|
PR GASTROSTOMY OPEN NEONATAL FOR FEEDING
|
Professional
|
Both
|
$2,132.00
|
|
|
Service Code
|
HCPCS 43831
|
| Min. Negotiated Rate |
$394.90 |
| Max. Negotiated Rate |
$1,385.80 |
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Aetna Medicare |
$612.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$789.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$848.15
|
| Rate for Payer: BCBS Complete |
$414.64
|
| Rate for Payer: BCBS MAPPO |
$588.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,286.41
|
| Rate for Payer: BCN Commercial |
$895.74
|
| Rate for Payer: BCN Medicare Advantage |
$588.99
|
| Rate for Payer: Cash Price |
$1,705.60
|
| Rate for Payer: Cash Price |
$1,705.60
|
| Rate for Payer: Cofinity Commercial |
$789.25
|
| Rate for Payer: Cofinity Commercial |
$848.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$618.44
|
| Rate for Payer: Meridian Medicaid |
$414.64
|
| Rate for Payer: Nomi Health Commercial |
$706.79
|
| Rate for Payer: PACE SWMI |
$588.99
|
| Rate for Payer: PHP Commercial |
$824.59
|
| Rate for Payer: PHP Medicare Advantage |
$588.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$394.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,100.71
|
| Rate for Payer: Priority Health Medicare |
$588.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,100.71
|
| Rate for Payer: Priority Health SBD |
$1,100.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$588.99
|
| Rate for Payer: UHC Medicare Advantage |
$588.99
|
| Rate for Payer: UHCCP Medicaid |
$394.90
|
| Rate for Payer: UMR Bronson Commercial |
$980.72
|
|
|
PR GASTROSTOMY OPEN W/CONSTJ GASTRIC TUBE
|
Professional
|
Both
|
$2,934.00
|
|
|
Service Code
|
HCPCS 43832
|
| Min. Negotiated Rate |
$673.72 |
| Max. Negotiated Rate |
$1,907.10 |
| Rate for Payer: Aetna Commercial |
$1,364.23
|
| Rate for Payer: Aetna Medicare |
$1,058.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,364.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,466.04
|
| Rate for Payer: BCBS Complete |
$707.41
|
| Rate for Payer: BCBS MAPPO |
$1,018.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,303.84
|
| Rate for Payer: BCN Commercial |
$1,523.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,018.08
|
| Rate for Payer: Cash Price |
$2,347.20
|
| Rate for Payer: Cash Price |
$2,347.20
|
| Rate for Payer: Cofinity Commercial |
$1,364.23
|
| Rate for Payer: Cofinity Commercial |
$1,466.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,018.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,068.98
|
| Rate for Payer: Meridian Medicaid |
$707.41
|
| Rate for Payer: Nomi Health Commercial |
$1,221.70
|
| Rate for Payer: PACE SWMI |
$1,018.08
|
| Rate for Payer: PHP Commercial |
$1,425.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,018.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$673.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,907.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,876.88
|
| Rate for Payer: Priority Health Medicare |
$1,018.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,876.88
|
| Rate for Payer: Priority Health SBD |
$1,876.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,018.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,018.08
|
| Rate for Payer: UHCCP Medicaid |
$673.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,349.64
|
|
|
PR GASTROSTOMY OPEN W/O CONSTJ GASTRIC TUBE SPX
|
Professional
|
Both
|
$2,132.00
|
|
|
Service Code
|
HCPCS 43830
|
| Min. Negotiated Rate |
$281.06 |
| Max. Negotiated Rate |
$1,385.80 |
| Rate for Payer: Aetna Commercial |
$912.51
|
| Rate for Payer: Aetna Medicare |
$708.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$912.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$980.61
|
| Rate for Payer: BCBS Complete |
$476.15
|
| Rate for Payer: BCBS MAPPO |
$680.98
|
| Rate for Payer: BCBS Trust/PPO |
$281.06
|
| Rate for Payer: BCN Commercial |
$1,030.14
|
| Rate for Payer: BCN Medicare Advantage |
$680.98
|
| Rate for Payer: Cash Price |
$1,705.60
|
| Rate for Payer: Cash Price |
$1,705.60
|
| Rate for Payer: Cofinity Commercial |
$912.51
|
| Rate for Payer: Cofinity Commercial |
$980.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$680.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$715.03
|
| Rate for Payer: Meridian Medicaid |
$476.15
|
| Rate for Payer: Nomi Health Commercial |
$817.18
|
| Rate for Payer: PACE SWMI |
$680.98
|
| Rate for Payer: PHP Commercial |
$953.37
|
| Rate for Payer: PHP Medicare Advantage |
$680.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,264.18
|
| Rate for Payer: Priority Health Medicare |
$680.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,264.18
|
| Rate for Payer: Priority Health SBD |
$1,264.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$680.98
|
| Rate for Payer: UHC Medicare Advantage |
$680.98
|
| Rate for Payer: UHCCP Medicaid |
$453.48
|
| Rate for Payer: UMR Bronson Commercial |
$980.72
|
|
|
PR GASTROTOMY W/EXPLORATION/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$2,256.00
|
|
|
Service Code
|
