|
PR LIGMOUS RCNSTJ AGMNTJ KNE INTRA-ARTICULAR XTR
|
Professional
|
Both
|
$2,234.00
|
|
|
Service Code
|
HCPCS 27429
|
| Min. Negotiated Rate |
$819.84 |
| Max. Negotiated Rate |
$2,210.41 |
| Rate for Payer: Aetna Commercial |
$1,628.27
|
| Rate for Payer: Aetna Medicare |
$1,263.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,628.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,749.79
|
| Rate for Payer: BCBS Complete |
$860.83
|
| Rate for Payer: BCBS MAPPO |
$1,215.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,210.41
|
| Rate for Payer: BCN Commercial |
$1,846.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,215.13
|
| Rate for Payer: Cash Price |
$1,787.20
|
| Rate for Payer: Cash Price |
$1,787.20
|
| Rate for Payer: Cofinity Commercial |
$1,628.27
|
| Rate for Payer: Cofinity Commercial |
$1,749.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,215.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,275.89
|
| Rate for Payer: Meridian Medicaid |
$860.83
|
| Rate for Payer: Nomi Health Commercial |
$1,458.16
|
| Rate for Payer: PACE SWMI |
$1,215.13
|
| Rate for Payer: PHP Commercial |
$1,701.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,215.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$819.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,452.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,940.80
|
| Rate for Payer: Priority Health Medicare |
$1,215.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,940.80
|
| Rate for Payer: Priority Health SBD |
$1,940.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,215.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,215.13
|
| Rate for Payer: UHCCP Medicaid |
$819.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,027.64
|
|
|
PR LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG
|
Professional
|
Both
|
$1,126.00
|
|
|
Service Code
|
HCPCS 37761
|
| Min. Negotiated Rate |
$336.11 |
| Max. Negotiated Rate |
$898.64 |
| Rate for Payer: Aetna Commercial |
$683.53
|
| Rate for Payer: Aetna Medicare |
$530.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.54
|
| Rate for Payer: BCBS Complete |
$352.92
|
| Rate for Payer: BCBS MAPPO |
$510.10
|
| Rate for Payer: BCBS Trust/PPO |
$898.64
|
| Rate for Payer: BCN Commercial |
$778.46
|
| Rate for Payer: BCN Medicare Advantage |
$510.10
|
| Rate for Payer: Cash Price |
$900.80
|
| Rate for Payer: Cash Price |
$900.80
|
| Rate for Payer: Cofinity Commercial |
$683.53
|
| Rate for Payer: Cofinity Commercial |
$734.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$535.60
|
| Rate for Payer: Meridian Medicaid |
$352.92
|
| Rate for Payer: Nomi Health Commercial |
$612.12
|
| Rate for Payer: PACE SWMI |
$510.10
|
| Rate for Payer: PHP Commercial |
$714.14
|
| Rate for Payer: PHP Medicare Advantage |
$510.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.60
|
| Rate for Payer: Priority Health Medicare |
$510.10
|
| Rate for Payer: Priority Health Narrow Network |
$845.60
|
| Rate for Payer: Priority Health SBD |
$845.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.10
|
| Rate for Payer: UHC Medicare Advantage |
$510.10
|
| Rate for Payer: UHCCP Medicaid |
$336.11
|
| Rate for Payer: UMR Bronson Commercial |
$517.96
|
|
|
PR LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 58611
|
| Min. Negotiated Rate |
$47.93 |
| Max. Negotiated Rate |
$219.05 |
| Rate for Payer: Aetna Commercial |
$97.16
|
| Rate for Payer: Aetna Medicare |
$75.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.16
|
| Rate for Payer: BCBS Complete |
$50.33
|
| Rate for Payer: BCBS MAPPO |
$72.51
|
| Rate for Payer: BCBS Trust/PPO |
$194.94
|
| Rate for Payer: BCN Commercial |
$110.45
|
| Rate for Payer: BCN Medicare Advantage |
$72.51
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$104.41
|
| Rate for Payer: Cofinity Commercial |
$97.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.14
|
| Rate for Payer: Meridian Medicaid |
$50.33
|
| Rate for Payer: Nomi Health Commercial |
$87.01
|
