|
PR LUX IR ARMS
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 00095
|
|
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 LUX IR BUTTOCKS
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 00098
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
|
|
PR LUX IR CHEST
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 00094
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
|
|
PR LUX IR FACE & NECK
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00093
|
|
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 LUX IR UP LEGS
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00096
|
|
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 LYMPHANGIOTOMY/OTH OPRATIONS LYMPHATIC CHANNELS
|
Professional
|
Both
|
$930.00
|
|
|
Service Code
|
HCPCS 38308
|
| Min. Negotiated Rate |
$305.44 |
| Max. Negotiated Rate |
$945.36 |
| Rate for Payer: Aetna Commercial |
$610.45
|
| Rate for Payer: Aetna Medicare |
$473.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$610.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$656.01
|
| Rate for Payer: BCBS Complete |
$320.71
|
| Rate for Payer: BCBS MAPPO |
$455.56
|
| Rate for Payer: BCBS Trust/PPO |
$635.54
|
| Rate for Payer: BCN Commercial |
$681.71
|
| Rate for Payer: BCN Medicare Advantage |
$455.56
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cofinity Commercial |
$656.01
|
| Rate for Payer: Cofinity Commercial |
$610.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$455.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$478.34
|
| Rate for Payer: Meridian Medicaid |
$320.71
|
| Rate for Payer: Nomi Health Commercial |
$546.67
|
| Rate for Payer: PACE SWMI |
$455.56
|
| Rate for Payer: PHP Commercial |
$637.78
|
| Rate for Payer: PHP Medicare Advantage |
$455.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$945.36
|
| Rate for Payer: Priority Health Medicare |
$455.56
|
| Rate for Payer: Priority Health Narrow Network |
$945.36
|
| Rate for Payer: Priority Health SBD |
$945.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$455.56
|
| Rate for Payer: UHC Medicare Advantage |
$455.56
|
| Rate for Payer: UHCCP Medicaid |
$305.44
|
| Rate for Payer: UMR Bronson Commercial |
$427.80
|
|
|
PR LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
HCPCS 54162
|
| Min. Negotiated Rate |
$129.08 |
| Max. Negotiated Rate |
$1,225.13 |
| Rate for Payer: Aetna Commercial |
$256.64
|
| Rate for Payer: Aetna Medicare |
$199.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.79
|
| Rate for Payer: BCBS Complete |
$135.53
|
| Rate for Payer: BCBS MAPPO |
$191.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,225.13
|
| Rate for Payer: BCN Commercial |
$374.33
|
| Rate for Payer: BCN Medicare Advantage |
$191.52
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cofinity Commercial |
$256.64
|
| Rate for Payer: Cofinity Commercial |
$275.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.10
|
| Rate for Payer: Meridian Medicaid |
$135.53
|
| Rate for Payer: Nomi Health Commercial |
$229.82
|
| Rate for Payer: PACE SWMI |
$191.52
|
| Rate for Payer: PHP Commercial |
$268.13
|
| Rate for Payer: PHP Medicare Advantage |
$191.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.62
|
| Rate for Payer: Priority Health Medicare |
$191.52
|
| Rate for Payer: Priority Health Narrow Network |
$320.62
|
| Rate for Payer: Priority Health SBD |
$320.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.52
|
| Rate for Payer: UHC Medicare Advantage |
$191.52
|
| Rate for Payer: UHCCP Medicaid |
$129.08
|
| Rate for Payer: UMR Bronson Commercial |
$239.66
|
|
|
PR LYSIS INTRANASAL SYNECHIA
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
HCPCS 30560
|
| Min. Negotiated Rate |
$96.70 |
| Max. Negotiated Rate |
$805.66 |
| Rate for Payer: Aetna Commercial |
$186.60
|
| Rate for Payer: Aetna Medicare |
$144.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.52
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS MAPPO |
$139.25
|
| Rate for Payer: BCBS Trust/PPO |
$805.66
|
| Rate for Payer: BCN Commercial |
$479.88
|
