|
PR LATISSE
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 00267
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$118.95 |
| Rate for Payer: Aetna Medicare |
$91.50
|
| Rate for Payer: BCBS Complete |
$73.20
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: UMR Bronson Commercial |
$84.18
|
|
|
PR LAVAGE CANNULATION MAXILLARY SINUS
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 31000
|
| Min. Negotiated Rate |
$71.57 |
| Max. Negotiated Rate |
$694.71 |
| Rate for Payer: Aetna Commercial |
$139.12
|
| Rate for Payer: Aetna Medicare |
$107.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.50
|
| Rate for Payer: BCBS Complete |
$75.15
|
| Rate for Payer: BCBS MAPPO |
$103.82
|
| Rate for Payer: BCBS Trust/PPO |
$694.71
|
| Rate for Payer: BCN Commercial |
$274.15
|
| Rate for Payer: BCN Medicare Advantage |
$103.82
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cofinity Commercial |
$149.50
|
| Rate for Payer: Cofinity Commercial |
$139.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.01
|
| Rate for Payer: Meridian Medicaid |
$75.15
|
| Rate for Payer: Nomi Health Commercial |
$124.58
|
| Rate for Payer: PACE SWMI |
$103.82
|
| Rate for Payer: PHP Commercial |
$145.35
|
| Rate for Payer: PHP Medicare Advantage |
$103.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.26
|
| Rate for Payer: Priority Health Medicare |
$103.82
|
| Rate for Payer: Priority Health Narrow Network |
$155.26
|
| Rate for Payer: Priority Health SBD |
$155.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.82
|
| Rate for Payer: UHC Medicare Advantage |
$103.82
|
| Rate for Payer: UHCCP Medicaid |
$71.57
|
| Rate for Payer: UMR Bronson Commercial |
$134.32
|
|
|
PR LAVAGE CANNULATION SPHENOID SINUS
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 31002
|
| Min. Negotiated Rate |
$119.49 |
| Max. Negotiated Rate |
$689.96 |
| Rate for Payer: Aetna Commercial |
$231.35
|
| Rate for Payer: Aetna Medicare |
$179.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.62
|
| Rate for Payer: BCBS Complete |
$125.46
|
| Rate for Payer: BCBS MAPPO |
$172.65
|
| Rate for Payer: BCBS Trust/PPO |
$689.96
|
| Rate for Payer: BCN Commercial |
$282.46
|
| Rate for Payer: BCN Medicare Advantage |
$172.65
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$231.35
|
| Rate for Payer: Cofinity Commercial |
$248.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.28
|
| Rate for Payer: Meridian Medicaid |
$125.46
|
| Rate for Payer: Nomi Health Commercial |
$207.18
|
| Rate for Payer: PACE SWMI |
$172.65
|
| Rate for Payer: PHP Commercial |
$241.71
|
| Rate for Payer: PHP Medicare Advantage |
$172.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$264.64
|
| Rate for Payer: Priority Health Medicare |
$172.65
|
| Rate for Payer: Priority Health Narrow Network |
$264.64
|
| Rate for Payer: Priority Health SBD |
$264.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.65
|
| Rate for Payer: UHC Medicare Advantage |
$172.65
|
| Rate for Payer: UHCCP Medicaid |
$119.49
|
| Rate for Payer: UMR Bronson Commercial |
$155.02
|
|
|
PR LEFT HEART CATH BY TRANSEPTAL PUNCTURE
|
Professional
|
Both
|
$442.00
|
|
|
Service Code
|
HCPCS 93462
|
| Min. Negotiated Rate |
$129.08 |
| Max. Negotiated Rate |
$548.90 |
| Rate for Payer: Aetna Commercial |
$263.11
|
| Rate for Payer: Aetna Medicare |
$204.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.74
|
| Rate for Payer: BCBS Complete |
$135.53
|
| Rate for Payer: BCBS MAPPO |
$196.35
|
| Rate for Payer: BCBS Trust/PPO |
$548.90
|
| Rate for Payer: BCN Commercial |
$298.58
|
| Rate for Payer: BCN Medicare Advantage |
$196.35
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cofinity Commercial |
$263.11
|
| Rate for Payer: Cofinity Commercial |
$282.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.17
|
| Rate for Payer: Meridian Medicaid |
$135.53
|
| Rate for Payer: Nomi Health Commercial |
$235.62
|
| Rate for Payer: PACE SWMI |
$196.35
|
| Rate for Payer: PHP Commercial |
$274.89
|
| Rate for Payer: PHP Medicare Advantage |
$196.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$285.32
|
| Rate for Payer: Priority Health Medicare |
$196.35
|
| Rate for Payer: Priority Health Narrow Network |
$285.32