| Rate for Payer: PACE SWMI |
$72.51
|
| Rate for Payer: PHP Commercial |
$101.51
|
| Rate for Payer: PHP Medicare Advantage |
$72.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.62
|
| Rate for Payer: Priority Health Medicare |
$72.51
|
| Rate for Payer: Priority Health Narrow Network |
$111.62
|
| Rate for Payer: Priority Health SBD |
$111.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.51
|
| Rate for Payer: UHC Medicare Advantage |
$72.51
|
| Rate for Payer: UHCCP Medicaid |
$47.93
|
| Rate for Payer: UMR Bronson Commercial |
$155.02
|
|
|
PR LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 58600
|
| Min. Negotiated Rate |
$78.19 |
| Max. Negotiated Rate |
$835.25 |
| Rate for Payer: Aetna Commercial |
$476.41
|
| Rate for Payer: Aetna Medicare |
$369.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$511.96
|
| Rate for Payer: BCBS Complete |
$250.49
|
| Rate for Payer: BCBS MAPPO |
$355.53
|
| Rate for Payer: BCBS Trust/PPO |
$78.19
|
| Rate for Payer: BCN Commercial |
$545.36
|
| Rate for Payer: BCN Medicare Advantage |
$355.53
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cofinity Commercial |
$476.41
|
| Rate for Payer: Cofinity Commercial |
$511.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$355.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$373.31
|
| Rate for Payer: Meridian Medicaid |
$250.49
|
| Rate for Payer: Nomi Health Commercial |
$426.64
|
| Rate for Payer: PACE SWMI |
$355.53
|
| Rate for Payer: PHP Commercial |
$497.74
|
| Rate for Payer: PHP Medicare Advantage |
$355.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$238.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$835.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$557.06
|
| Rate for Payer: Priority Health Medicare |
$355.53
|
| Rate for Payer: Priority Health Narrow Network |
$557.06
|
| Rate for Payer: Priority Health SBD |
$557.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$355.53
|
| Rate for Payer: UHC Medicare Advantage |
$355.53
|
| Rate for Payer: UHCCP Medicaid |
$238.56
|
| Rate for Payer: UMR Bronson Commercial |
$591.10
|
|
|
PR LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 58605
|
| Min. Negotiated Rate |
$216.62 |
| Max. Negotiated Rate |
$562.25 |
| Rate for Payer: Aetna Commercial |
$431.94
|
| Rate for Payer: Aetna Medicare |
$335.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$431.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.17
|
| Rate for Payer: BCBS Complete |
$227.45
|
| Rate for Payer: BCBS MAPPO |
$322.34
|
| Rate for Payer: BCBS Trust/PPO |
$264.15
|
| Rate for Payer: BCN Commercial |
$496.00
|
| Rate for Payer: BCN Medicare Advantage |
$322.34
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$464.17
|
| Rate for Payer: Cofinity Commercial |
$431.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.46
|
| Rate for Payer: Meridian Medicaid |
$227.45
|
| Rate for Payer: Nomi Health Commercial |
$386.81
|
| Rate for Payer: PACE SWMI |
$322.34
|
| Rate for Payer: PHP Commercial |
$451.28
|
| Rate for Payer: PHP Medicare Advantage |
$322.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$216.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$506.47
|
| Rate for Payer: Priority Health Medicare |
$322.34
|
| Rate for Payer: Priority Health Narrow Network |
$506.47
|
| Rate for Payer: Priority Health SBD |
$506.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.34
|
| Rate for Payer: UHC Medicare Advantage |
$322.34
|
| Rate for Payer: UHCCP Medicaid |
$216.62
|
| Rate for Payer: UMR Bronson Commercial |
$397.90
|
|
|
PR LILETTA, 52 MG
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
HCPCS J7297
|
| Min. Negotiated Rate |
$404.80 |
| Max. Negotiated Rate |
$1,037.01 |
| Rate for Payer: Aetna Commercial |
$845.10
|
| Rate for Payer: Aetna Medicare |
$440.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$845.10
|
| Rate for Payer: BCBS Complete |
$1,037.01
|
| Rate for Payer: BCBS Trust/PPO |
$856.93
|
| Rate for Payer: BCN Commercial |
$856.93