| Rate for Payer: BCN Medicare Advantage |
$139.25
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$186.60
|
| Rate for Payer: Cofinity Commercial |
$200.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.21
|
| Rate for Payer: Meridian Medicaid |
$101.54
|
| Rate for Payer: Nomi Health Commercial |
$167.10
|
| Rate for Payer: PACE SWMI |
$139.25
|
| Rate for Payer: PHP Commercial |
$194.95
|
| Rate for Payer: PHP Medicare Advantage |
$139.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.27
|
| Rate for Payer: Priority Health Medicare |
$139.25
|
| Rate for Payer: Priority Health Narrow Network |
$212.27
|
| Rate for Payer: Priority Health SBD |
$212.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.25
|
| Rate for Payer: UHC Medicare Advantage |
$139.25
|
| Rate for Payer: UHCCP Medicaid |
$96.70
|
| Rate for Payer: UMR Bronson Commercial |
$237.36
|
|
|
PR LYSIS LABIAL ADHESIONS
|
Professional
|
Both
|
$492.00
|
|
|
Service Code
|
HCPCS 56441
|
| Min. Negotiated Rate |
$99.68 |
| Max. Negotiated Rate |
$488.15 |
| Rate for Payer: Aetna Commercial |
$196.00
|
| Rate for Payer: Aetna Medicare |
$152.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.63
|
| Rate for Payer: BCBS Complete |
$104.66
|
| Rate for Payer: BCBS MAPPO |
$146.27
|
| Rate for Payer: BCBS Trust/PPO |
$488.15
|
| Rate for Payer: BCN Commercial |
$270.24
|
| Rate for Payer: BCN Medicare Advantage |
$146.27
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$210.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.58
|
| Rate for Payer: Meridian Medicaid |
$104.66
|
| Rate for Payer: Nomi Health Commercial |
$175.52
|
| Rate for Payer: PACE SWMI |
$146.27
|
| Rate for Payer: PHP Commercial |
$204.78
|
| Rate for Payer: PHP Medicare Advantage |
$146.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.63
|
| Rate for Payer: Priority Health Medicare |
$146.27
|
| Rate for Payer: Priority Health Narrow Network |
$233.63
|
| Rate for Payer: Priority Health SBD |
$233.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.27
|
| Rate for Payer: UHC Medicare Advantage |
$146.27
|
| Rate for Payer: UHCCP Medicaid |
$99.68
|
| Rate for Payer: UMR Bronson Commercial |
$226.32
|
|
|
PR LYSIS OF ADHESIONS SALPINX/OVARY
|
Professional
|
Both
|
$2,428.00
|
|
|
Service Code
|
HCPCS 58740
|
| Min. Negotiated Rate |
$207.09 |
| Max. Negotiated Rate |
$1,578.20 |
| Rate for Payer: Aetna Commercial |
$1,167.03
|
| Rate for Payer: Aetna Medicare |
$905.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,167.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,254.12
|
| Rate for Payer: BCBS Complete |
$610.56
|
| Rate for Payer: BCBS MAPPO |
$870.92
|
| Rate for Payer: BCBS Trust/PPO |
$207.09
|
| Rate for Payer: BCN Commercial |
$1,323.34
|
| Rate for Payer: BCN Medicare Advantage |
$870.92
|
| Rate for Payer: Cash Price |
$1,942.40
|
| Rate for Payer: Cash Price |
$1,942.40
|
| Rate for Payer: Cofinity Commercial |
$1,167.03
|
| Rate for Payer: Cofinity Commercial |
$1,254.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$870.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$914.47
|
| Rate for Payer: Meridian Medicaid |
$610.56
|
| Rate for Payer: Nomi Health Commercial |
$1,045.10
|
| Rate for Payer: PACE SWMI |
$870.92
|
| Rate for Payer: PHP Commercial |
$1,219.29
|
| Rate for Payer: PHP Medicare Advantage |
$870.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$581.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,578.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,349.25
|
| Rate for Payer: Priority Health Medicare |
$870.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,349.25
|
| Rate for Payer: Priority Health SBD |
$1,349.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$870.92
|
| Rate for Payer: UHC Medicare Advantage |
$870.92
|
| Rate for Payer: UHCCP Medicaid |
$581.49
|
| Rate for Payer: UMR Bronson Commercial |
$1,116.88
|
|
|
PR MA/EC CONTRACEPTIVEINJECTION
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS J1056
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Aetna Medicare |
$17.00
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.10
