
|
| Rate for Payer: UHC Medicare Advantage |
$97.94
|
| Rate for Payer: UMR Bronson Commercial |
$87.86
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN
|
Professional
|
Both
|
$392.00
|
|
|
Service Code
|
HCPCS 99236
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$283.67 |
| Rate for Payer: Aetna Commercial |
$263.97
|
| Rate for Payer: Aetna Medicare |
$204.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.97
|
| Rate for Payer: BCBS Complete |
$156.80
|
| Rate for Payer: BCBS MAPPO |
$196.99
|
| Rate for Payer: BCN Medicare Advantage |
$196.99
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cofinity Commercial |
$283.67
|
| Rate for Payer: Cofinity Commercial |
$263.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.84
|
| Rate for Payer: Nomi Health Commercial |
$236.39
|
| Rate for Payer: PACE SWMI |
$196.99
|
| Rate for Payer: PHP Commercial |
$275.79
|
| Rate for Payer: PHP Medicare Advantage |
$196.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.80
|
| Rate for Payer: Priority Health Medicare |
$196.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.99
|
| Rate for Payer: UHC Medicare Advantage |
$196.99
|
| Rate for Payer: UMR Bronson Commercial |
$180.32
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE MOD MDM 70 MIN
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 99235
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$216.65 |
| Rate for Payer: Aetna Commercial |
$201.60
|
| Rate for Payer: Aetna Medicare |
$156.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.60
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: BCBS MAPPO |
$150.45
|
| Rate for Payer: BCN Medicare Advantage |
$150.45
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$216.65
|
| Rate for Payer: Cofinity Commercial |
$201.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.97
|
| Rate for Payer: Nomi Health Commercial |
$180.54
|
| Rate for Payer: PACE SWMI |
$150.45
|
| Rate for Payer: PHP Commercial |
$210.63
|
| Rate for Payer: PHP Medicare Advantage |
$150.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health Medicare |
$150.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.45
|
| Rate for Payer: UHC Medicare Advantage |
$150.45
|
| Rate for Payer: UMR Bronson Commercial |
$145.36
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 99234
|
| Min. Negotiated Rate |
$92.57 |
| Max. Negotiated Rate |
$156.65 |
| Rate for Payer: Aetna Commercial |
$124.04
|
| Rate for Payer: Aetna Medicare |
$96.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.04
|
| Rate for Payer: BCBS Complete |
$96.40
|
| Rate for Payer: BCBS MAPPO |
$92.57
|
| Rate for Payer: BCN Medicare Advantage |
$92.57
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cofinity Commercial |
$133.30
|
| Rate for Payer: Cofinity Commercial |
$124.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.20
|
| Rate for Payer: Nomi Health Commercial |
$111.08
|
| Rate for Payer: PACE SWMI |
$92.57
|
| Rate for Payer: PHP Commercial |
$129.60
|
| Rate for Payer: PHP Medicare Advantage |
$92.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health Medicare |
$92.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.57
|
| Rate for Payer: UHC Medicare Advantage |
$92.57
|
| Rate for Payer: UMR Bronson Commercial |
$110.86
|
|
|
PR HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 99239
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Commercial |
$145.15
|
| Rate for Payer: Aetna Medicare |
$112.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.15
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCBS MAPPO |
$108.32
|
| Rate for Payer: BCN Medicare Advantage |
$108.32
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$155.98
|
| Rate for Payer: Cofinity Commercial |
$145.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.74
|
| Rate for Payer: Nomi Health Commercial |
$129.98
|
| Rate for Payer: PACE SWMI |
$108.32
|
| Rate for Payer: PHP Commercial |
$151.65
|
| Rate for Payer: PHP Medicare Advantage |
$108.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health Medicare |
$108.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.32
|
| Rate for Payer: UHC Medicare Advantage |
$108.32
|
| Rate for Payer: UMR Bronson Commercial |
$117.30
|
|
|
PR HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/<
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 99238
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$110.38 |
| Rate for Payer: Aetna Commercial |
$102.71
|
| Rate for Payer: Aetna Medicare |