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Meridian Medicaid |
$1,037.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$987.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$572.00
|
| Rate for Payer: UHCCP Medicaid |
$987.63
|
| Rate for Payer: UMR Bronson Commercial |
$404.80
|
|
|
PR LIMITED VISUAL FIELD XM UNI/BI I&R
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 92081
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$1,007.47 |
| Rate for Payer: Aetna Commercial |
$40.87
|
| Rate for Payer: Aetna Medicare |
$31.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.92
|
| Rate for Payer: BCBS Complete |
$10.51
|
| Rate for Payer: BCBS MAPPO |
$30.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,007.47
|
| Rate for Payer: BCN Commercial |
$48.38
|
| Rate for Payer: BCN Medicare Advantage |
$30.50
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$43.92
|
| Rate for Payer: Cofinity Commercial |
$40.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.02
|
| Rate for Payer: Meridian Medicaid |
$10.51
|
| Rate for Payer: Nomi Health Commercial |
$36.60
|
| Rate for Payer: PACE SWMI |
$30.50
|
| Rate for Payer: PHP Commercial |
$42.70
|
| Rate for Payer: PHP Medicare Advantage |
$30.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.53
|
| Rate for Payer: Priority Health Medicare |
$30.50
|
| Rate for Payer: Priority Health Narrow Network |
$41.53
|
| Rate for Payer: Priority Health SBD |
$19.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.50
|
| Rate for Payer: UHC Medicare Advantage |
$30.50
|
| Rate for Payer: UHCCP Medicaid |
$10.01
|
| Rate for Payer: UMR Bronson Commercial |
$35.88
|
|
|
PR LINCOMYCIN INJECTION
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J2010
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: Aetna Medicare |
$5.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.08
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$5.61
|
| Rate for Payer: BCBS Trust/PPO |
$7.48
|
| Rate for Payer: BCN Commercial |
$7.86
|
| Rate for Payer: BCN Medicare Advantage |
$5.61
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$7.52
|
| Rate for Payer: Cofinity Commercial |
$8.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.89
|
| Rate for Payer: Nomi Health Commercial |
$6.73
|
| Rate for Payer: PACE SWMI |
$5.61
|
| Rate for Payer: PHP Commercial |
$7.85
|
| Rate for Payer: PHP Medicare Advantage |
$5.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$5.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.61
|
| Rate for Payer: UHC Medicare Advantage |
$5.61
|
| Rate for Payer: UMR Bronson Commercial |
$9.20
|
|
|
PR LITHOLAPAXY COMP/LG > 2.5 CM
|
Professional
|
Both
|
$936.00
|
|
|
Service Code
|
HCPCS 52318
|
| Min. Negotiated Rate |
$298.63 |
| Max. Negotiated Rate |
$1,353.50 |
| Rate for Payer: Aetna Commercial |
$601.74
|
| Rate for Payer: Aetna Medicare |
$467.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.65
|
| Rate for Payer: BCBS Complete |
$313.56
|
| Rate for Payer: BCBS MAPPO |
$449.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,353.50
|
| Rate for Payer: BCN Commercial |
$674.37
|
| Rate for Payer: BCN Medicare Advantage |
$449.06
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cofinity Commercial |
$601.74
|
| Rate for Payer: Cofinity Commercial |
$646.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$471.51
|
| Rate for Payer: Meridian Medicaid |
$313.56
|
| Rate for Payer: Nomi Health Commercial |
$538.87
|
| Rate for Payer: PACE SWMI |
$449.06
|
| Rate for Payer: PHP Commercial |
$628.68
|
| Rate for Payer: PHP Medicare Advantage |
$449.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$742.45
|
| Rate for Payer: Priority Health Medicare |
$449.06
|
| Rate for Payer: Priority Health Narrow Network |
$742.45
|
| Rate for Payer: Priority Health SBD |
$742.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$449.06
|
| Rate for Payer: UHC Medicare Advantage |
$449.06
|
| Rate for Payer: UHCCP Medicaid |
$298.63
|
| Rate for Payer: UMR Bronson Commercial |