|
| Rate for Payer: UMR Bronson Commercial |
$15.64
|
|
|
PR MAJOR RECONSTRUCTION CHEST WALL POSTTRAUMATIC
|
Professional
|
Both
|
$3,348.00
|
|
|
Service Code
|
HCPCS 32820
|
| Min. Negotiated Rate |
$878.56 |
| Max. Negotiated Rate |
$2,176.20 |
| Rate for Payer: Aetna Commercial |
$1,792.56
|
| Rate for Payer: Aetna Medicare |
$1,391.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,792.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,926.33
|
| Rate for Payer: BCBS Complete |
$931.51
|
| Rate for Payer: BCBS MAPPO |
$1,337.73
|
| Rate for Payer: BCBS Trust/PPO |
$878.56
|
| Rate for Payer: BCN Commercial |
$1,919.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,337.73
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cofinity Commercial |
$1,926.33
|
| Rate for Payer: Cofinity Commercial |
$1,792.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,337.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,404.62
|
| Rate for Payer: Meridian Medicaid |
$931.51
|
| Rate for Payer: Nomi Health Commercial |
$1,605.28
|
| Rate for Payer: PACE SWMI |
$1,337.73
|
| Rate for Payer: PHP Commercial |
$1,872.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,337.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$887.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,176.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,831.62
|
| Rate for Payer: Priority Health Medicare |
$1,337.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,831.62
|
| Rate for Payer: Priority Health SBD |
$1,831.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,337.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,337.73
|
| Rate for Payer: UHCCP Medicaid |
$887.15
|
| Rate for Payer: UMR Bronson Commercial |
$1,540.08
|
|
|
PR MAKENA, 10 MG
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J1726
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$19.41 |
| Rate for Payer: Aetna Commercial |
$19.41
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.41
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS Trust/PPO |
$6.80
|
| Rate for Payer: BCN Commercial |
$6.80
|
| 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 MAMMAPLASTY AUGMENTATION - GEL
|
Professional
|
Both
|
$4,937.00
|
|
|
Service Code
|
HCPCS 00261
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,974.80 |
| Max. Negotiated Rate |
$3,209.05 |
| Rate for Payer: Aetna Medicare |
$2,468.50
|
| Rate for Payer: BCBS Complete |
$1,974.80
|
| Rate for Payer: Cash Price |
$3,949.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,209.05
|
| Rate for Payer: UMR Bronson Commercial |
$2,271.02
|
|
|
PR MAMMAPLASTY AUGMENTATION - SALINE
|
Professional
|
Both
|
$3,774.00
|
|
|
Service Code
|
HCPCS 00262
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,509.60 |
| Max. Negotiated Rate |
$2,453.10 |
| Rate for Payer: Aetna Medicare |
$1,887.00
|
| Rate for Payer: BCBS Complete |
$1,509.60
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,453.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,736.04
|
|
|
PR MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 26341
|
| Min. Negotiated Rate |
$50.91 |
| Max. Negotiated Rate |
$354.49 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$77.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.70
|
| Rate for Payer: BCBS Complete |
$53.46
|
| Rate for Payer: BCBS MAPPO |
$74.40
|
| Rate for Payer: BCBS Trust/PPO |
$354.49
|
| Rate for Payer: BCN Commercial |
$173.48
|
| Rate for Payer: BCN Medicare Advantage |
$74.40
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$99.70
|
| Rate for Payer: Cofinity Commercial |
$107.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.12
|
| Rate for Payer: Meridian Medicaid |
$53.46
|
| Rate for Payer: Nomi Health Commercial |
$89.28
|
| Rate for Payer: PACE SWMI |
$74.40
|
| Rate for Payer: PHP Commercial |
$104.16
|
| Rate for Payer: PHP Medicare Advantage |
$74.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.10
|
| Rate for Payer: Priority Health Medicare |
$74.40
|
| Rate for Payer: Priority Health Narrow Network |