$79.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.71
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$76.65
|
| Rate for Payer: BCN Medicare Advantage |
$76.65
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$110.38
|
| Rate for Payer: Cofinity Commercial |
$102.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.48
|
| Rate for Payer: Nomi Health Commercial |
$91.98
|
| Rate for Payer: PACE SWMI |
$76.65
|
| Rate for Payer: PHP Commercial |
$107.31
|
| Rate for Payer: PHP Medicare Advantage |
$76.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$76.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.65
|
| Rate for Payer: UHC Medicare Advantage |
$76.65
|
| Rate for Payer: UMR Bronson Commercial |
$57.50
|
|
|
PR HO W/O JOINTS CF
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS L3919
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$427.62 |
| Rate for Payer: Aetna Commercial |
$397.93
|
| Rate for Payer: Aetna Medicare |
$308.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.93
|
| Rate for Payer: BCBS Complete |
$101.20
|
| Rate for Payer: BCBS MAPPO |
$296.96
|
| Rate for Payer: BCN Medicare Advantage |
$296.96
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cofinity Commercial |
$427.62
|
| Rate for Payer: Cofinity Commercial |
$397.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.81
|
| Rate for Payer: Nomi Health Commercial |
$356.35
|
| Rate for Payer: PACE SWMI |
$296.96
|
| Rate for Payer: PHP Commercial |
$415.74
|
| Rate for Payer: PHP Medicare Advantage |
$296.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.45
|
| Rate for Payer: Priority Health Medicare |
$296.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.96
|
| Rate for Payer: UHC Medicare Advantage |
$296.96
|
| Rate for Payer: UMR Bronson Commercial |
$116.38
|
|
|
PR HRHC 1 COL/GRP W/FSTULECTMY INCL FSSRECTOMY
|
Professional
|
Both
|
$1,182.00
|
|
|
Service Code
|
HCPCS 46258
|
| Min. Negotiated Rate |
$466.71 |
| Max. Negotiated Rate |
$768.30 |
| Rate for Payer: Aetna Commercial |
$625.39
|
| Rate for Payer: Aetna Medicare |
$485.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$672.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$625.39
|
| Rate for Payer: BCBS Complete |
$472.80
|
| Rate for Payer: BCBS MAPPO |
$466.71
|
| Rate for Payer: BCN Medicare Advantage |
$466.71
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cofinity Commercial |
$672.06
|
| Rate for Payer: Cofinity Commercial |
$625.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$466.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$490.05
|
| Rate for Payer: Nomi Health Commercial |
$560.05
|
| Rate for Payer: PACE SWMI |
$466.71
|
| Rate for Payer: PHP Commercial |
$653.39
|
| Rate for Payer: PHP Medicare Advantage |
$466.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$768.30
|
| Rate for Payer: Priority Health Medicare |
$466.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$466.71
|
| Rate for Payer: UHC Medicare Advantage |
$466.71
|
| Rate for Payer: UMR Bronson Commercial |
$543.72
|
|
|
PR HRHC 2/> COL/GRP W/FSTULECTMY INCL FSSRECTMY
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 46262
|
| Min. Negotiated Rate |
$567.95 |
| Max. Negotiated Rate |
$1,153.75 |
| Rate for Payer: Aetna Commercial |
$761.05
|
| Rate for Payer: Aetna Medicare |
$590.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$817.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.05
|
| Rate for Payer: BCBS Complete |
$710.00
|
| Rate for Payer: BCBS MAPPO |
$567.95
|
| Rate for Payer: BCN Medicare Advantage |
$567.95
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cofinity Commercial |
$817.85
|
| Rate for Payer: Cofinity Commercial |
$761.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$567.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$596.35
|
| Rate for Payer: Nomi Health Commercial |
$681.54
|
| Rate for Payer: PACE SWMI |
$567.95
|
| Rate for Payer: PHP Commercial |
$795.13
|
| Rate for Payer: PHP Medicare Advantage |
$567.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,153.75
|
| Rate for Payer: Priority Health Medicare |
$567.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$567.95
|
| Rate for Payer: UHC Medicare Advantage |
$567.95
|
| Rate for Payer: UMR Bronson Commercial |
$816.50
|
|
|
PR HRHC NTRNL & XTRNL 2/> COLUMN/GROUP W/FISSU
|
Professional
|
Both
|
$1,732.00
|
|
|
Service Code
|
HCPCS 46261
|
| Min. Negotiated Rate |
$512.00 |
| Max. Negotiated Rate |
$1,125.80 |