$430.56
|
|
|
PR LITHOLAPAXY SMPL/SM <2.5 CM
|
Professional
|
Both
|
$1,658.00
|
|
|
Service Code
|
HCPCS 52317
|
| Min. Negotiated Rate |
$218.96 |
| Max. Negotiated Rate |
$1,298.41 |
| Rate for Payer: Aetna Commercial |
$441.11
|
| Rate for Payer: Aetna Medicare |
$342.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.03
|
| Rate for Payer: BCBS Complete |
$229.91
|
| Rate for Payer: BCBS MAPPO |
$329.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,148.52
|
| Rate for Payer: BCN Commercial |
$1,298.41
|
| Rate for Payer: BCN Medicare Advantage |
$329.19
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Cofinity Commercial |
$441.11
|
| Rate for Payer: Cofinity Commercial |
$474.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.65
|
| Rate for Payer: Meridian Medicaid |
$229.91
|
| Rate for Payer: Nomi Health Commercial |
$395.03
|
| Rate for Payer: PACE SWMI |
$329.19
|
| Rate for Payer: PHP Commercial |
$460.87
|
| Rate for Payer: PHP Medicare Advantage |
$329.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$218.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$543.25
|
| Rate for Payer: Priority Health Medicare |
$329.19
|
| Rate for Payer: Priority Health Narrow Network |
$543.25
|
| Rate for Payer: Priority Health SBD |
$543.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$329.19
|
| Rate for Payer: UHC Medicare Advantage |
$329.19
|
| Rate for Payer: UHCCP Medicaid |
$218.96
|
| Rate for Payer: UMR Bronson Commercial |
$762.68
|
|
|
PR LITHOTRIPSY XTRCORP SHOCK WAVE
|
Professional
|
Both
|
$1,547.00
|
|
|
Service Code
|
HCPCS 50590
|
| Min. Negotiated Rate |
$367.43 |
| Max. Negotiated Rate |
$1,184.30 |
| Rate for Payer: Aetna Commercial |
$732.12
|
| Rate for Payer: Aetna Medicare |
$568.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$732.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$786.76
|
| Rate for Payer: BCBS Complete |
$385.80
|
| Rate for Payer: BCBS MAPPO |
$546.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,004.83
|
| Rate for Payer: BCN Commercial |
$1,184.30
|
| Rate for Payer: BCN Medicare Advantage |
$546.36
|
| Rate for Payer: Cash Price |
$1,237.60
|
| Rate for Payer: Cash Price |
$1,237.60
|
| Rate for Payer: Cofinity Commercial |
$732.12
|
| Rate for Payer: Cofinity Commercial |
$786.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$546.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$573.68
|
| Rate for Payer: Meridian Medicaid |
$385.80
|
| Rate for Payer: Nomi Health Commercial |
$655.63
|
| Rate for Payer: PACE SWMI |
$546.36
|
| Rate for Payer: PHP Commercial |
$764.90
|
| Rate for Payer: PHP Medicare Advantage |
$546.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$913.41
|
| Rate for Payer: Priority Health Medicare |
$546.36
|
| Rate for Payer: Priority Health Narrow Network |
$913.41
|
| Rate for Payer: Priority Health SBD |
$913.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$546.36
|
| Rate for Payer: UHC Medicare Advantage |
$546.36
|
| Rate for Payer: UHCCP Medicaid |
$367.43
|
| Rate for Payer: UMR Bronson Commercial |
$711.62
|
|
|
PR LMTD LMPHADEC STAGING SPX PEL&PARA-AORTIC
|
Professional
|
Both
|
$3,942.00
|
|
|
Service Code
|
HCPCS 38562
|
| Min. Negotiated Rate |
$456.89 |
| Max. Negotiated Rate |
$2,562.30 |
| Rate for Payer: Aetna Commercial |
$912.26
|
| Rate for Payer: Aetna Medicare |
$708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$912.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$980.34
|
| Rate for Payer: BCBS Complete |
$479.73
|
| Rate for Payer: BCBS MAPPO |
$680.79
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$1,029.16
|
| Rate for Payer: BCN Medicare Advantage |
$680.79
|
| Rate for Payer: Cash Price |
$3,153.60
|
| Rate for Payer: Cash Price |
$3,153.60
|
| Rate for Payer: Cofinity Commercial |
$912.26
|
| Rate for Payer: Cofinity Commercial |
$980.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$680.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$714.83
|