|
| Rate for Payer: Priority Health SBD |
$285.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.35
|
| Rate for Payer: UHC Medicare Advantage |
$196.35
|
| Rate for Payer: UHCCP Medicaid |
$129.08
|
| Rate for Payer: UMR Bronson Commercial |
$203.32
|
|
|
PR LENGTHENING TENDON EXTENSOR HAND/FINGER EACH
|
Professional
|
Both
|
$1,348.00
|
|
|
Service Code
|
HCPCS 26476
|
| Min. Negotiated Rate |
$415.14 |
| Max. Negotiated Rate |
$1,727.54 |
| Rate for Payer: Aetna Commercial |
$802.73
|
| Rate for Payer: Aetna Medicare |
$623.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.63
|
| Rate for Payer: BCBS Complete |
$435.90
|
| Rate for Payer: BCBS MAPPO |
$599.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,727.54
|
| Rate for Payer: BCN Commercial |
$959.76
|
| Rate for Payer: BCN Medicare Advantage |
$599.05
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cofinity Commercial |
$802.73
|
| Rate for Payer: Cofinity Commercial |
$862.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.00
|
| Rate for Payer: Meridian Medicaid |
$435.90
|
| Rate for Payer: Nomi Health Commercial |
$718.86
|
| Rate for Payer: PACE SWMI |
$599.05
|
| Rate for Payer: PHP Commercial |
$838.67
|
| Rate for Payer: PHP Medicare Advantage |
$599.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$415.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$998.89
|
| Rate for Payer: Priority Health Medicare |
$599.05
|
| Rate for Payer: Priority Health Narrow Network |
$998.89
|
| Rate for Payer: Priority Health SBD |
$998.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.05
|
| Rate for Payer: UHC Medicare Advantage |
$599.05
|
| Rate for Payer: UHCCP Medicaid |
$415.14
|
| Rate for Payer: UMR Bronson Commercial |
$620.08
|
|
|
PR LENGTHENING TENDON FLEXOR HAND/FINGER EACH
|
Professional
|
Both
|
$2,040.00
|
|
|
Service Code
|
HCPCS 26478
|
| Min. Negotiated Rate |
$425.79 |
| Max. Negotiated Rate |
$1,326.00 |
| Rate for Payer: Aetna Commercial |
$824.86
|
| Rate for Payer: Aetna Medicare |
$640.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$824.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$886.42
|
| Rate for Payer: BCBS Complete |
$447.08
|
| Rate for Payer: BCBS MAPPO |
$615.57
|
| Rate for Payer: BCBS Trust/PPO |
$878.03
|
| Rate for Payer: BCN Commercial |
$989.08
|
| Rate for Payer: BCN Medicare Advantage |
$615.57
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cofinity Commercial |
$824.86
|
| Rate for Payer: Cofinity Commercial |
$886.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.35
|
| Rate for Payer: Meridian Medicaid |
$447.08
|
| Rate for Payer: Nomi Health Commercial |
$738.68
|
| Rate for Payer: PACE SWMI |
$615.57
|
| Rate for Payer: PHP Commercial |
$861.80
|
| Rate for Payer: PHP Medicare Advantage |
$615.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$425.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,019.25
|
| Rate for Payer: Priority Health Medicare |
$615.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,019.25
|
| Rate for Payer: Priority Health SBD |
$1,019.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.57
|
| Rate for Payer: UHC Medicare Advantage |
$615.57
|
| Rate for Payer: UHCCP Medicaid |
$425.79
|
| Rate for Payer: UMR Bronson Commercial |
$938.40
|
|
|
PR LESION <15
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 00074
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
| Rate for Payer: UMR Bronson Commercial |
$58.88
|
|
|
PR LESION FL FACE/NECK
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00075
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: UMR Bronson Commercial |
$117.30
|
|
|
PR LESION REMOVAL COLONOSCOPY
|
Professional
|
Both
|
$1,584.00
|
|
|
Service Code
|
HCPCS G6024
|
| Min. Negotiated Rate |
$633.60 |
| Max. Negotiated Rate |
$1,029.60 |
| Rate for Payer: Aetna Medicare |
$792.00
|
| Rate for Payer: BCBS Complete |
$633.60
|
| Rate for Payer: Cash Price |
$1,267.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,029.60
|
| Rate for Payer: UMR Bronson Commercial |
$728.64
|
|
|
PR LESION SINGLE
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 00073
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
PR LEUPROLIDE ACETATE /3.75 MG