| Rate for Payer: Aetna Commercial |
$686.08
|
| Rate for Payer: Aetna Medicare |
$532.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$737.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$686.08
|
| Rate for Payer: BCBS Complete |
$692.80
|
| Rate for Payer: BCBS MAPPO |
$512.00
|
| Rate for Payer: BCN Medicare Advantage |
$512.00
|
| Rate for Payer: Cash Price |
$1,385.60
|
| Rate for Payer: Cash Price |
$1,385.60
|
| Rate for Payer: Cofinity Commercial |
$737.28
|
| Rate for Payer: Cofinity Commercial |
$686.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$512.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$537.60
|
| Rate for Payer: Nomi Health Commercial |
$614.40
|
| Rate for Payer: PACE SWMI |
$512.00
|
| Rate for Payer: PHP Commercial |
$716.80
|
| Rate for Payer: PHP Medicare Advantage |
$512.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,125.80
|
| Rate for Payer: Priority Health Medicare |
$512.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$512.00
|
| Rate for Payer: UHC Medicare Advantage |
$512.00
|
| Rate for Payer: UMR Bronson Commercial |
$796.72
|
|
|
PR HYALGAN SUPARTZ VISCO-3 DOSE
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
HCPCS J7321
|
| Min. Negotiated Rate |
$71.52 |
| Max. Negotiated Rate |
$196.95 |
| Rate for Payer: Aetna Commercial |
$95.84
|
| Rate for Payer: Aetna Medicare |
$74.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.99
|
| Rate for Payer: BCBS Complete |
$121.20
|
| Rate for Payer: BCBS MAPPO |
$71.52
|
| Rate for Payer: BCN Medicare Advantage |
$71.52
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cofinity Commercial |
$95.84
|
| Rate for Payer: Cofinity Commercial |
$102.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.10
|
| Rate for Payer: Nomi Health Commercial |
$85.82
|
| Rate for Payer: PACE SWMI |
$71.52
|
| Rate for Payer: PHP Commercial |
$100.13
|
| Rate for Payer: PHP Medicare Advantage |
$71.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.95
|
| Rate for Payer: Priority Health Medicare |
$71.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.52
|
| Rate for Payer: UHC Medicare Advantage |
$71.52
|
| Rate for Payer: UMR Bronson Commercial |
$139.38
|
|
|
PR HYDROCORTISONE SODIUM SUCC I
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1720
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$30.69 |
| Rate for Payer: Aetna Commercial |
$28.56
|
| Rate for Payer: Aetna Medicare |
$22.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.56
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$21.31
|
| Rate for Payer: BCN Medicare Advantage |
$21.31
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$30.69
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.38
|
| Rate for Payer: Nomi Health Commercial |
$25.57
|
| Rate for Payer: PACE SWMI |
$21.31
|
| Rate for Payer: PHP Commercial |
$29.83
|
| Rate for Payer: PHP Medicare Advantage |
$21.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$21.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.31
|
| Rate for Payer: UHC Medicare Advantage |
$21.31
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR HYDROMORPHONE INJECTION
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J1170
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
|
|
PR HYDROXYPROGESTERONE CAPROATE
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J1725
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
|
|
PR HYDROXYZINE HCL INJECTION
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J3410
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.50
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.50
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$22.03
|
| Rate for Payer: Cofinity Commercial |
$20.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.07
|
| Rate for Payer: Nomi Health Commercial |
$18.36
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$21.42
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$15.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.30
|
| Rate for Payer: UHC Medicare Advantage |
$15.30
|
| Rate for Payer: UMR Bronson Commercial |
$6.90
|
|
|
PR HYMENOTOMY SIMPLE INCISION
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 56442
|
| Min. Negotiated Rate |
$45.79 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Aetna Commercial |
$61.36
|
| Rate for Payer: Aetna Medicare |
$47.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.36
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS MAPPO |
$45.79
|
| Rate for Payer: BCN Medicare Advantage |