HCPCS 43500
|
| Min. Negotiated Rate |
$508.22 |
| Max. Negotiated Rate |
$1,939.39 |
| Rate for Payer: Aetna Commercial |
$1,027.26
|
| Rate for Payer: Aetna Medicare |
$797.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,027.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,103.92
|
| Rate for Payer: BCBS Complete |
$533.63
|
| Rate for Payer: BCBS MAPPO |
$766.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,939.39
|
| Rate for Payer: BCN Commercial |
$1,144.97
|
| Rate for Payer: BCN Medicare Advantage |
$766.61
|
| Rate for Payer: Cash Price |
$1,804.80
|
| Rate for Payer: Cash Price |
$1,804.80
|
| Rate for Payer: Cofinity Commercial |
$1,027.26
|
| Rate for Payer: Cofinity Commercial |
$1,103.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$766.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$804.94
|
| Rate for Payer: Meridian Medicaid |
$533.63
|
| Rate for Payer: Nomi Health Commercial |
$919.93
|
| Rate for Payer: PACE SWMI |
$766.61
|
| Rate for Payer: PHP Commercial |
$1,073.25
|
| Rate for Payer: PHP Medicare Advantage |
$766.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,466.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,412.74
|
| Rate for Payer: Priority Health Medicare |
$766.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,412.74
|
| Rate for Payer: Priority Health SBD |
$1,412.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$766.61
|
| Rate for Payer: UHC Medicare Advantage |
$766.61
|
| Rate for Payer: UHCCP Medicaid |
$508.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,037.76
|
|
|
PR GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER
|
Professional
|
Both
|
$3,976.00
|
|
|
Service Code
|
HCPCS 43501
|
| Min. Negotiated Rate |
$864.57 |
| Max. Negotiated Rate |
$2,584.40 |
| Rate for Payer: Aetna Commercial |
$1,752.75
|
| Rate for Payer: Aetna Medicare |
$1,360.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,752.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,883.55
|
| Rate for Payer: BCBS Complete |
$907.80
|
| Rate for Payer: BCBS MAPPO |
$1,308.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,062.41
|
| Rate for Payer: BCN Commercial |
$1,964.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,308.02
|
| Rate for Payer: Cash Price |
$3,180.80
|
| Rate for Payer: Cash Price |
$3,180.80
|
| Rate for Payer: Cofinity Commercial |
$1,752.75
|
| Rate for Payer: Cofinity Commercial |
$1,883.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,308.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,373.42
|
| Rate for Payer: Meridian Medicaid |
$907.80
|
| Rate for Payer: Nomi Health Commercial |
$1,569.62
|
| Rate for Payer: PACE SWMI |
$1,308.02
|
| Rate for Payer: PHP Commercial |
$1,831.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,308.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$864.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,584.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,420.98
|
| Rate for Payer: Priority Health Medicare |
$1,308.02
|
| Rate for Payer: Priority Health Narrow Network |
$2,420.98
|
| Rate for Payer: Priority Health SBD |
$2,420.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,308.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,308.02
|
| Rate for Payer: UHCCP Medicaid |
$864.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,828.96
|
|
|
PR GEL-ONE
|
Professional
|
Both
|
$1,367.00
|
|
|
Service Code
|
HCPCS J7326
|
| Min. Negotiated Rate |
$506.67 |
| Max. Negotiated Rate |
$1,159.20 |
| Rate for Payer: Aetna Commercial |
$702.18
|
| Rate for Payer: Aetna Medicare |
$544.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$702.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$754.58
|
| Rate for Payer: BCBS Complete |
$546.80
|
| Rate for Payer: BCBS MAPPO |
$524.02
|
| Rate for Payer: BCBS Trust/PPO |
$506.67
|
| Rate for Payer: BCN Commercial |
$1,159.20
|
| Rate for Payer: BCN Medicare Advantage |
$524.02
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Cofinity Commercial |
$702.18
|
| Rate for Payer: Cofinity Commercial |
$754.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$524.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$550.22
|
| Rate for Payer: Nomi Health Commercial |
$628.82
|
| Rate for Payer: PACE SWMI |
$524.02
|
| Rate for Payer: PHP Commercial |
$733.62
|
| Rate for Payer: PHP Medicare Advantage |
$524.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$888.55
|
| Rate for Payer: Priority Health Medicare |
$524.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$524.02
|
| Rate for Payer: UHC Medicare Advantage |
$524.02
|
| Rate for Payer: UMR Bronson Commercial |
$628.82
|
|
|
PR GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 91112
|
| Min. Negotiated Rate |
$66.03 |
| Max. Negotiated Rate |
$2,415.54 |
| Rate for Payer: Aetna Commercial |
$1,813.27
|
| Rate for Payer: Aetna Commercial |
$1,813.27
|
| Rate for Payer: Aetna Medicare |
$1,407.32
|
| Rate for Payer: Aetna Medicare |