| Rate for Payer: Meridian Medicaid |
$479.73
|
| Rate for Payer: Nomi Health Commercial |
$816.95
|
| Rate for Payer: PACE SWMI |
$680.79
|
| Rate for Payer: PHP Commercial |
$953.11
|
| Rate for Payer: PHP Medicare Advantage |
$680.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$456.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,562.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,416.72
|
| Rate for Payer: Priority Health Medicare |
$680.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,416.72
|
| Rate for Payer: Priority Health SBD |
$1,416.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$680.79
|
| Rate for Payer: UHC Medicare Advantage |
$680.79
|
| Rate for Payer: UHCCP Medicaid |
$456.89
|
| Rate for Payer: UMR Bronson Commercial |
$1,813.32
|
|
|
PR LMTD LMPHADEC STAGING SPX RPR AORTIC&/SPLENIC
|
Professional
|
Both
|
$2,831.00
|
|
|
Service Code
|
HCPCS 38564
|
| Min. Negotiated Rate |
$452.84 |
| Max. Negotiated Rate |
$1,840.15 |
| Rate for Payer: Aetna Commercial |
$911.21
|
| Rate for Payer: Aetna Medicare |
$707.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$911.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.21
|
| Rate for Payer: BCBS Complete |
$475.48
|
| Rate for Payer: BCBS MAPPO |
$680.01
|
| Rate for Payer: BCBS Trust/PPO |
$543.62
|
| Rate for Payer: BCN Commercial |
$1,024.27
|
| Rate for Payer: BCN Medicare Advantage |
$680.01
|
| Rate for Payer: Cash Price |
$2,264.80
|
| Rate for Payer: Cash Price |
$2,264.80
|
| Rate for Payer: Cofinity Commercial |
$911.21
|
| Rate for Payer: Cofinity Commercial |
$979.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$680.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$714.01
|
| Rate for Payer: Meridian Medicaid |
$475.48
|
| Rate for Payer: Nomi Health Commercial |
$816.01
|
| Rate for Payer: PACE SWMI |
$680.01
|
| Rate for Payer: PHP Commercial |
$952.01
|
| Rate for Payer: PHP Medicare Advantage |
$680.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$452.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,840.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,402.06
|
| Rate for Payer: Priority Health Medicare |
$680.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,402.06
|
| Rate for Payer: Priority Health SBD |
$1,402.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$680.01
|
| Rate for Payer: UHC Medicare Advantage |
$680.01
|
| Rate for Payer: UHCCP Medicaid |
$452.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,302.26
|
|
|
PR LMTD OPH XM&EVAL GENERAL ANES W/WO MNPJ GLOBE
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 92019
|
| Min. Negotiated Rate |
$46.22 |
| Max. Negotiated Rate |
$1,793.58 |
| Rate for Payer: Aetna Commercial |
$91.31
|
| Rate for Payer: Aetna Medicare |
$70.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.12
|
| Rate for Payer: BCBS Complete |
$48.53
|
| Rate for Payer: BCBS MAPPO |
$68.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,793.58
|
| Rate for Payer: BCN Commercial |
$75.59
|
| Rate for Payer: BCN Medicare Advantage |
$68.14
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$91.31
|
| Rate for Payer: Cofinity Commercial |
$98.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.55
|
| Rate for Payer: Meridian Medicaid |
$48.53
|
| Rate for Payer: Nomi Health Commercial |
$81.77
|
| Rate for Payer: PACE SWMI |
$68.14
|
| Rate for Payer: PHP Commercial |
$95.40
|
| Rate for Payer: PHP Medicare Advantage |
$68.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.28
|
| Rate for Payer: Priority Health Medicare |
$68.14
|
| Rate for Payer: Priority Health Narrow Network |
$89.28
|
| Rate for Payer: Priority Health SBD |
$89.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.14
|
| Rate for Payer: UHC Medicare Advantage |
$68.14
|
| Rate for Payer: UHCCP Medicaid |
$46.22
|
| Rate for Payer: UMR Bronson Commercial |
$67.62
|
|
|
PR LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN
|
Professional
|
Both
|
$1,620.00
|
|
|
Service Code
|
HCPCS 25280
|