$121.10
|
| Rate for Payer: Priority Health SBD |
$121.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.40
|
| Rate for Payer: UHC Medicare Advantage |
$74.40
|
| Rate for Payer: UHCCP Medicaid |
$50.91
|
| Rate for Payer: UMR Bronson Commercial |
$188.60
|
|
|
PR MANIPULATION ANKLE UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 27860
|
| Min. Negotiated Rate |
$106.71 |
| Max. Negotiated Rate |
$1,252.07 |
| Rate for Payer: Aetna Commercial |
$210.90
|
| Rate for Payer: Aetna Medicare |
$163.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.64
|
| Rate for Payer: BCBS Complete |
$112.05
|
| Rate for Payer: BCBS MAPPO |
$157.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,252.07
|
| Rate for Payer: BCN Commercial |
$240.92
|
| Rate for Payer: BCN Medicare Advantage |
$157.39
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$210.90
|
| Rate for Payer: Cofinity Commercial |
$226.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$165.26
|
| Rate for Payer: Meridian Medicaid |
$112.05
|
| Rate for Payer: Nomi Health Commercial |
$188.87
|
| Rate for Payer: PACE SWMI |
$157.39
|
| Rate for Payer: PHP Commercial |
$220.35
|
| Rate for Payer: PHP Medicare Advantage |
$157.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.88
|
| Rate for Payer: Priority Health Medicare |
$157.39
|
| Rate for Payer: Priority Health Narrow Network |
$251.88
|
| Rate for Payer: Priority Health SBD |
$251.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.39
|
| Rate for Payer: UHC Medicare Advantage |
$157.39
|
| Rate for Payer: UHCCP Medicaid |
$106.71
|
| Rate for Payer: UMR Bronson Commercial |
$289.80
|
|
|
PR MANIPULATION ELBOW UNDER ANESTHESIA
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 24300
|
| Min. Negotiated Rate |
$92.45 |
| Max. Negotiated Rate |
$691.55 |
| Rate for Payer: Aetna Commercial |
$567.33
|
| Rate for Payer: Aetna Medicare |
$440.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$567.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.67
|
| Rate for Payer: BCBS Complete |
$307.74
|
| Rate for Payer: BCBS MAPPO |
$423.38
|
| Rate for Payer: BCBS Trust/PPO |
$92.45
|
| Rate for Payer: BCN Commercial |
$648.96
|
| Rate for Payer: BCN Medicare Advantage |
$423.38
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$567.33
|
| Rate for Payer: Cofinity Commercial |
$609.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$423.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$444.55
|
| Rate for Payer: Meridian Medicaid |
$307.74
|
| Rate for Payer: Nomi Health Commercial |
$508.06
|
| Rate for Payer: PACE SWMI |
$423.38
|
| Rate for Payer: PHP Commercial |
$592.73
|
| Rate for Payer: PHP Medicare Advantage |
$423.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$293.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$691.55
|
| Rate for Payer: Priority Health Medicare |
$423.38
|
| Rate for Payer: Priority Health Narrow Network |
$691.55
|
| Rate for Payer: Priority Health SBD |
$691.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$423.38
|
| Rate for Payer: UHC Medicare Advantage |
$423.38
|
| Rate for Payer: UHCCP Medicaid |
$293.09
|
| Rate for Payer: UMR Bronson Commercial |
$329.36
|
|
|
PR MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 26340
|
| Min. Negotiated Rate |
$108.30 |
| Max. Negotiated Rate |
$562.30 |
| Rate for Payer: Aetna Commercial |
$460.14
|
| Rate for Payer: Aetna Medicare |
$357.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.48
|
| Rate for Payer: BCBS Complete |
$251.16
|
| Rate for Payer: BCBS MAPPO |
$343.39
|
| Rate for Payer: BCBS Trust/PPO |
$108.30
|
| Rate for Payer: BCN Commercial |
$528.26
|
| Rate for Payer: BCN Medicare Advantage |
$343.39
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$460.14
|
| Rate for Payer: Cofinity Commercial |
$494.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$343.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$360.56
|
| Rate for Payer: Meridian Medicaid |
$251.16
|
| Rate for Payer: Nomi Health Commercial |
$412.07
|
| Rate for Payer: PACE SWMI |
$343.39
|