$1,407.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,813.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,948.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,948.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,813.27
|
| Rate for Payer: BCBS Complete |
$69.33
|
| Rate for Payer: BCBS Complete |
$69.33
|
| Rate for Payer: BCBS MAPPO |
$1,353.19
|
| Rate for Payer: BCBS MAPPO |
$1,353.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,077.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,077.20
|
| Rate for Payer: BCN Commercial |
$2,415.54
|
| Rate for Payer: BCN Commercial |
$2,415.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,353.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,353.19
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$2,733.60
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$2,733.60
|
| Rate for Payer: Cofinity Commercial |
$1,948.59
|
| Rate for Payer: Cofinity Commercial |
$1,813.27
|
| Rate for Payer: Cofinity Commercial |
$1,813.27
|
| Rate for Payer: Cofinity Commercial |
$1,948.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,353.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,353.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,420.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,420.85
|
| Rate for Payer: Meridian Medicaid |
$69.33
|
| Rate for Payer: Meridian Medicaid |
$69.33
|
| Rate for Payer: Nomi Health Commercial |
$1,623.83
|
| Rate for Payer: Nomi Health Commercial |
$1,623.83
|
| Rate for Payer: PACE SWMI |
$1,353.19
|
| Rate for Payer: PACE SWMI |
$1,353.19
|
| Rate for Payer: PHP Commercial |
$1,894.47
|
| Rate for Payer: PHP Commercial |
$1,894.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,353.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,353.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,221.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,183.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,183.32
|
| Rate for Payer: Priority Health Medicare |
$1,353.19
|
| Rate for Payer: Priority Health Medicare |
$1,353.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,183.32
|
| Rate for Payer: Priority Health Narrow Network |
$2,183.32
|
| Rate for Payer: Priority Health SBD |
$140.22
|
| Rate for Payer: Priority Health SBD |
$140.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,353.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,353.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,353.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,353.19
|
| Rate for Payer: UHCCP Medicaid |
$66.03
|
| Rate for Payer: UHCCP Medicaid |
$66.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,571.82
|
| Rate for Payer: UMR Bronson Commercial |
$90.16
|
|
|
PR GI TRC IMG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R
|
Professional
|
Both
|
$1,618.00
|
|
|
Service Code
|
HCPCS 91110
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$1,091.21 |
| Rate for Payer: Aetna Commercial |
$834.31
|
| Rate for Payer: Aetna Medicare |
$647.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$834.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$896.57
|
| Rate for Payer: BCBS Complete |
$73.80
|
| Rate for Payer: BCBS MAPPO |
$622.62
|
| Rate for Payer: BCBS Trust/PPO |
$910.79
|
| Rate for Payer: BCN Commercial |
$1,091.21
|
| Rate for Payer: BCN Medicare Advantage |
$622.62
|
| Rate for Payer: Cash Price |
$1,294.40
|
| Rate for Payer: Cash Price |
$1,294.40
|
| Rate for Payer: Cofinity Commercial |
$834.31
|
| Rate for Payer: Cofinity Commercial |
$896.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$622.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$653.75
|
| Rate for Payer: Meridian Medicaid |
$73.80
|
| Rate for Payer: Nomi Health Commercial |
$747.14
|
| Rate for Payer: PACE SWMI |
$622.62
|
| Rate for Payer: PHP Commercial |
$871.67
|
| Rate for Payer: PHP Medicare Advantage |
$622.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$990.57
|
| Rate for Payer: Priority Health Medicare |
$622.62
|
| Rate for Payer: Priority Health Narrow Network |
$990.57
|
| Rate for Payer: Priority Health SBD |
$149.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$622.62
|
| Rate for Payer: UHC Medicare Advantage |
$622.62
|
| Rate for Payer: UHCCP Medicaid |
$70.29
|
| Rate for Payer: UMR Bronson Commercial |
$744.28
|
|
|
PR GLOSSECTOMY HEMIGLOSSECTOMY
|
Professional
|
Both
|
$2,388.00
|
|
|
Service Code
|
HCPCS 41130
|
| Min. Negotiated Rate |
$761.81 |
| Max. Negotiated Rate |
$2,339.24 |
| Rate for Payer: Aetna Commercial |
$1,634.44
|
| Rate for Payer: Aetna Medicare |
$1,268.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,634.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,756.41
|
| Rate for Payer: BCBS Complete |
$876.49
|
| Rate for Payer: BCBS MAPPO |
$1,219.73
|
| Rate for Payer: BCBS Trust/PPO |
$761.81
|
| Rate for Payer: BCN Commercial |
$1,923.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,219.73
|
| Rate for Payer: Cash Price |
$1,910.40
|
| Rate for Payer: Cash Price |
$1,910.40
|
| Rate for Payer: Cofinity Commercial |
$1,634.44
|
| Rate for Payer: Cofinity Commercial |