| Min. Negotiated Rate |
$372.54 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Aetna Commercial |
$734.91
|
| Rate for Payer: Aetna Medicare |
$570.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$789.75
|
| Rate for Payer: BCBS Complete |
$391.17
|
| Rate for Payer: BCBS MAPPO |
$548.44
|
| Rate for Payer: BCBS Trust/PPO |
$760.22
|
| Rate for Payer: BCN Commercial |
$837.11
|
| Rate for Payer: BCN Medicare Advantage |
$548.44
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cofinity Commercial |
$734.91
|
| Rate for Payer: Cofinity Commercial |
$789.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$548.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$575.86
|
| Rate for Payer: Meridian Medicaid |
$391.17
|
| Rate for Payer: Nomi Health Commercial |
$658.13
|
| Rate for Payer: PACE SWMI |
$548.44
|
| Rate for Payer: PHP Commercial |
$767.82
|
| Rate for Payer: PHP Medicare Advantage |
$548.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,053.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$881.35
|
| Rate for Payer: Priority Health Medicare |
$548.44
|
| Rate for Payer: Priority Health Narrow Network |
$881.35
|
| Rate for Payer: Priority Health SBD |
$881.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$548.44
|
| Rate for Payer: UHC Medicare Advantage |
$548.44
|
| Rate for Payer: UHCCP Medicaid |
$372.54
|
| Rate for Payer: UMR Bronson Commercial |
$745.20
|
|
|
PR LNGTH/SHRT TDN LEG/ANKLE MLT TDN SAME INC EA
|
Professional
|
Both
|
$1,362.00
|
|
|
Service Code
|
HCPCS 27686
|
| Min. Negotiated Rate |
$345.70 |
| Max. Negotiated Rate |
$2,402.18 |
| Rate for Payer: Aetna Commercial |
$683.83
|
| Rate for Payer: Aetna Medicare |
$530.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.86
|
| Rate for Payer: BCBS Complete |
$362.98
|
| Rate for Payer: BCBS MAPPO |
$510.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,402.18
|
| Rate for Payer: BCN Commercial |
$773.09
|
| Rate for Payer: BCN Medicare Advantage |
$510.32
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cofinity Commercial |
$683.83
|
| Rate for Payer: Cofinity Commercial |
$734.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$535.84
|
| Rate for Payer: Meridian Medicaid |
$362.98
|
| Rate for Payer: Nomi Health Commercial |
$612.38
|
| Rate for Payer: PACE SWMI |
$510.32
|
| Rate for Payer: PHP Commercial |
$714.45
|
| Rate for Payer: PHP Medicare Advantage |
$510.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$345.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$822.33
|
| Rate for Payer: Priority Health Medicare |
$510.32
|
| Rate for Payer: Priority Health Narrow Network |
$822.33
|
| Rate for Payer: Priority Health SBD |
$822.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.32
|
| Rate for Payer: UHC Medicare Advantage |
$510.32
|
| Rate for Payer: UHCCP Medicaid |
$345.70
|
| Rate for Payer: UMR Bronson Commercial |
$626.52
|
|
|
PR LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX
|
Professional
|
Both
|
$1,821.00
|
|
|
Service Code
|
HCPCS 27685
|
| Min. Negotiated Rate |
$303.74 |
| Max. Negotiated Rate |
$3,119.66 |
| Rate for Payer: Aetna Commercial |
$598.99
|
| Rate for Payer: Aetna Medicare |
$464.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$643.69
|
| Rate for Payer: BCBS Complete |
$318.93
|
| Rate for Payer: BCBS MAPPO |
$447.01
|
| Rate for Payer: BCBS Trust/PPO |
$3,119.66
|
| Rate for Payer: BCN Commercial |
$962.69
|
| Rate for Payer: BCN Medicare Advantage |
$447.01
|
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Cofinity Commercial |
$598.99
|
| Rate for Payer: Cofinity Commercial |
$643.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.36
|
| Rate for Payer: Meridian Medicaid |
$318.93
|
| Rate for Payer: Nomi Health Commercial |
$536.41
|
| Rate for Payer: PACE SWMI |
$447.01
|
| Rate for Payer: PHP Commercial |
$625.81
|
| Rate for Payer: PHP Medicare Advantage |
$447.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$303.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,183.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$721.05