$45.79
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$65.94
|
| Rate for Payer: Cofinity Commercial |
$61.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.08
|
| Rate for Payer: Nomi Health Commercial |
$54.95
|
| Rate for Payer: PACE SWMI |
$45.79
|
| Rate for Payer: PHP Commercial |
$64.11
|
| Rate for Payer: PHP Medicare Advantage |
$45.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
| Rate for Payer: Priority Health Medicare |
$45.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.79
|
| Rate for Payer: UHC Medicare Advantage |
$45.79
|
| Rate for Payer: UMR Bronson Commercial |
$71.76
|
|
|
PR HYPOPHYSEC/EXC PITUITARY TUM TRANSNASAL/SEPTAL
|
Professional
|
Both
|
$8,489.00
|
|
|
Service Code
|
HCPCS 61548
|
| Min. Negotiated Rate |
$1,543.76 |
| Max. Negotiated Rate |
$5,517.85 |
| Rate for Payer: Aetna Commercial |
$2,068.64
|
| Rate for Payer: Aetna Medicare |
$1,605.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,223.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,068.64
|
| Rate for Payer: BCBS Complete |
$3,395.60
|
| Rate for Payer: BCBS MAPPO |
$1,543.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,543.76
|
| Rate for Payer: Cash Price |
$6,791.20
|
| Rate for Payer: Cash Price |
$6,791.20
|
| Rate for Payer: Cofinity Commercial |
$2,223.01
|
| Rate for Payer: Cofinity Commercial |
$2,068.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,543.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,620.95
|
| Rate for Payer: Nomi Health Commercial |
$1,852.51
|
| Rate for Payer: PACE SWMI |
$1,543.76
|
| Rate for Payer: PHP Commercial |
$2,161.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,543.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,517.85
|
| Rate for Payer: Priority Health Medicare |
$1,543.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,543.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,543.76
|
| Rate for Payer: UMR Bronson Commercial |
$3,904.94
|
|
|
PR HYSTERORRHAPHY RUPTURED UTERUS
|
Professional
|
Both
|
$1,312.00
|
|
|
Service Code
|
HCPCS 59350
|
| Min. Negotiated Rate |
$272.69 |
| Max. Negotiated Rate |
$852.80 |
| Rate for Payer: Aetna Commercial |
$365.40
|
| Rate for Payer: Aetna Medicare |
$283.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.40
|
| Rate for Payer: BCBS Complete |
$524.80
|
| Rate for Payer: BCBS MAPPO |
$272.69
|
| Rate for Payer: BCN Medicare Advantage |
$272.69
|
| Rate for Payer: Cash Price |
$1,049.60
|
| Rate for Payer: Cash Price |
$1,049.60
|
| Rate for Payer: Cofinity Commercial |
$392.67
|
| Rate for Payer: Cofinity Commercial |
$365.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.32
|
| Rate for Payer: Nomi Health Commercial |
$327.23
|
| Rate for Payer: PACE SWMI |
$272.69
|
| Rate for Payer: PHP Commercial |
$381.77
|
| Rate for Payer: PHP Medicare Advantage |
$272.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$852.80
|
| Rate for Payer: Priority Health Medicare |
$272.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$272.69
|
| Rate for Payer: UHC Medicare Advantage |
$272.69
|
| Rate for Payer: UMR Bronson Commercial |
$603.52
|
|
|
PR HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS
|
Professional
|
Both
|
$3,366.00
|
|
|
Service Code
|
HCPCS 58565
|
| Min. Negotiated Rate |
$436.27 |
| Max. Negotiated Rate |
$2,187.90 |
| Rate for Payer: Aetna Commercial |
$584.60
|
| Rate for Payer: Aetna Medicare |
$453.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$584.60
|
| Rate for Payer: BCBS Complete |
$1,346.40
|
| Rate for Payer: BCBS MAPPO |
$436.27
|
| Rate for Payer: BCN Medicare Advantage |
$436.27
|
| Rate for Payer: Cash Price |
$2,692.80
|
| Rate for Payer: Cash Price |
$2,692.80
|
| Rate for Payer: Cofinity Commercial |
$628.23
|
| Rate for Payer: Cofinity Commercial |
$584.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$436.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$458.08
|
| Rate for Payer: Nomi Health Commercial |
$523.52
|
| Rate for Payer: PACE SWMI |
$436.27
|
| Rate for Payer: PHP Commercial |
$610.78
|
| Rate for Payer: PHP Medicare Advantage |
$436.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,187.90
|
| Rate for Payer: Priority Health Medicare |
$436.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$436.27
|
| Rate for Payer: UHC Medicare Advantage |
$436.27
|
| Rate for Payer: UMR Bronson Commercial |
$1,548.36
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Professional
|
Both
|
$1,371.00
|
|
|
Service Code
|