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
HCPCS J1950
|
| Min. Negotiated Rate |
$441.20 |
| Max. Negotiated Rate |
$2,501.42 |
| Rate for Payer: Aetna Commercial |
$2,327.71
|
| Rate for Payer: Aetna Medicare |
$1,806.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,327.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,501.42
|
| Rate for Payer: BCBS Complete |
$441.20
|
| Rate for Payer: BCBS MAPPO |
$1,737.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,111.82
|
| Rate for Payer: BCN Commercial |
$1,126.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,737.10
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cofinity Commercial |
$2,501.42
|
| Rate for Payer: Cofinity Commercial |
$2,327.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,737.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,823.95
|
| Rate for Payer: Nomi Health Commercial |
$2,084.52
|
| Rate for Payer: PACE SWMI |
$1,737.10
|
| Rate for Payer: PHP Commercial |
$2,431.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,737.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.95
|
| Rate for Payer: Priority Health Medicare |
$1,737.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,737.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,737.10
|
| Rate for Payer: UMR Bronson Commercial |
$507.38
|
|
|
PR LEUPROLIDE ACETATE INJECITON
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS J9218
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Aetna Commercial |
$14.16
|
| Rate for Payer: Aetna Medicare |
$19.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.16
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Trust/PPO |
$13.04
|
| Rate for Payer: BCN Commercial |
$7.60
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: UMR Bronson Commercial |
$17.48
|
|
|
PR LEUPROLIDE ACETATE SUSPNSION
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS J9217
|
| Min. Negotiated Rate |
$155.42 |
| Max. Negotiated Rate |
$299.65 |
| Rate for Payer: Aetna Commercial |
$208.26
|
| Rate for Payer: Aetna Medicare |
$161.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.80
|
| Rate for Payer: BCBS Complete |
$184.40
|
| Rate for Payer: BCBS MAPPO |
$155.42
|
| Rate for Payer: BCBS Trust/PPO |
$191.56
|
| Rate for Payer: BCN Commercial |
$182.32
|
| Rate for Payer: BCN Medicare Advantage |
$155.42
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$208.26
|
| Rate for Payer: Cofinity Commercial |
$223.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.19
|
| Rate for Payer: Nomi Health Commercial |
$186.50
|
| Rate for Payer: PACE SWMI |
$155.42
|
| Rate for Payer: PHP Commercial |
$217.59
|
| Rate for Payer: PHP Medicare Advantage |
$155.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.65
|
| Rate for Payer: Priority Health Medicare |
$155.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.42
|
| Rate for Payer: UHC Medicare Advantage |
$155.42
|
| Rate for Payer: UMR Bronson Commercial |
$212.06
|
|
|
PR LEVALBUTEROL NON-COMP UNIT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J7614
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$0.12
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.13
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$0.13
|
| Rate for Payer: Cofinity Commercial |
$0.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Nomi Health Commercial |
$0.11
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PHP Commercial |
$0.12
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
|
|
PR LEVONORGESTREL IMPLANT SYS
|
Professional
|
Both
|
$561.00
|
|
|
Service Code
|
HCPCS J7306
|
| Min. Negotiated Rate |
$224.40 |
| Max. Negotiated Rate |
$2,147.54 |
| Rate for Payer: Aetna Commercial |
$406.00
|
| Rate for Payer: Aetna Medicare |
$280.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$406.00
|
| Rate for Payer: BCBS Complete |
$224.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,147.54
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.65
|
| Rate for Payer: UMR Bronson Commercial |
$258.06
|
|
|
PR LEVONORGESTREL IU CONTRACEPT
|
Professional
|
Both
|
$839.00
|
|
|
Service Code
|
HCPCS J7302
|
| Min. Negotiated Rate |
$335.60 |
| Max. Negotiated Rate |
$545.35 |
| Rate for Payer: Aetna Medicare |