$1,756.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,219.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,280.72
|
| Rate for Payer: Meridian Medicaid |
$876.49
|
| Rate for Payer: Nomi Health Commercial |
$1,463.68
|
| Rate for Payer: PACE SWMI |
$1,219.73
|
| Rate for Payer: PHP Commercial |
$1,707.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,219.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$834.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,552.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,339.24
|
| Rate for Payer: Priority Health Medicare |
$1,219.73
|
| Rate for Payer: Priority Health Narrow Network |
$2,339.24
|
| Rate for Payer: Priority Health SBD |
$2,339.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,219.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,219.73
|
| Rate for Payer: UHCCP Medicaid |
$834.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,098.48
|
|
|
PR GLOSSECTOMY <ONE-HALF TONGUE
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 41120
|
| Min. Negotiated Rate |
$640.83 |
| Max. Negotiated Rate |
$1,891.20 |
| Rate for Payer: Aetna Commercial |
$1,311.81
|
| Rate for Payer: Aetna Medicare |
$1,018.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,311.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,409.70
|
| Rate for Payer: BCBS Complete |
$708.30
|
| Rate for Payer: BCBS MAPPO |
$978.96
|
| Rate for Payer: BCBS Trust/PPO |
$640.83
|
| Rate for Payer: BCN Commercial |
$1,557.41
|
| Rate for Payer: BCN Medicare Advantage |
$978.96
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cofinity Commercial |
$1,311.81
|
| Rate for Payer: Cofinity Commercial |
$1,409.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$978.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,027.91
|
| Rate for Payer: Meridian Medicaid |
$708.30
|
| Rate for Payer: Nomi Health Commercial |
$1,174.75
|
| Rate for Payer: PACE SWMI |
$978.96
|
| Rate for Payer: PHP Commercial |
$1,370.54
|
| Rate for Payer: PHP Medicare Advantage |
$978.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,235.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,891.20
|
| Rate for Payer: Priority Health Medicare |
$978.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,891.20
|
| Rate for Payer: Priority Health SBD |
$1,891.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$978.96
|
| Rate for Payer: UHC Medicare Advantage |
$978.96
|
| Rate for Payer: UHCCP Medicaid |
$674.57
|
| Rate for Payer: UMR Bronson Commercial |
$874.00
|
|
|
PR GLOSSECTOMY PRTL W/UNI RADICAL NECK DSJ
|
Professional
|
Both
|
$3,945.00
|
|
|
Service Code
|
HCPCS 41135
|
| Min. Negotiated Rate |
$438.49 |
| Max. Negotiated Rate |
$3,855.19 |
| Rate for Payer: Aetna Commercial |
$2,715.38
|
| Rate for Payer: Aetna Medicare |
$2,107.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,715.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,918.02
|
| Rate for Payer: BCBS Complete |
$1,444.33
|
| Rate for Payer: BCBS MAPPO |
$2,026.40
|
| Rate for Payer: BCBS Trust/PPO |
$438.49
|
| Rate for Payer: BCN Commercial |
$3,161.74
|
| Rate for Payer: BCN Medicare Advantage |
$2,026.40
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Cofinity Commercial |
$2,715.38
|
| Rate for Payer: Cofinity Commercial |
$2,918.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,026.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,127.72
|
| Rate for Payer: Meridian Medicaid |
$1,444.33
|
| Rate for Payer: Nomi Health Commercial |
$2,431.68
|
| Rate for Payer: PACE SWMI |
$2,026.40
|
| Rate for Payer: PHP Commercial |
$2,836.96
|
| Rate for Payer: PHP Medicare Advantage |
$2,026.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,375.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,564.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,855.19
|
| Rate for Payer: Priority Health Medicare |
$2,026.40
|
| Rate for Payer: Priority Health Narrow Network |
$3,855.19
|
| Rate for Payer: Priority Health SBD |
$3,855.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,026.40
|
| Rate for Payer: UHC Medicare Advantage |
$2,026.40
|
| Rate for Payer: UHCCP Medicaid |
$1,375.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,814.70
|
|
|
PR GLSSC COMPOSIT W/RESCJ FLOOR & MANDIBULAR RESCJ
|
Professional
|
Both
|
$4,098.00
|
|
|
Service Code
|
HCPCS 41150
|
| Min. Negotiated Rate |
$567.92 |
| Max. Negotiated Rate |
$3,911.86 |
| Rate for Payer: Aetna Commercial |
$2,751.07
|
| Rate for Payer: Aetna Medicare |
$2,135.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,751.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,956.38
|
| Rate for Payer: BCBS Complete |
$1,464.91
|
| Rate for Payer: BCBS MAPPO |
$2,053.04
|
| Rate for Payer: BCBS Trust/PPO |
$567.92
|
| Rate for Payer: BCN Commercial |
$3,210.12
|
| Rate for Payer: BCN Medicare Advantage |
$2,053.04
|
| Rate for Payer: Cash Price |
$3,278.40
|
| Rate for Payer: Cash Price |
$3,278.40
|
| Rate for Payer: Cofinity Commercial |
$2,751.07
|
| Rate for Payer: Cofinity Commercial |