|
| Rate for Payer: Priority Health Medicare |
$447.01
|
| Rate for Payer: Priority Health Narrow Network |
$721.05
|
| Rate for Payer: Priority Health SBD |
$721.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$447.01
|
| Rate for Payer: UHC Medicare Advantage |
$447.01
|
| Rate for Payer: UHCCP Medicaid |
$303.74
|
| Rate for Payer: UMR Bronson Commercial |
$837.66
|
|
|
PR LOCM 250-299MG/ML IODINE,1ML
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS Q9948
|
| 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 LORAZEPAM INJECTION
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J2060
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Commercial |
$1.76
|
| Rate for Payer: Aetna Medicare |
$1.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS MAPPO |
$1.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: BCN Medicare Advantage |
$1.32
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Cofinity Commercial |
$1.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.38
|
| Rate for Payer: Nomi Health Commercial |
$1.58
|
| Rate for Payer: PACE SWMI |
$1.32
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: PHP Medicare Advantage |
$1.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: Priority Health Medicare |
$1.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.32
|
| Rate for Payer: UHC Medicare Advantage |
$1.32
|
| Rate for Payer: UMR Bronson Commercial |
$3.22
|
|
|
PR LOWER LID BLEPHAROPLASTY
|
Professional
|
Both
|
$1,836.00
|
|
|
Service Code
|
HCPCS 00531
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$734.40 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna Medicare |
$918.00
|
| Rate for Payer: BCBS Complete |
$734.40
|
| Rate for Payer: Cash Price |
$1,468.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,193.40
|
| Rate for Payer: UMR Bronson Commercial |
$844.56
|
|
|
PR LOW INTENSITY US STIMJ BONE HEALING NONINVASIVE
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 20979
|
| Min. Negotiated Rate |
$29.78 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$39.91
|
| Rate for Payer: Aetna Medicare |
$30.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.88
|
| Rate for Payer: BCBS Complete |
$41.60
|
| Rate for Payer: BCBS MAPPO |
$29.78
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$82.58
|
| Rate for Payer: BCN Medicare Advantage |
$29.78
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Commercial |
$39.91
|
| Rate for Payer: Cofinity Commercial |
$42.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.27
|
| Rate for Payer: Nomi Health Commercial |
$35.74
|
| Rate for Payer: PACE SWMI |
$29.78
|
| Rate for Payer: PHP Commercial |
$41.69
|
| Rate for Payer: PHP Medicare Advantage |
$29.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.34
|
| Rate for Payer: Priority Health Medicare |
$29.78
|
| Rate for Payer: Priority Health Narrow Network |
$48.34
|
| Rate for Payer: Priority Health SBD |
$48.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.78
|
| Rate for Payer: UHC Medicare Advantage |
$29.78
|
| Rate for Payer: UMR Bronson Commercial |
$47.84
|
|
|
PR LT COMPRES BAND >=3"" <5""/YD
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS A6449
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCN Commercial |
$1.93
|
| 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 LT COMPRES BAND <3""/YD
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS A6448
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCN Commercial |
$1.27
|
| 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 LT COMPRES BAND >=5""/YD
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS A6450
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCN Commercial |
$1.93
|
| Rate for Payer: Cash Price |
$4.00
|
| 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 LUX IR ABD/BACK
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00097
|
|
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
|
|