| Rate for Payer: PHP Commercial |
$480.75
|
| Rate for Payer: PHP Medicare Advantage |
$343.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$562.30
|
| Rate for Payer: Priority Health Medicare |
$343.39
|
| Rate for Payer: Priority Health Narrow Network |
$562.30
|
| Rate for Payer: Priority Health SBD |
$562.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$343.39
|
| Rate for Payer: UHC Medicare Advantage |
$343.39
|
| Rate for Payer: UHCCP Medicaid |
$239.20
|
| Rate for Payer: UMR Bronson Commercial |
$328.44
|
|
|
PR MANIPULATION HIP JOINT GENERAL ANESTHESIA
|
Professional
|
Both
|
$1,008.00
|
|
|
Service Code
|
HCPCS 27275
|
| Min. Negotiated Rate |
$120.98 |
| Max. Negotiated Rate |
$4,431.91 |
| Rate for Payer: Aetna Commercial |
$238.57
|
| Rate for Payer: Aetna Medicare |
$185.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.38
|
| Rate for Payer: BCBS Complete |
$127.03
|
| Rate for Payer: BCBS MAPPO |
$178.04
|
| Rate for Payer: BCBS Trust/PPO |
$4,431.91
|
| Rate for Payer: BCN Commercial |
$270.73
|
| Rate for Payer: BCN Medicare Advantage |
$178.04
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cofinity Commercial |
$238.57
|
| Rate for Payer: Cofinity Commercial |
$256.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.94
|
| Rate for Payer: Meridian Medicaid |
$127.03
|
| Rate for Payer: Nomi Health Commercial |
$213.65
|
| Rate for Payer: PACE SWMI |
$178.04
|
| Rate for Payer: PHP Commercial |
$249.26
|
| Rate for Payer: PHP Medicare Advantage |
$178.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$655.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$285.47
|
| Rate for Payer: Priority Health Medicare |
$178.04
|
| Rate for Payer: Priority Health Narrow Network |
$285.47
|
| Rate for Payer: Priority Health SBD |
$285.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.04
|
| Rate for Payer: UHC Medicare Advantage |
$178.04
|
| Rate for Payer: UHCCP Medicaid |
$120.98
|
| Rate for Payer: UMR Bronson Commercial |
$463.68
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 27570
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$1,799.92 |
| Rate for Payer: Aetna Commercial |
$199.57
|
| Rate for Payer: Aetna Medicare |
$154.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.46
|
| Rate for Payer: BCBS Complete |
$106.68
|
| Rate for Payer: BCBS MAPPO |
$148.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,799.92
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: BCN Medicare Advantage |
$148.93
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$199.57
|
| Rate for Payer: Cofinity Commercial |
$214.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.38
|
| Rate for Payer: Meridian Medicaid |
$106.68
|
| Rate for Payer: Nomi Health Commercial |
$178.72
|
| Rate for Payer: PACE SWMI |
$148.93
|
| Rate for Payer: PHP Commercial |
$208.50
|
| Rate for Payer: PHP Medicare Advantage |
$148.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.16
|
| Rate for Payer: Priority Health Medicare |
$148.93
|
| Rate for Payer: Priority Health Narrow Network |
$239.16
|
| Rate for Payer: Priority Health SBD |
$239.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.93
|
| Rate for Payer: UHC Medicare Advantage |
$148.93
|
| Rate for Payer: UHCCP Medicaid |
$101.60
|
| Rate for Payer: UMR Bronson Commercial |
$307.74
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 27570
|
| Hospital Charge Code |
27570
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$1,799.92 |
| Rate for Payer: Aetna Commercial |
$199.57
|
| Rate for Payer: Aetna Medicare |
$154.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.46
|
| Rate for Payer: BCBS Complete |
$106.68
|
| Rate for Payer: BCBS MAPPO |
$148.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,799.92
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: BCN Medicare Advantage |
$148.93
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$214.46
|
| Rate for Payer: Cofinity Commercial |
$199.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.38
|
| Rate for Payer: Meridian Medicaid |
$106.68
|
| Rate for Payer: Nomi Health Commercial |