$2,956.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,053.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,155.69
|
| Rate for Payer: Meridian Medicaid |
$1,464.91
|
| Rate for Payer: Nomi Health Commercial |
$2,463.65
|
| Rate for Payer: PACE SWMI |
$2,053.04
|
| Rate for Payer: PHP Commercial |
$2,874.26
|
| Rate for Payer: PHP Medicare Advantage |
$2,053.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,395.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,663.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,911.86
|
| Rate for Payer: Priority Health Medicare |
$2,053.04
|
| Rate for Payer: Priority Health Narrow Network |
$3,911.86
|
| Rate for Payer: Priority Health SBD |
$3,911.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,053.04
|
| Rate for Payer: UHC Medicare Advantage |
$2,053.04
|
| Rate for Payer: UHCCP Medicaid |
$1,395.15
|
| Rate for Payer: UMR Bronson Commercial |
$1,885.08
|
|
|
PR GONIOSCOPY SEPARATE PROCEDURE
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 92020
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$1,100.98 |
| Rate for Payer: Aetna Commercial |
$25.23
|
| Rate for Payer: Aetna Medicare |
$19.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.12
|
| Rate for Payer: BCBS Complete |
$13.42
|
| Rate for Payer: BCBS MAPPO |
$18.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,100.98
|
| Rate for Payer: BCN Commercial |
$29.38
|
| Rate for Payer: BCN Medicare Advantage |
$18.83
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$25.23
|
| Rate for Payer: Cofinity Commercial |
$27.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.77
|
| Rate for Payer: Meridian Medicaid |
$13.42
|
| Rate for Payer: Nomi Health Commercial |
$22.60
|
| Rate for Payer: PACE SWMI |
$18.83
|
| Rate for Payer: PHP Commercial |
$26.36
|
| Rate for Payer: PHP Medicare Advantage |
$18.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.91
|
| Rate for Payer: Priority Health Medicare |
$18.83
|
| Rate for Payer: Priority Health Narrow Network |
$24.91
|
| Rate for Payer: Priority Health SBD |
$24.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.83
|
| Rate for Payer: UHC Medicare Advantage |
$18.83
|
| Rate for Payer: UHCCP Medicaid |
$12.78
|
| Rate for Payer: UMR Bronson Commercial |
$23.92
|
|
|
PR GRAFT COMPOSITE W/PRIMARY CLOSURE DONOR AREA
|
Professional
|
Both
|
$1,703.00
|
|
|
Service Code
|
HCPCS 15760
|
| Min. Negotiated Rate |
$449.86 |
| Max. Negotiated Rate |
$12,622.63 |
| Rate for Payer: Aetna Commercial |
$887.55
|
| Rate for Payer: Aetna Medicare |
$688.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$887.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$953.78
|
| Rate for Payer: BCBS Complete |
$472.35
|
| Rate for Payer: BCBS MAPPO |
$662.35
|
| Rate for Payer: BCBS Trust/PPO |
$12,622.63
|
| Rate for Payer: BCN Commercial |
$1,239.29
|
| Rate for Payer: BCN Medicare Advantage |
$662.35
|
| Rate for Payer: Cash Price |
$1,362.40
|
| Rate for Payer: Cash Price |
$1,362.40
|
| Rate for Payer: Cofinity Commercial |
$887.55
|
| Rate for Payer: Cofinity Commercial |
$953.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$662.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$695.47
|
| Rate for Payer: Meridian Medicaid |
$472.35
|
| Rate for Payer: Nomi Health Commercial |
$794.82
|
| Rate for Payer: PACE SWMI |
$662.35
|
| Rate for Payer: PHP Commercial |
$927.29
|
| Rate for Payer: PHP Medicare Advantage |
$662.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$449.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,106.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$946.83
|
| Rate for Payer: Priority Health Medicare |
$662.35
|
| Rate for Payer: Priority Health Narrow Network |
$946.83
|
| Rate for Payer: Priority Health SBD |
$946.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$662.35
|
| Rate for Payer: UHC Medicare Advantage |
$662.35
|
| Rate for Payer: UHCCP Medicaid |
$449.86
|
| Rate for Payer: UMR Bronson Commercial |
$783.38
|
|
|
PR GRAFT DERMA-FAT-FASCIA
|
Professional
|
Both
|
$1,469.00
|
|
|
Service Code
|
HCPCS 15770
|
| Min. Negotiated Rate |
$435.80 |
| Max. Negotiated Rate |
$12,622.63 |
| Rate for Payer: Aetna Commercial |
$859.15
|
| Rate for Payer: Aetna Medicare |
$666.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$859.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.27
|
| Rate for Payer: BCBS Complete |
$457.59
|
| Rate for Payer: BCBS MAPPO |
$641.16
|
| Rate for Payer: BCBS Trust/PPO |
$12,622.63
|
| Rate for Payer: BCN Commercial |
$982.24
|
| Rate for Payer: BCN Medicare Advantage |
$641.16
|
| Rate for Payer: Cash Price |
$1,175.20
|
| Rate for Payer: Cash Price |
$1,175.20
|
| Rate for Payer: Cofinity Commercial |
$859.15
|
| Rate for Payer: Cofinity Commercial |
$923.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$673.22
|
| Rate for Payer: Meridian Medicaid |
$457.59
|
| Rate for Payer: Nomi Health Commercial |
$769.39
|
| Rate for Payer: PACE SWMI |
$641.16
|
| Rate for Payer: PHP Commercial |
$897.62
|
| Rate for Payer: PHP Medicare Advantage |