HCPCS 58558
|
| Min. Negotiated Rate |
$222.53 |
| Max. Negotiated Rate |
$891.15 |
| Rate for Payer: Aetna Commercial |
$298.19
|
| Rate for Payer: Aetna Medicare |
$231.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.19
|
| Rate for Payer: BCBS Complete |
$548.40
|
| Rate for Payer: BCBS MAPPO |
$222.53
|
| Rate for Payer: BCN Medicare Advantage |
$222.53
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$298.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.66
|
| Rate for Payer: Nomi Health Commercial |
$267.04
|
| Rate for Payer: PACE SWMI |
$222.53
|
| Rate for Payer: PHP Commercial |
$311.54
|
| Rate for Payer: PHP Medicare Advantage |
$222.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.15
|
| Rate for Payer: Priority Health Medicare |
$222.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.53
|
| Rate for Payer: UHC Medicare Advantage |
$222.53
|
| Rate for Payer: UMR Bronson Commercial |
$630.66
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Facility
|
IP
|
$1,371.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
58558
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$603.24 |
| Max. Negotiated Rate |
$1,233.90 |
| Rate for Payer: Aetna American Axle |
$891.15
|
| Rate for Payer: Aetna Commercial |
$1,165.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$891.15
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cofinity Commercial |
$1,179.06
|
| Rate for Payer: Cofinity Commercial |
$959.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$959.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,096.80
|
| Rate for Payer: Healthscope Commercial |
$1,233.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$959.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,028.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,165.35
|
| Rate for Payer: PHP Commercial |
$1,165.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.15
|
| Rate for Payer: Priority Health SBD |
$863.73
|
| Rate for Payer: UMR Bronson Commercial |
$603.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,028.25
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Professional
|
Both
|
$1,371.00
|
|
|
Service Code
|
HCPCS 58558
|
| Hospital Charge Code |
58558
|
| Min. Negotiated Rate |
$222.53 |
| Max. Negotiated Rate |
$891.15 |
| Rate for Payer: Aetna Commercial |
$298.19
|
| Rate for Payer: Aetna Medicare |
$231.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.19
|
| Rate for Payer: BCBS Complete |
$548.40
|
| Rate for Payer: BCBS MAPPO |
$222.53
|
| Rate for Payer: BCN Medicare Advantage |
$222.53
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$298.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.66
|
| Rate for Payer: Nomi Health Commercial |
$267.04
|
| Rate for Payer: PACE SWMI |
$222.53
|
| Rate for Payer: PHP Commercial |
$311.54
|
| Rate for Payer: PHP Medicare Advantage |
$222.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.15
|
| Rate for Payer: Priority Health Medicare |
$222.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.53
|
| Rate for Payer: UHC Medicare Advantage |
$222.53
|
| Rate for Payer: UMR Bronson Commercial |
$630.66
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Facility
|
OP
|
$1,371.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
58558
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$507.27 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna American Axle |
$891.15
|
| Rate for Payer: Aetna Commercial |
$1,165.35
|
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$891.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cofinity Commercial |
$959.70
|
| Rate for Payer: Cofinity Commercial |
$1,179.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$959.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,096.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$1,233.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$959.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,028.25
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,165.35
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Commercial |
$1,165.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.15
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Priority Health SBD |
$863.73
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Exchange |
$5,926.19
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,662.10
|
| Rate for Payer: UMR Bronson Commercial |
$507.27
|
| Rate for Payer: VA VA |
$3,100.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,028.25
|
|