$178.72
|
| Rate for Payer: PACE SWMI |
$148.93
|
| Rate for Payer: PHP Commercial |
$208.50
|
| Rate for Payer: PHP Medicare Advantage |
$148.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.16
|
| Rate for Payer: Priority Health Medicare |
$148.93
|
| Rate for Payer: Priority Health Narrow Network |
$239.16
|
| Rate for Payer: Priority Health SBD |
$239.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.93
|
| Rate for Payer: UHC Medicare Advantage |
$148.93
|
| Rate for Payer: UHCCP Medicaid |
$101.60
|
| Rate for Payer: UMR Bronson Commercial |
$307.74
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Facility
|
IP
|
$669.00
|
|
|
Service Code
|
CPT 27570
|
| Hospital Charge Code |
27570
|
| Min. Negotiated Rate |
$294.36 |
| Max. Negotiated Rate |
$602.10 |
| Rate for Payer: Aetna American Axle |
$434.85
|
| Rate for Payer: Aetna Commercial |
$568.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.85
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$468.30
|
| Rate for Payer: Cofinity Commercial |
$575.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$468.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.20
|
| Rate for Payer: Healthscope Commercial |
$602.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.65
|
| Rate for Payer: PHP Commercial |
$568.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health SBD |
$421.47
|
| Rate for Payer: UMR Bronson Commercial |
$294.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.75
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Facility
|
OP
|
$669.00
|
|
|
Service Code
|
CPT 27570
|
| Hospital Charge Code |
27570
|
| Min. Negotiated Rate |
$148.59 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna American Axle |
$434.85
|
| Rate for Payer: Aetna Commercial |
$568.65
|
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,787.42
|
| Rate for Payer: BCN Commercial |
$1,787.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$468.30
|
| Rate for Payer: Cofinity Commercial |
$575.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$468.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Healthscope Commercial |
$602.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.75
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.65
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Commercial |
$568.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Priority Health SBD |
$421.47
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.45
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$148.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: UMR Bronson Commercial |
$247.53
|
| Rate for Payer: VA VA |
$1,568.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.75
|
|
|
PR MANIPULATION SPINE REQUIRING ANESTHESIA
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 22505
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$316.55 |
| Rate for Payer: Aetna Commercial |
$196.81
|
| Rate for Payer: Aetna Medicare |
$152.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.49
|
| Rate for Payer: BCBS Complete |
$102.43
|
| Rate for Payer: BCBS MAPPO |
$146.87
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$209.31
|
| Rate for Payer: BCN Medicare Advantage |
$146.87
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cofinity Commercial |
$196.81
|
| Rate for Payer: Cofinity Commercial |
$211.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.21
|
| Rate for Payer: Meridian Medicaid |
$102.43
|
| Rate for Payer: Nomi Health Commercial |
$176.24
|
| Rate for Payer: PACE SWMI |
$146.87
|
| Rate for Payer: PHP Commercial |
$205.62
|
| Rate for Payer: PHP Medicare Advantage |
$146.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$199.98
|
| Rate for Payer: Priority Health Medicare |
$146.87
|
| Rate for Payer: Priority Health Narrow Network |
$199.98
|
| Rate for Payer: Priority Health SBD |
$199.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.87
|
| Rate for Payer: UHC Medicare Advantage |
$146.87
|
| Rate for Payer: UHCCP Medicaid |
$97.55
|
| Rate for Payer: UMR Bronson Commercial |
$224.02
|
|