$641.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$435.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$917.03
|
| Rate for Payer: Priority Health Medicare |
$641.16
|
| Rate for Payer: Priority Health Narrow Network |
$917.03
|
| Rate for Payer: Priority Health SBD |
$917.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.16
|
| Rate for Payer: UHC Medicare Advantage |
$641.16
|
| Rate for Payer: UHCCP Medicaid |
$435.80
|
| Rate for Payer: UMR Bronson Commercial |
$675.74
|
|
|
PR GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 21235
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$1,079.00 |
| Rate for Payer: Aetna Commercial |
$724.54
|
| Rate for Payer: Aetna Medicare |
$562.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$778.61
|
| Rate for Payer: BCBS Complete |
$387.37
|
| Rate for Payer: BCBS MAPPO |
$540.70
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$1,079.00
|
| Rate for Payer: BCN Medicare Advantage |
$540.70
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cofinity Commercial |
$724.54
|
| Rate for Payer: Cofinity Commercial |
$778.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$540.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$567.74
|
| Rate for Payer: Meridian Medicaid |
$387.37
|
| Rate for Payer: Nomi Health Commercial |
$648.84
|
| Rate for Payer: PACE SWMI |
$540.70
|
| Rate for Payer: PHP Commercial |
$756.98
|
| Rate for Payer: PHP Medicare Advantage |
$540.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$877.28
|
| Rate for Payer: Priority Health Medicare |
$540.70
|
| Rate for Payer: Priority Health Narrow Network |
$877.28
|
| Rate for Payer: Priority Health SBD |
$877.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$540.70
|
| Rate for Payer: UHC Medicare Advantage |
$540.70
|
| Rate for Payer: UHCCP Medicaid |
$368.92
|
| Rate for Payer: UMR Bronson Commercial |
$563.50
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 25 CC OR LESS
|
Professional
|
Both
|
$1,168.00
|
|
|
Service Code
|
HCPCS 15773
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$873.76 |
| Rate for Payer: Aetna Commercial |
$642.37
|
| Rate for Payer: Aetna Medicare |
$498.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$642.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$690.31
|
| Rate for Payer: BCBS Complete |
$341.51
|
| Rate for Payer: BCBS MAPPO |
$479.38
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$873.76
|
| Rate for Payer: BCN Medicare Advantage |
$479.38
|
| Rate for Payer: Cash Price |
$934.40
|
| Rate for Payer: Cash Price |
$934.40
|
| Rate for Payer: Cofinity Commercial |
$642.37
|
| Rate for Payer: Cofinity Commercial |
$690.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$479.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$503.35
|
| Rate for Payer: Meridian Medicaid |
$341.51
|
| Rate for Payer: Nomi Health Commercial |
$575.26
|
| Rate for Payer: PACE SWMI |
$479.38
|
| Rate for Payer: PHP Commercial |
$671.13
|
| Rate for Payer: PHP Medicare Advantage |
$479.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$682.24
|
| Rate for Payer: Priority Health Medicare |
$479.38
|
| Rate for Payer: Priority Health Narrow Network |
$682.24
|
| Rate for Payer: Priority Health SBD |
$682.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$479.38
|
| Rate for Payer: UHC Medicare Advantage |
$479.38
|
| Rate for Payer: UHCCP Medicaid |
$325.25
|
| Rate for Payer: UMR Bronson Commercial |
$537.28
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 50 CC OR LESS
|
Professional
|
Both
|
$1,157.00
|
|
|
Service Code
|
HCPCS 15771
|
| Min. Negotiated Rate |
$332.49 |
| Max. Negotiated Rate |
$889.40 |
| Rate for Payer: Aetna Commercial |
$656.55
|
| Rate for Payer: Aetna Medicare |
$509.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$656.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$705.54
|
| Rate for Payer: BCBS Complete |
$349.11
|
| Rate for Payer: BCBS MAPPO |
$489.96
|
| Rate for Payer: BCBS Trust/PPO |
$529.69
|
| Rate for Payer: BCN Commercial |
$889.40
|
| Rate for Payer: BCN Medicare Advantage |
$489.96
|
| Rate for Payer: Cash Price |
$925.60
|
| Rate for Payer: Cash Price |
$925.60
|
| Rate for Payer: Cofinity Commercial |
$656.55
|
| Rate for Payer: Cofinity Commercial |
$705.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$514.46
|
| Rate for Payer: Meridian Medicaid |
$349.11
|
| Rate for Payer: Nomi Health Commercial |
$587.95
|
| Rate for Payer: PACE SWMI |
$489.96
|
| Rate for Payer: PHP Commercial |
$685.94
|
| Rate for Payer: PHP Medicare Advantage |
$489.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$752.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$697.14
|
| Rate for Payer: Priority Health Medicare |
$489.96
|
| Rate for Payer: Priority Health Narrow Network |
$697.14
|
| Rate for Payer: Priority Health SBD |
$697.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$489.96
|
| Rate for Payer: UHC Medicare Advantage |
$489.96
|
| Rate for Payer: UHCCP Medicaid |
$332.49
|
| Rate for Payer: UMR Bronson Commercial |
$532.22