$419.50
|
| Rate for Payer: BCBS Complete |
$335.60
|
| Rate for Payer: Cash Price |
$671.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.35
|
| Rate for Payer: UMR Bronson Commercial |
$385.94
|
|
|
PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
|
Professional
|
Both
|
$495.00
|
|
|
Service Code
|
HCPCS 93452
|
| Min. Negotiated Rate |
$146.76 |
| Max. Negotiated Rate |
$1,383.09 |
| Rate for Payer: Aetna Commercial |
$1,040.47
|
| Rate for Payer: Aetna Medicare |
$807.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,040.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,118.12
|
| Rate for Payer: BCBS Complete |
$154.10
|
| Rate for Payer: BCBS MAPPO |
$776.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,383.09
|
| Rate for Payer: BCN Commercial |
$1,319.43
|
| Rate for Payer: BCN Medicare Advantage |
$776.47
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$1,118.12
|
| Rate for Payer: Cofinity Commercial |
$1,040.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$776.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$815.29
|
| Rate for Payer: Meridian Medicaid |
$154.10
|
| Rate for Payer: Nomi Health Commercial |
$931.76
|
| Rate for Payer: PACE SWMI |
$776.47
|
| Rate for Payer: PHP Commercial |
$1,087.06
|
| Rate for Payer: PHP Medicare Advantage |
$776.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,248.65
|
| Rate for Payer: Priority Health Medicare |
$776.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,248.65
|
| Rate for Payer: Priority Health SBD |
$324.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$776.47
|
| Rate for Payer: UHC Medicare Advantage |
$776.47
|
| Rate for Payer: UHCCP Medicaid |
$146.76
|
| Rate for Payer: UMR Bronson Commercial |
$227.70
|
|
|
PR LIDOCAINE INJECTION
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J2001
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$2.40
|
| 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 LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR
|
Professional
|
Both
|
$2,489.00
|
|
|
Service Code
|
HCPCS 27427
|
| Min. Negotiated Rate |
$462.42 |
| Max. Negotiated Rate |
$1,617.85 |
| Rate for Payer: Aetna Commercial |
$916.37
|
| Rate for Payer: Aetna Medicare |
$711.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$916.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$984.76
|
| Rate for Payer: BCBS Complete |
$485.54
|
| Rate for Payer: BCBS MAPPO |
$683.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,194.49
|
| Rate for Payer: BCN Commercial |
$1,046.26
|
| Rate for Payer: BCN Medicare Advantage |
$683.86
|
| Rate for Payer: Cash Price |
$1,991.20
|
| Rate for Payer: Cash Price |
$1,991.20
|
| Rate for Payer: Cofinity Commercial |
$916.37
|
| Rate for Payer: Cofinity Commercial |
$984.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$718.05
|
| Rate for Payer: Meridian Medicaid |
$485.54
|
| Rate for Payer: Nomi Health Commercial |
$820.63
|
| Rate for Payer: PACE SWMI |
$683.86
|
| Rate for Payer: PHP Commercial |
$957.40
|
| Rate for Payer: PHP Medicare Advantage |
$683.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$462.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,617.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,096.60
|
| Rate for Payer: Priority Health Medicare |
$683.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,096.60
|
| Rate for Payer: Priority Health SBD |
$1,096.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$683.86
|
| Rate for Payer: UHC Medicare Advantage |
$683.86
|
| Rate for Payer: UHCCP Medicaid |
$462.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,144.94
|
|
|
PR LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR
|
Professional
|
Both
|
$3,247.00
|
|
|
Service Code
|
HCPCS 27428
|
| Min. Negotiated Rate |
$727.18 |
| Max. Negotiated Rate |
$2,110.55 |
| Rate for Payer: Aetna Commercial |
$1,444.17
|
| Rate for Payer: Aetna Medicare |
$1,120.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,444.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,551.95
|
| Rate for Payer: BCBS Complete |
$763.54
|
| Rate for Payer: BCBS MAPPO |
$1,077.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,728.07
|
| Rate for Payer: BCN Commercial |