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 25 CC
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 15774
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$273.17 |
| Rate for Payer: Aetna Commercial |
$185.62
|
| Rate for Payer: Aetna Medicare |
$144.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.47
|
| Rate for Payer: BCBS Complete |
$96.84
|
| Rate for Payer: BCBS MAPPO |
$138.52
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$273.17
|
| Rate for Payer: BCN Medicare Advantage |
$138.52
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cofinity Commercial |
$185.62
|
| Rate for Payer: Cofinity Commercial |
$199.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.45
|
| Rate for Payer: Meridian Medicaid |
$96.84
|
| Rate for Payer: Nomi Health Commercial |
$166.22
|
| Rate for Payer: PACE SWMI |
$138.52
|
| Rate for Payer: PHP Commercial |
$193.93
|
| Rate for Payer: PHP Medicare Advantage |
$138.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.34
|
| Rate for Payer: Priority Health Medicare |
$138.52
|
| Rate for Payer: Priority Health Narrow Network |
$192.34
|
| Rate for Payer: Priority Health SBD |
$192.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.52
|
| Rate for Payer: UHC Medicare Advantage |
$138.52
|
| Rate for Payer: UHCCP Medicaid |
$92.23
|
| Rate for Payer: UMR Bronson Commercial |
$163.76
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 50 CC
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 15772
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$6,614.63 |
| Rate for Payer: Aetna Commercial |
$191.61
|
| Rate for Payer: Aetna Medicare |
$148.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.91
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS MAPPO |
$142.99
|
| Rate for Payer: BCBS Trust/PPO |
$6,614.63
|
| Rate for Payer: BCN Commercial |
$279.04
|
| Rate for Payer: BCN Medicare Advantage |
$142.99
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cofinity Commercial |
$191.61
|
| Rate for Payer: Cofinity Commercial |
$205.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.14
|
| Rate for Payer: Meridian Medicaid |
$99.97
|
| Rate for Payer: Nomi Health Commercial |
$171.59
|
| Rate for Payer: PACE SWMI |
$142.99
|
| Rate for Payer: PHP Commercial |
$200.19
|
| Rate for Payer: PHP Medicare Advantage |
$142.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$199.12
|
| Rate for Payer: Priority Health Medicare |
$142.99
|
| Rate for Payer: Priority Health Narrow Network |
$199.12
|
| Rate for Payer: Priority Health SBD |
$199.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.99
|
| Rate for Payer: UHC Medicare Advantage |
$142.99
|
| Rate for Payer: UHCCP Medicaid |
$95.21
|
| Rate for Payer: UMR Bronson Commercial |
$168.82
|
|
|
PR GRAFTING OF AUTOLOGOUS SOFT TISS BY DIRECT EXC
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 15769
|
| Min. Negotiated Rate |
$310.77 |
| Max. Negotiated Rate |
$703.20 |
| Rate for Payer: Aetna Commercial |
$615.96
|
| Rate for Payer: Aetna Medicare |
$478.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.92
|
| Rate for Payer: BCBS Complete |
$326.31
|
| Rate for Payer: BCBS MAPPO |
$459.67
|
| Rate for Payer: BCBS Trust/PPO |
$543.75
|
| Rate for Payer: BCN Commercial |
$703.20
|
| Rate for Payer: BCN Medicare Advantage |
$459.67
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cofinity Commercial |
$615.96
|
| Rate for Payer: Cofinity Commercial |
$661.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$459.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$482.65
|
| Rate for Payer: Meridian Medicaid |
$326.31
|
| Rate for Payer: Nomi Health Commercial |
$551.60
|
| Rate for Payer: PACE SWMI |
$459.67
|
| Rate for Payer: PHP Commercial |
$643.54
|
| Rate for Payer: PHP Medicare Advantage |
$459.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$310.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$653.79
|
| Rate for Payer: Priority Health Medicare |
$459.67
|
| Rate for Payer: Priority Health Narrow Network |
$653.79
|
| Rate for Payer: Priority Health SBD |
$653.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$459.67
|
| Rate for Payer: UHC Medicare Advantage |
$459.67
|
| Rate for Payer: UHCCP Medicaid |
$310.77
|
| Rate for Payer: UMR Bronson Commercial |
$448.50
|
|
|
PR GRAFT THIERSCH RCT INCONTINENCE &/PROLAPSE
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 46753
|
| Min. Negotiated Rate |
$402.14 |
| Max. Negotiated Rate |
$1,116.23 |
| Rate for Payer: Aetna Commercial |
$805.35
|
| Rate for Payer: Aetna Medicare |
$625.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$865.45
|
| Rate for Payer: BCBS Complete |
$422.25
|
| Rate for Payer: BCBS MAPPO |
$601.01
|
| Rate for Payer: BCBS Trust/PPO |
$586.41
|
| Rate for Payer: BCN Commercial |
$910.89
|
| Rate for Payer: BCN Medicare Advantage |
$601.01
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cofinity Commercial |
$865.45
|
| Rate for Payer: Cofinity Commercial |
$805.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$601.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$631.06