$1,639.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,077.74
|
| Rate for Payer: Cash Price |
$2,597.60
|
| Rate for Payer: Cash Price |
$2,597.60
|
| Rate for Payer: Cofinity Commercial |
$1,444.17
|
| Rate for Payer: Cofinity Commercial |
$1,551.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,077.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,131.63
|
| Rate for Payer: Meridian Medicaid |
$763.54
|
| Rate for Payer: Nomi Health Commercial |
$1,293.29
|
| Rate for Payer: PACE SWMI |
$1,077.74
|
| Rate for Payer: PHP Commercial |
$1,508.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,077.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$727.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,110.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,721.99
|
| Rate for Payer: Priority Health Medicare |
$1,077.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,721.99
|
| Rate for Payer: Priority Health SBD |
$1,721.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,077.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,077.74
|
| Rate for Payer: UHCCP Medicaid |
$727.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,493.62
|
|
|
PR LIGATION ARTERIES ETHMOIDAL
|
Professional
|
Both
|
$1,038.00
|
|
|
Service Code
|
HCPCS 30915
|
| Min. Negotiated Rate |
$385.74 |
| Max. Negotiated Rate |
$935.09 |
| Rate for Payer: Aetna Commercial |
$755.96
|
| Rate for Payer: Aetna Medicare |
$586.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$755.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$812.38
|
| Rate for Payer: BCBS Complete |
$405.03
|
| Rate for Payer: BCBS MAPPO |
$564.15
|
| Rate for Payer: BCBS Trust/PPO |
$935.09
|
| Rate for Payer: BCN Commercial |
$892.81
|
| Rate for Payer: BCN Medicare Advantage |
$564.15
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cofinity Commercial |
$755.96
|
| Rate for Payer: Cofinity Commercial |
$812.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.36
|
| Rate for Payer: Meridian Medicaid |
$405.03
|
| Rate for Payer: Nomi Health Commercial |
$676.98
|
| Rate for Payer: PACE SWMI |
$564.15
|
| Rate for Payer: PHP Commercial |
$789.81
|
| Rate for Payer: PHP Medicare Advantage |
$564.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$846.29
|
| Rate for Payer: Priority Health Medicare |
$564.15
|
| Rate for Payer: Priority Health Narrow Network |
$846.29
|
| Rate for Payer: Priority Health SBD |
$846.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$564.15
|
| Rate for Payer: UHC Medicare Advantage |
$564.15
|
| Rate for Payer: UHCCP Medicaid |
$385.74
|
| Rate for Payer: UMR Bronson Commercial |
$477.48
|
|
|
PR LIGATION ARTERIES INT MAXILLARY TRANSANTRAL
|
Professional
|
Both
|
$1,501.00
|
|
|
Service Code
|
HCPCS 30920
|
| Min. Negotiated Rate |
$556.78 |
| Max. Negotiated Rate |
$2,317.12 |
| Rate for Payer: Cash Price |
$1,200.80
|
| Rate for Payer: Aetna Commercial |
$1,093.44
|
| Rate for Payer: Aetna Medicare |
$848.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,093.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,175.04
|
| Rate for Payer: BCBS Complete |
$584.62
|
| Rate for Payer: BCBS MAPPO |
$816.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,317.12
|
| Rate for Payer: BCN Commercial |
$1,291.09
|
| Rate for Payer: BCN Medicare Advantage |
$816.00
|
| Rate for Payer: Cash Price |
$1,200.80
|
| Rate for Payer: Cofinity Commercial |
$1,093.44
|
| Rate for Payer: Cofinity Commercial |
$1,175.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$816.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$856.80
|
| Rate for Payer: Meridian Medicaid |
$584.62
|
| Rate for Payer: Nomi Health Commercial |
$979.20
|
| Rate for Payer: PACE SWMI |
$816.00
|
| Rate for Payer: PHP Commercial |
$1,142.40
|
| Rate for Payer: PHP Medicare Advantage |
$816.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$556.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$975.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,220.77
|
| Rate for Payer: Priority Health Medicare |
$816.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,220.77
|
| Rate for Payer: Priority Health SBD |
$1,220.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$816.00
|
| Rate for Payer: UHC Medicare Advantage |
$816.00
|
| Rate for Payer: UHCCP Medicaid |
$556.78
|
| Rate for Payer: UMR Bronson Commercial |
$690.46
|
|
|
PR LIGATION/BIOPSY TEMPORAL ARTERY
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 37609
|
| Hospital Charge Code |
37609
|
| Min. Negotiated Rate |
$129.93 |
| Max. Negotiated Rate |
$911.85 |
| Rate for Payer: Aetna Commercial |
$259.91
|
| Rate for Payer: Aetna Medicare |
$201.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.30
|
| Rate for Payer: BCBS Complete |
$136.43
|
| Rate for Payer: BCBS MAPPO |
$193.96
|
| Rate for Payer: BCBS Trust/PPO |
$911.85
|
| Rate for Payer: BCN Commercial |
$458.86
|
| Rate for Payer: BCN Medicare Advantage |
$193.96
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cofinity Commercial |
$279.30
|
| Rate for Payer: Cofinity Commercial |
$259.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.66
|
| Rate for Payer: Meridian Medicaid |
$136.43
|
| Rate for Payer: Nomi Health Commercial |
$232.75
|
| Rate for Payer: PACE SWMI |
$193.96
|
| Rate for Payer: PHP Commercial |
$271.54
|
| Rate for Payer: PHP Medicare Advantage |
$193.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$324.95
|
| Rate for Payer: Priority Health Medicare |
$193.96
|
| Rate for Payer: Priority Health Narrow Network |
$324.95
|
| Rate for Payer: Priority Health SBD |
$324.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.96
|
| Rate for Payer: UHC Medicare Advantage |
$193.96
|
| Rate for Payer: UHCCP Medicaid |
$129.93
|
| Rate for Payer: UMR Bronson Commercial |
$414.00
|
|
|
PR LIGATION/BIOPSY TEMPORAL ARTERY
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
37609
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$196.64 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna American Axle |
$585.00
|
| Rate for Payer: Aetna Commercial |
$765.00
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,832.84
|
| Rate for Payer: BCN Commercial |
$2,832.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cofinity Commercial |
$630.00
|
| Rate for Payer: Cofinity Commercial |
$774.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$630.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$810.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$630.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$675.00
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.00
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$765.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$567.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.30
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$196.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: UMR Bronson Commercial |
$333.00
|
| Rate for Payer: VA VA |
$1,587.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$675.00
|
|
|
PR LIGATION/BIOPSY TEMPORAL ARTERY
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 37609
|
| Min. Negotiated Rate |
$129.93 |
| Max. Negotiated Rate |
$911.85 |
| Rate for Payer: Aetna Commercial |
$259.91
|
| Rate for Payer: Aetna Medicare |
$201.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.30
|
| Rate for Payer: BCBS Complete |
$136.43
|
| Rate for Payer: BCBS MAPPO |
$193.96
|
| Rate for Payer: BCBS Trust/PPO |
$911.85
|
| Rate for Payer: BCN Commercial |
$458.86
|
| Rate for Payer: BCN Medicare Advantage |
$193.96
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cofinity Commercial |
$259.91
|
| Rate for Payer: Cofinity Commercial |
$279.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.66
|
| Rate for Payer: Meridian Medicaid |
$136.43
|
| Rate for Payer: Nomi Health Commercial |
$232.75
|
| Rate for Payer: PACE SWMI |
$193.96
|
| Rate for Payer: PHP Commercial |
$271.54
|
| Rate for Payer: PHP Medicare Advantage |
$193.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$324.95
|
| Rate for Payer: Priority Health Medicare |
$193.96
|
| Rate for Payer: Priority Health Narrow Network |
$324.95
|
| Rate for Payer: Priority Health SBD |
$324.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.96
|
| Rate for Payer: UHC Medicare Advantage |
$193.96
|
| Rate for Payer: UHCCP Medicaid |
$129.93
|
| Rate for Payer: UMR Bronson Commercial |
$414.00
|
|