|
| Rate for Payer: Meridian Medicaid |
$422.25
|
| Rate for Payer: Nomi Health Commercial |
$721.21
|
| Rate for Payer: PACE SWMI |
$601.01
|
| Rate for Payer: PHP Commercial |
$841.41
|
| Rate for Payer: PHP Medicare Advantage |
$601.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$402.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$780.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,116.23
|
| Rate for Payer: Priority Health Medicare |
$601.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,116.23
|
| Rate for Payer: Priority Health SBD |
$1,116.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$601.01
|
| Rate for Payer: UHC Medicare Advantage |
$601.01
|
| Rate for Payer: UHCCP Medicaid |
$402.14
|
| Rate for Payer: UMR Bronson Commercial |
$552.00
|
|
|
PR GROUP BEHAVE COUNS 2-10
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS G0473
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$3,048.82 |
| Rate for Payer: Aetna Commercial |
$14.43
|
| Rate for Payer: Aetna Medicare |
$11.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.51
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$10.77
|
| Rate for Payer: BCBS Trust/PPO |
$3,048.82
|
| Rate for Payer: BCN Commercial |
$18.08
|
| Rate for Payer: BCN Medicare Advantage |
$10.77
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Cofinity Commercial |
$14.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.31
|
| Rate for Payer: Nomi Health Commercial |
$12.92
|
| Rate for Payer: PACE SWMI |
$10.77
|
| Rate for Payer: PHP Commercial |
$15.08
|
| Rate for Payer: PHP Medicare Advantage |
$10.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.10
|
| Rate for Payer: Priority Health Medicare |
$10.77
|
| Rate for Payer: Priority Health Narrow Network |
$15.10
|
| Rate for Payer: Priority Health SBD |
$15.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.77
|
| Rate for Payer: UHC Medicare Advantage |
$10.77
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
|
|
PR GROUP PSYCHOTHERAPY
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 90853
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$1,235.69 |
| Rate for Payer: Aetna Commercial |
$32.35
|
| Rate for Payer: Aetna Medicare |
$25.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.76
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS MAPPO |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,235.69
|
| Rate for Payer: BCN Commercial |
$31.02
|
| Rate for Payer: BCN Medicare Advantage |
$24.14
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$32.35
|
| Rate for Payer: Cofinity Commercial |
$34.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.35
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Nomi Health Commercial |
$28.97
|
| Rate for Payer: PACE SWMI |
$24.14
|
| Rate for Payer: PHP Commercial |
$33.80
|
| Rate for Payer: PHP Medicare Advantage |
$24.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.48
|
| Rate for Payer: Priority Health Medicare |
$24.14
|
| Rate for Payer: Priority Health Narrow Network |
$33.48
|
| Rate for Payer: Priority Health SBD |
$33.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.14
|
| Rate for Payer: UHC Medicare Advantage |
$24.14
|
| Rate for Payer: UHCCP Medicaid |
$15.98
|
| Rate for Payer: UMR Bronson Commercial |
$25.30
|
|
|
PR GSTRCT PRTL DSTL W/GASTRODUODENOSTOMY
|
Professional
|
Both
|
$2,608.00
|
|
|
Service Code
|
HCPCS 43631
|
| Min. Negotiated Rate |
$790.34 |
| Max. Negotiated Rate |
$2,593.40 |
| Rate for Payer: Aetna Commercial |
$1,891.48
|
| Rate for Payer: Aetna Medicare |
$1,468.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,891.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,032.63
|
| Rate for Payer: BCBS Complete |
$978.92
|
| Rate for Payer: BCBS MAPPO |
$1,411.55
|
| Rate for Payer: BCBS Trust/PPO |
$790.34
|
| Rate for Payer: BCN Commercial |
$2,109.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,411.55
|
| Rate for Payer: Cash Price |
$2,086.40
|
| Rate for Payer: Cash Price |
$2,086.40
|
| Rate for Payer: Cofinity Commercial |
$1,891.48
|
| Rate for Payer: Cofinity Commercial |
$2,032.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,411.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,482.13
|
| Rate for Payer: Meridian Medicaid |
$978.92
|
| Rate for Payer: Nomi Health Commercial |
$1,693.86
|
| Rate for Payer: PACE SWMI |
$1,411.55
|
| Rate for Payer: PHP Commercial |
$1,976.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,411.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$932.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,695.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,593.40
|
| Rate for Payer: Priority Health Medicare |
$1,411.55
|
| Rate for Payer: Priority Health Narrow Network |
$2,593.40
|
| Rate for Payer: Priority Health SBD |
$2,593.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,411.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,411.55
|
| Rate for Payer: UHCCP Medicaid |
$932.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,199.68
|
|
